Compliance Monthly Update
June 2025
A brief update on what happened the prior month in group health plan compliance at the federal level, organized chronologically. An update for the state and local level are further down. If you would like additional information, please reach out to the GBS Compliance Team.
Federal Compliance Update
DOL/EBSA launch opinion letter program.
On June 2, the DOL announced the relaunch of its opinion letter program in an expansion of its compliance assistance tools. The program is designed to provide plan sponsors (and others) with clear, tailored guidance related to group benefit plans from the DOL’s Employee Benefits Security Administration (EBSA). The EBSA is responsible for enforcing ERISA and will be able to issue opinion letters in the form of (1) advisory opinions that will apply the law to specific factual situations presented by requesters or (2) information letters that will provide general interpretation of the law without applying it to specific facts. Anyone can request an opinion letter, and to request one, the requesting party should submit a detailed inquiry to EBSA outlining the specific facts and questions for which guidance is sought. Submission guidelines are available on DOL’s website. Note that opinion letters are somewhat limited in their application. For advisory opinions, the opinion assumes that all material facts and representations set forth in the request are accurate, and the opinion applies only to the situation described in the submission. Other particular circumstances may be different enough to warrant a different result. Additionally, only the parties described in the request for opinion may rely on the opinion, and they may rely on the opinion only to the extent that the request fully and accurately contains all the material facts and representations necessary to issuance of the opinion. Information letters are informational only and not binding on the DOL/EBSA.
Reminder that PCORI fee and filing is due by July 31.
The annual ACA Patient-Centered Outcomes Research Institute (PCORI) filing and fee on insurers and sponsors of self-funded medical plans (including HRAs) is coming up. The filing and payment due July 31, 2025, is required for policy and plan years that ended during the 2024 calendar year. For plan years that ended January 1, 2024 – September 30, 2024, the fee is $3.22 per covered life. For plan years that ended October 1, 2024 – December 31, 2024 (including calendar year plans that ended December 31, 2024), the fee is $3.47 per covered life. The PCORI fee is reported and paid using IRS Form 720. See the Form 720 Instructions for more information and instructions on reporting and paying the fee. Please also refer to our branded resource on the topic. As a reminder:
- Insurers report and pay the fee for fully insured group medical plans.
- For self-funded plans, the plan sponsor (e.g., the employer) reports and pays the fee.
- An employer that sponsors an HRA along with a fully insured medical plan must pay the PCORI fee based on the number of employees (dependents are not included in this count) participating in the HRA, while the insurer pays the PCORI fee on the individuals (including dependents) covered under the insured plan.
- Where an employer maintains an HRA along with a self-funded medical plan and both have the same plan year, the employer pays a single PCORI fee. Each person covered by both plans is only counted once. If the HRA covers anyone who is not also covered under the self-funded medical plan, the sponsor counts those individuals using the one life per participant rule.
Federal court blocks enforcement of ACA Section 1557 regulations against Catholic association.
On June 5, a federal court blocked enforcement of ACA Section 1557 regulations against members of a Catholic employer association. The association challenged the 2024 Section 1557 regulations that prohibit discrimination on the basis of gender identity and provides a case-by-case procedure for religious exemptions. The association argued the rules violate the Religious Freedom Restoration Act (RFRA) by requiring Catholic organizations to cover or provide gender-transition procedures, which they consider immoral. The court sided with the association, ruling that the 2024 regulations’ prohibition of discrimination on the basis of gender identity violates the members’ sincerely held religious beliefs under the RFRA. Concluding that the 2024 regulations’ new case-by-case procedure for exemptions substantially burdened the members’ exercise of religion because it did not allow them to predict their legal exposure and was not the “least restrictive means available,” the court issued a permanent injunction preventing HHS and the EEOC from enforcing regulations that require the members to perform or provide insurance coverage for gender-transition procedures. While this case was decided under the RFRA and applies only to the current members of this association, another court has issued a broader nationwide injunction and stay on the portions of the 2024 regulations that extend the protections of Section 1557 to gender identity.
Supreme Court upholds state law banning transgender treatment for minors.
On June 18, the Supreme Court of the United States (SCOTUS) in United States v. Skrmetti upheld a Tennessee law banning certain medical treatments for transgender minors—ruling the law does not violate the equal protection clause of the 14th amendment.
