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On December 7, 2021, the Supreme Court of the United States (SCOTUS or the Supreme Court) will hear oral arguments in CVS Pharmacy, Inc. v. John Doe. The case involves claims by the plaintiffs, named John Doe to protect their anonymity, against their employer health plans’ pharmacy benefits manager (PBM) CVS Caremark. According to the claimants’ filings, changes to the PBM’s policy on in-network access to specialty drugs disproportionately affects individuals with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The Supreme Court accepted the case for review to settle the alleged disparate-impact cause of actions …

… estimates of expected charges, the independent dispute resolution (IDR) process, the patient-provider dispute resolution process for uninsured and self-pay patients, and the new external review requirements. The comment period for the new final interim rule closes on December 6, 2021. The Centers for Medicare & Medicaid Services (CMS) and Employee Benefits Security Administration (EBSA) created Surprise Billing webpages that provide information on the NSA. HHS created the IDR Entity Certification Application Web Form Quick Reference Guide that explains the process for an arbitration organization to become a certified IDR entity. To be certified, an IDR entity must possess (directly …

… care (LTC) benefits. An employee payroll tax will provide funding for the WA Cares Fund. Washington employees may opt out of the payroll tax if they meet certain criteria by the exemption deadlines. However, exemption from the WA Cares payroll tax disqualifies a worker from ever receiving future WA Cares benefits. The newly created WA Cares Fund provides eligible Washington workers with state payroll tax-funded LTC insurance benefits beginning January 1, 2025. Employee premiums completely fund the WA Cares benefits. Employers are not required to contribute to any portion of the WA Cares premium – a 0.58% ($0.58 …

… of employees. Covered employees receive: One week of unpaid leave, if the employer has 20-49 employees; and Two weeks of unpaid leave if the employer has 50 or greater employees. Employees may take this unpaid leave intermittently or on a reduced work schedule. VESSA also entitles covered employees to benefits and employment protection. Employees cannot lose any accrued benefits while on leave, and their employer must maintain their healthcare coverage. Additionally, employers must return employees to their same or an equivalent position upon their return from leave. Finally, VESSA requires employers to make reasonable safety accommodations for employees who …