Health & Welfare Plans

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Seyfarth Synopsis: The DOL’s latest MHPAEA guidance gives plan sponsors a practical roadmap for where parity compliance reviews should focus next. Although the DOL has announced limited nonenforcement relief for certain portions of the 2024 Final Rule, the agency made clear that it continues to enforce MHPAEA’s core statutory requirements, including the obligation to prepare and maintain written NQTL comparative analyses. The key takeaway is to review written plan terms and operational practices for warning signs involving treatment exclusions, medical necessity, utilization management, and network adequacy, and to make sure service providers will provide support.

Consistent with the DOL’s enforcement priorities for 2026, earlier this week the Department of Labor (“DOL”) released Field Assistance Bulletin No. 2026-03 and an accompanying web page (“Identifying Potential Problems: If You See the Following in Written Plan Provisions or Plan Operations, Think Twice about Possible MHPAEA Compliance Problems”), which spotlight three key focus areas for enforcement and provide a checklist for identifying warning signs that might indicate potential compliance problems under the Mental Health Parity and Addiction Equity Act (MHPAEA).

Three Key Focus Areas

The Field Assistance Bulletin explains that the DOL intends to focus its MHPAEA NQTL enforcement on three areas where it sees significant risk of participant harm:

  1. Treatment exclusions for mental health and substance use disorder benefits;
  2. Medical necessity and utilization management processes, including prior authorization, concurrent review, and related claims review standards; and
  3. Network adequacy and provider reimbursement, including standards for admitting MH/SUD providers to networks and methodologies that may contribute to inadequate access.

Employer Takeaway: According to the guidance, these are the places the DOL is most likely to look first. Treat the DOL’s three focus areas as the starting point for your next MHPAEA review.

Continue Reading DOL Hands Employers a Mental Health Parity Roadmap
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Seyfarth Synopsis: The Department of Health and Human Services has delegated enforcement authority to the Office of Civil Rights for 42 CFR Part 2, which protects the confidentiality of substance use disorder records. Covered entities must update their HIPAA documents to reflect these changes by February 16, 2026.

On August 25, 2025, the U.S. Department of Health and Human Services (HHS) Office of the Secretary authorized the Director of the Office for Civil Rights (OCR) to enforce the “Confidentiality of Substance Use Disorder (SUD) Patient Records” regulations found at 42 CFR Part 2, including the right to impose civil penalties, issue subpoenas and take corrective actions for noncompliance. These rules, finalized in February 2024, aim to protect the privacy of patients’ SUD treatment records, and require updates to HIPAA Privacy Policies and Notices of Privacy Practices.

Continue Reading Enforcement of Substance Use Disorder Records
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Seyfarth Synopsis: Recently the IRS issued Rev. Proc. 2025-32 and 2025-61, announcing the cost-of-living adjustments to certain welfare and fringe benefit plan limits for 2026 and applicable dollar amounts for the remainder of 2025.

2026 Limits for Certain Health and Fringe Benefits

The Affordable Care Act (ACA) established the Patient-Centered Outcomes Research Institute (“PCORI”), to…

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Artificial intelligence (AI) is transforming many industries — and employee benefit plan administration is no exception. In the latest episode of Seyfarth’s Health Care Beat podcast, co-hosts Chris DeMeo and Amanda Genovese continue their discussion on AI & Health Care: Innovation, Regulation, and Reality with Employee Benefits attorney Caroline Pieper. Together, they explore…

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Benefits and Beyond: What Happens to PTO, Health Insurance, Retirement Plans, and other Benefits?

When an employee passes away, their benefits don’t just vanish into the HR ether. There’s a surprising amount of paperwork, plan rules, and tax codes that come into play—and yes, you’ll probably need to call your benefits administrator (and maybe your…

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Let’s face it—no one wants to think about what happens when an employee dies. It’s a deeply human moment, and yet, somewhere between the condolences and the memorial service, someone in Human Resources is quietly asking: “So… what do we do about their final pay?”

It’s not cold-hearted—it’s compliance. When an employee passes away, employers…

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Seyfarth Synopsis: On July 4, 2025, Donald Trump signed the One Big Beautiful Bill (OBBB) into law. Although most have focused on the sweeping tax reform included in the OBBB, a number of key employee benefits provisions are included in the OBBB as well. Most significantly, the OBBB expands access to and eligible expenses payable…

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Seyfarth Synopsis: In a closely watched decision, the Supreme Court has upheld the authority of the U.S. Preventive Services Task Force (Task Force), preserving the Affordable Care Act’s (ACA) requirement that health plans cover preventive services–such as HIV prevention medication–without cost sharing. The ruling ensures continued access to a wide range of preventive care for…

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Seyfarth Synopsis: In the wake of a recent federal District Court decision, the reproductive health care HIPAA Privacy rules finalized during the Biden Administration have been vacated and plan sponsors should re-evaluate the language included in their HIPAA compliance documents.

In a somewhat unsurprising turn of events, a Texas District Court vacated the HIPAA…

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Seyfarth Synopsis: As expected, the lawsuits have commenced following the enactment of the Arkansas legislation prohibiting pharmacy benefit managers (PBM’s) from owning or operating actual pharmacies within the state. Michigan has filed its own lawsuit against PBMs. Further, a similar bill targeting PBMs is winding its way through the Illinois legislature.

Arkansas Law

As we discussed in our blog post here, Arkansas recently became the first state in the nation to prohibit licenses for retail, mail order or specialty pharmacies that are owned (directly or indirectly) by a PBM. The law does contain a limited exception that allows the issuance of licenses to PBM-affiliated pharmacies for certain rare, orphan, or limited distribution drugs, but this window for exceptions closes in September 2027 (presumably intended to provide a transition period to source these drugs through pharmacies not affiliated with PBMs). 

PBM Reaction

Two lawsuits have now been filed by PBMs challenging Arkansas’ authority to pass this legislation. The lawsuits allege harm to residents of Arkansas by causing the closure of many brick and mortar pharmacies across the state and the inability to access mail-order pharmacies. Express Scripts, in its suit, argues that the Arkansas state law violates several provisions of the United States Constitution, claiming that:

  • the intended purpose of the state statute — to protect local pharmacies — violates the Commerce Clause.
  • the protectionist purpose of burdening out-of-state citizens violates the Privileges and Immunities Clause
  • the singling out of PBMs and their affiliated pharmacies for punishment violates the Attainder Clause, which bars legislative punishment (including banishment) of specific groups.

Because Express Scripts and its affiliates provide services to the US Defense Department’s TRICARE program, the suit also claims that the state statute is preempted by the federal law and regulations surrounding that program.

Arkansas has not yet filed its response to the suits.

Continue Reading States Seeking Remedies for the Rising Costs of Prescription Drugs