- The Tennessee law (which is similar to laws in about half the states) prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.” Such medical treatments may include surgery, puberty blockers, and hormone therapy. Those treatments are permitted for other medical purposes besides treating gender dysphoria, gender identity disorder, or gender incongruence.
- SCOTUS reasoned that the law classifies on the basis of age and medical use—both of which are subject to rational basis review—and not on the basis of sex which would trigger heightened scrutiny by the Court. Chief Justice Robert wrote that while the law’s “prohibitions reference sex, the Court has never suggested that mere reference to sex is sufficient to trigger heightened scrutiny. And such an approach would be especially inappropriate in the medical context, where some treatments and procedures are uniquely bound up in sex.” The Court distinguished this case from Bostock (the 2020 SCOTUS ruling finding that Title VII of the Civil Rights Act prohibits an employer from firing workers for being gay or transgender) because Bostock held that firing individuals for being gay/transgender is sex discrimination because the individual’s sex is a “but-for” cause of differing outcomes. Here in Skrmetti, SCOTUS found that sex is not a “but-for” cause because neither a boy nor a girl would have access to the prohibited treatment for gender dysphoria or certain conditions under the law.
- The majority found the law was constitutional under the rational basis standard due to the legitimate interest of the Tennessee legislature in preventing harm associated with using puberty blockers to treat gender dysphoria in minors. The Court reached this holding while acknowledging that under Tennessee law puberty blockers remain a legal treatment of minors for conditions other than gender dysphoria. The Court found this distinction did not create an unlawful sex-based distinction.
- For group health plan sponsors, coverage of transgender care for minors should be viewed similarly to abortion—in that SCOTUS is essentially leaving the regulation of these items to the states. Skrmetti does nothing to limit access to transgender care for minors in states that do not currently ban or restrict such care, or where states have taken extra steps to protect these types of transgender treatment. That is, employer group health plans can cover these services as long as it is legal where provided. For example, In the case of insured plans, currently about half the states prohibit plan exclusions of transgender care, and these states may soon follow Colorado’s lead and affirmatively require coverage for medically necessary “gender-affirming” care.
Federal court vacates 2024 HIPAA reproductive health care privacy rule.
On June 18, a federal district court issued an order vacating, on a national basis, a majority of the 2024 HIPAA Privacy Rule to Support Reproductive Health Care Privacy. As a reminder, HHS had issued the 2024 Privacy Rule in response to the Supreme Court’s Dobbs decision holding that the Constitution does not prohibit states from regulating or banning abortion. The 2024 Privacy Rule amended the broader HIPAA Privacy Rules with new definitions, imposed a new attestation requirement for requests of Protected Health Information (PHI) potentially related to reproductive health care, and required covered entities to make changes to their Notice of Privacy Practices (NPP). Here, the court concluded that the 2024 Privacy Rule unlawfully limits disclosures to state authorities regarding abuse and public health and exceeds HHS’s authority by unlawfully defining “person” to exclude unborn children and narrowing the definition of “public health.” The court further held that HHS had acted outside its statutory authority by promulgating special protections for reproductive health care information, regulating a matter of great political significance that is traditionally left to the states, without clear Congressional authorization. While the court struck down the requirement to update the NPP related to reproductive health care, the court left in place the changes to the NPP regarding substance use disorder records. Plan sponsors should review their HIPAA policies and procedures, Business Association Agreements (BAAs), NPP, and any HIPAA training materials to ensure they are current and do not reflect the parts of the 2024 Privacy Rule that were vacated. But the NPP will still need to be revised to include language about confidentiality of substance use disorder records by February 16, 2026. We expect HHS to release an updated model NPP prior to this deadline.
HHS finalizes ACA exchange coverage and affordability rule with revised 2026 cost-sharing limits.
On June 20, HHS and CMS released final regulations titled “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability” (and an associated press release and fact sheet). The final rule largely finalized with little or no changes to the proposed rule we discussed in March earlier this year. The final regulations address the integrity of the ACA Exchanges (aka Marketplaces), the affordability of health coverage, changes to annual cost-sharing limits, eligibility and enrollment procedures, and the definition of essential health benefits (EHBs). Below are the highlights.
