Employee Benefits Security Administration (EBSA) has identified key focus areas for enforcement under ERISA:
- Cybersecurity: Increased emphasis on system hardening and secure data handling.
- Mental Health & Substance Use Disorder Parity: Ongoing investigations around:
- Access to in-network MH/SUD providers
- Medical necessity criteria
- Barriers to autism therapy, eating disorder treatments, and Medication Assisted Treatment for opioid use disorders
- Surprise Billing
- A high number of Independent Dispute Resolution cases were decided in favor of providers.
- Plans need to ensure correct processes/documentation.
- Abusive MEWAs: Continued monitoring of noncompliant association health plans, which can pose fraud or insolvency risks.
Bottom line:
Employers should review compliance processes proactively. Issues in these areas can lead to audits, penalties, or investigations.
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