- Revised 2026 annual cost-sharing limits. HHS has updated the methodology for calculating the “premium adjustment percentage” (which is used to set several ACA parameters) to align with premium trends, beginning in 2026. Based on this change, the maximum annual limitation on cost-sharing for 2026 has been revised to $10,600 for self-only coverage and $21,200 for other than self-only coverage. The revised limitation supersedes the previously announced 2026 limits of $10,150 and $20,300.
- Prohibition of coverage of transgender procedures as an EHB for individual and small group plans. Beginning in 2026, HHS will prohibit insurance plans subject to the ACA EHB coverage requirements from providing “specified sex-trait modification procedures” as an EHB. HHS provides a lengthy definition of specified sex-trait modification procedures which includes “any pharmaceutical or surgical intervention provided for the purpose of attempting to align physical appearance with an asserted identity that differs from biological sex” such as puberty blockers, sex hormones and surgical procedures. But the prohibition does not extend to mental health services, including for persons with gender dysphoria. This will impact all non-grandfathered plans in the individual and small group market (which are subject to the EHB requirements). HHS explains that insurers may still voluntarily cover specified sex-trait modification procedures and states are generally not prohibited from mandating coverage of such services, but they are not considered EHB.
- Exchange eligibility and enrollment. The Exchange integrity changes (which do not have a direct impact on group health plans) are designed to tamp down on improper enrollments, to stop the excess flow of federal funds that resulted from the temporary expansion of ACA premium subsidies in response to COVID, to protect against adverse selection, and to lower individual coverage premiums. The final regulations include revised standards for Exchange income verification processes, new rules for pre-enrollment verification for special enrollment periods, and modified eligibility redetermination procedures. These provisions will apply for the 2026 plan year but are currently scheduled to sunset at the end of that year. The regulations also remove Deferred Action for Childhood Arrivals (DACA) recipients from the definition of “lawfully present” for eligibility and enrollment in Exchanges, effective August 24, 2025. Starting in 2027, the Exchange annual open enrollment period has been revised to begin no later than November 1 and end no later than December 31 of the calendar year preceding the benefit year, with the period not to exceed 9 weeks. The federal Exchange open enrollment period will run from November 1 through December 15. Coverage for enrollments during the open enrollment period must begin on January 1.
Supreme Court upholds constitutionality of ACA preventive services mandate.
On June 27, the Supreme of the United States (SCOTUS) in Kennedy v. Braidwood Management, Inc. upheld as constitutional the appointment of members of the U.S. Preventive Services Task Force (PSTF)—one body whose recommendations help determine which items and services are “preventive care” for purposes of required coverage under the ACA.
- As a reminder, the ACA requires health plans to cover preventive services with no cost-sharing for participants, and the ACA empowers three agencies—the U.S Preventive Services Task Force (PSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP)—to determine what kinds of preventive care fall within each category of mandatory coverage by issuing guidelines or recommendations.
- In March of 2023, a district court ruled in the Braidwood case that the ACA requirement to provide preventive services as recommended by the PSTF is unconstitutional and issued a nationwide injunction that prohibited the federal government from enforcing the ACA preventive services mandate. However, that district court ruling was stayed pending the outcome of the appeal.
- In June of 2024, the Fifth Circuit affirmed that the PSTF’s members had not been validly appointed under the Constitution because they were not nominated by the President and confirmed by the Senate. The court explained that this appointment process is necessary due to the level of power exercised by the PSTF in making recommendations on preventive services required to be covered under the ACA. Under this ruling, HHS was enjoined from enforcing PSTF recommendations, but only as to the Braidwood The court reversed the trial court’s decision to vacate all agency actions taken to enforce the preventive services mandates and to universally block the agencies from enforcing the mandates with a nationwide injunction. The court withheld judgment and remanded the case back to the trial court to determine if the members of HRSA and ACIP were also unconstitutionally appointed. So, although the Fifth Circuit ruled that some aspects of the ACA preventive service requirements are unconstitutional, those requirements still applied to group health plans nationwide (except for the plaintiffs who brought this lawsuit). Therefore, the preventive services requirement remained intact for the time being.
- Then the DOJ, under the Biden administration, asked SCOTUS to review the Fifth Circuit holding that the appointment of the PSTF is unconstitutional. On January 10, 2025, SCOTUS agreed to hear the case, and on April 21, 2025, oral arguments were held.
- Now, on June 27, 2025, SCOTUS held that the PSTF members were validly appointed by the Secretary of HHS. The Court explained that whether the appointment was constitutional turns on whether the members are “principal officers” or “inferior officers.” Principal officers must be nominated by the President and confirmed by the Senate, whereas inferior officers may be appointed by department heads, such as the Secretary of HHS. SCOTUS held that PSTF members are inferior officers because they are supervised and directed by the Secretary, removable at will by the Secretary, and their recommendations are reviewable and may be revoked by the Secretary. The Court concluded that, because Congress has the authority to vest the power to appoint inferior officers in the Secretary (and has done so), the Secretary’s appointment of members pursuant to that grant of authority is valid under the Constitution. SCOTUS’s decision affirms the constitutional authority of the PSTF to shape the ACA preventive services mandate. Group health plans generally should not require any immediate action since the Fifth Circuit decision was put on hold pending appeal and the coverage requirements remained in effect during the litigation.
State/Local Compliance Update
A brief update on what happened the prior month in group health plan compliance at the state and local level, listed alphabetically. If you would like additional information, please reach out to the GBS Compliance Team.
Alabama
Alabama launches portable benefits option for independent contractors.
A new law (SB 86, the “Portable Benefits Act”) that takes effect December 31, 2025, will allow Alabama businesses to voluntarily make contributions to portable benefit accounts owned by an independent contractor whom the employer hires or enters into a contract for the performance of work. Contributions under this law will not be subject to state taxes. That is, companies can voluntarily contribute to a contractor’s portable benefits (like health insurance, retirement savings, and life insurance), and the contributions will be tax-deductible to the business (for state tax purposes) and workers will not pay state taxes on the value received. There is a question if this would create a multiple employer welfare arrangement (MEWA), which is a special arrangement used to provide employee welfare benefits to the employees of two or more employers that are not part of the same control group of businesses. The DOL has informally indicated that a plan maintained by one employer covering several independent contractors along with the employer’s common-law employees would result in a MEWA. In most cases, employers want to avoid creating a MEWA because they are subject to significant additional regulation and compliance burdens at both the state and federal level.
Arizona
Arizona law bans the use of AI in claim denials.
Governor Hobbs recently signed HB 2175 that will require a physician license in the state to conduct an individual review and use independent medical judgment to determine whether a claim should be denied. It will also require a similar review of a direct denial of prior authorization for a service that a provider asked for and involves medical necessity. The purpose of this law is to ensure that a doctor (and not AI) is making medical decisions. This law goes into effect July 1, 2025.
Arkansas
Legal challenges filed against new Arkansas PBM law.
As was discussed in our April update, Arkansas was the first state to prohibit PBMs from acquiring or holding a direct or indirect interest in a pharmacy. Under Act 624, as of January 1, 2026, the Arkansas State Board of Pharmacy must either revoke or not renew pharmacy permits where the permit holder is a PBM or its subsidiary, is an entity managed by a PBM, or is an entity that has a direct or indirect ownership interest in a PBM. Now, two PBMs have filed lawsuits challenging Arkansas’ authority to pass the legislation arguing it violates the Constitution and is preempted by ERISA. The jurisprudence of ERISA preemption and state PBM laws has been evolving, and we will be monitoring the litigation involving this law as well as other state PBM laws.
California
California delays insurance coverage of infertility benefits until January 1, 2026.
As a reminder, Governor Newson signed SB 729 on September 29, 2025, expanding fertility insurance coverage, including in vitro fertilization (IVF). The new law was to apply to policies written or renewed on or after July 1, 2025. But now the effective date has been delayed until January 1, 2026, when on June 30, 2025, Governor Newsom signed AB 116 (the health omnibus bill that is part of the 2025 – 2026 state budget). The benefits that insured group health plans will be required to provide under the SB 729 will depend on if the plan is a large or small plan.
- Large fully insured plans (those with 101 or more employees) must provide coverage for the diagnosis and treatment of infertility and fertility services. This includes up to three completed rounds of IVF.
- Small fully insured plans (those with 100 or fewer employees) must offer employers the option to provide coverage for the diagnosis and treatment of infertility and fertility services as a rider to small group policies. But it does not mandate that the coverage be included in the policies.
- For both large and small group policies, the policy may not impose any limitations or cost sharing on such infertility or fertility services that are different from those imposed upon benefits for services not related to infertility or fertility.
- The law expands the definition of infertility to include a condition or status characterized by any of the following:
- (a) A licensed physician’s findings, based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- (b) A person’s inability to reproduce either as an individual or with their partner without medical intervention (which would cover single individuals and same-sex couples).
- (c) The failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse (which is after 12 months for a person under 35 years old; and 6 months for older persons).
- For fully insured plans outside California, SB 729 includes the following statement: “This section applies to every … policy that is issued, amended, or renewed to residents of this state regardless of the situs of the contract.” In other words, the law purports to have extraterritorial reach to apply for any employee in California regardless of whether the policy is sitused in California. It is not clear if/how California can enforce such a provision. We expect more guidance form the Department of Managed Health Care as we near the implementation date.
- Exemptions. SB 729 does not apply to self-insured (including level funded) plans. The law also specifically does not apply to religious employers who meet certain requirements; or accident-only, specified disease, hospital indemnity, Medicare supplement, or specialized disability insurance policies.
Colorado
Colorado FAMLI amended to lower premiums and include Neonatal Care Leave.
Governor Polis has signed SB 25-144 that effective January 1, 2026, amends the Colorado Family and Medical Leave Insurance (FAMLI) Act to expand coverage to include “Neonatal Care Leave” and will also slightly lower premiums. First, the legislation amended FAMLI to provide up to an additional 12 weeks of paid family and medical leave for any parent who has a child receiving care in a neonatal intensive care unit (NICU). This means any parent whose child is in the NICU could receive up to a total of 24 total weeks of paid FAMLI leave (12 weeks of bonding leave and 12 weeks for time that the newborn is in the NICU). Second, the amendment lowers the 2026 premiums to 0.88% of wages (from the current 0.9%). For each subsequent calendar year, the director of the FAMLI Division will set the premium on or before September 1st of the preceding year, with a maximum possible premium rate of 1.2% of wages per employee.
Idaho
Idaho issues guidance related to supplemental breast cancer screening coverage requirement.
Idaho has published Bulletin 25-03 (and a fact sheet) to provide guidance on HB 134, which was passed earlier this year and will require fully insured plans regulated by the Idaho DOI and written or renewed on or after January 1, 2026, to provide additional preventive breast cancer screenings with no cost share. This free additional screening must be provided to individuals identified as having an increased risk of breast cancer.
Illinois
Illinois passes PBM reform bill.
Governor Pritzker has sign HB 1697 (the Prescription Drug Affordability Act) with comprehensive PBM reforms including eliminating spread pricing, ending PBM steering practices, and mandating 100% rebate pass-through. It also institutes an oversight structure for PBMs that will require annual transparency reports, plan audits, and market conduct examinations.
Indiana
Indiana passes PBM reform bill.
Governor Braun has signed SB 140 that imposes wide-ranging PBM reforms. The law addresses pharmacy network adequacy and prohibits PBMs from entering network contracts that would prevent pharmacists from advising patients about lower cost options. The law requires all pharmacy networks to be “reasonably adequate and accessible,” mandating at minimum that insured individuals have access to a non-mail-order pharmacy within 30 miles of their residence to the extent a pharmacy is available. Insurers and PBMs will also be required to submit annual reports regarding network adequacy to the Indiana DOI, which will directly oversee compliance. And while insurers and PBMs may still promote their in-network providers, any communication regarding the network must be accurate and inclusive of all eligible pharmacies. PBMs are also prohibited from requiring an employer to enter a contract with a particular PBM—in other words, PBM carve outs must be allowed. The new law also prohibits charging a carve out fee to employers who choose a different PBM.
Iowa
Iowa passes PBM reform bill, but it is now subject to a temporary injunction.
Governor Reynolds has signed SF 383 with PBM reforms that would bar PBMs from steering patients to specific pharmacies or choosing to exclude certain pharmacies from their networks in an unfair way. The law would also require PBMs to reimburse independent or unaffiliated pharmacies at the same rate they pay affiliated facilities and also pay dispensing fees for prescriptions. But a federal judge has temporarily blocked the enforcement of this new PBM law (just hours before it was to take effect on July 1) because of the likelihood the plaintiffs will ultimately prevail on their claim the law is preempted by ERISA.
Maryland
Maryland delays and amends FAMLI program.
Governor Moore has signed HB 102, that amends the Maryland paid Family and Medical Leave Insurance (FAMLI) program. Notably, Maryland employers and employees will now begin making contributions to the FAMLI program on January 1, 2027 (a delay to the previous start date of July 1, 2025). The bill requires the Maryland Department of Labor to set the contribution rate for the 2027 calendar year by May 1, 2026, and to announce the rate for each subsequent calendar year by November 1 of the prior year. The Department must also set, for the submission of benefit claims, a date no earlier than January 1, 2027, but no later than January 3, 2028. In addition, the new law requires that on or before July 1, 2028, the Secretary must adopt regulations that establish an optional self-employed enrollment program that includes contribution amounts, benefit amounts, and enrollment procedures.
Nebraska
Nebraska amends upcoming paid sick time law.
Governor Pillen has signed LB 415 that modifies the Nebraska Healthy Families and Workplace Act (HFWA) in advance of its October 1, 2025, effective date. Initially passed via ballot initiative in November of 2024, the HWFA mandates paid sick leave for most employers and employees in the state—40 hours per year for employers with between 11 and 19 employees, and 56 hours per year for employers with 20 or more employees. Highlights of the amendments include that: (a) employers with 10 or fewer employees will no longer be covered by the law, (b) accrual for new hires may be delayed until they have completed 80 hours of consecutive employment in Nebraska, and (c) for 2025, employers offering benefits on a calendar year basis will receive credit for any paid sick time provided to an employee on or after January 1, 2025 and before the law becomes effective on October 1, 2025.
New York
New York City amends ESSTA rules to add paid prenatal leave.
New York City has released amended Earned Safe and Sick Time Act (ESSTA) rules (and updated FAQs) that include specific paid prenatal leave amendments that go into effect July 2, 2025. Until now, New York employers’ paid prenatal leave obligations were determined by New York State law. Going forward, employers with operations in New York City will need to assess both the existing New York State Paid Prenatal Leave entitlement and the New York City paid prenatal leave requirements in the amended ESSTA rules to determine their compliance requirements.
North Dakota
Amendment to North Dakota military leave.
North Dakota law was amended to provide leave of absence benefits for state employees in the National Guard or federal service. Officers or employees of the state or political subdivisions who are members of the National Guard, armed forces reserve, or are called to federal service, are entitled to a leave of absence without loss of status or efficiency rating. It provides for 20 workdays of leave without loss of pay each calendar year for those who have been employed continuously for 90 days prior to the leave. Additionally, it allows for a leave of absence without loss of pay for the first 30 days in cases of full or partial mobilization of reserve and National Guard forces. The bill also updates the definition of a veteran to include individuals who served on continuous federalized active duty for at least 180 days or the full period they were called to duty and were discharged under conditions other than dishonorable.
Oklahoma
Oklahoma coverage mandate for genetic testing and cancer imaging for those with increased cancer risk.
Effective November 1, 2025, fully insured health benefit plans must cover (1) clinical genetic testing or an inherited gene mutation for individuals with a personal or family history of cancer when such test provides clinical utility and when ordered or recommended by a health care provider in accordance with medical and scientific evidence and (2) evidence-based cancer imaging (preventative screening and imaging) for individuals with an increased risk of cancer when such test provides clinical utility and when ordered or recommended by a health care provider in accordance with the most recent version of the NCCN clinical practice recommendations that are Category 2A or higher, or in accordance with other nationally recognized clinical practice guidelines. Such coverage is not subject to deductibles, copays, or coinsurance limits. Also, coverage for mammogram screenings are expanded to include coverage for low-dose mammography screenings for the presence of occult breast cancer and diagnostic and supplemental examinations for breast cancer that include contrast-enhanced mammography, diagnostic mammogram, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging that is (a) used to screen for breast cancer when there is no abnormality seen or suspected, and (b) based on personal or family medical history or additional factors that increase the individual’s risk of breast cancer, including heterogeneously or extremely dense breasts.
Oregon
Oregon expands reasons employees can use paid sick time to include blood donation.
Governor Kotek has signed SB 1108 that expands Oregon’s paid sick time law to allow time off to donate blood. Effective January 1, 2026, an employee may use sick time earned for blood donation that is made in connection with a voluntary program for the donation of blood that is approved or accredited by the American Association of Blood Banks or the American Red Cross.
Pennsylvania
Pittsburg amends paid sick leave law.
Mayor Gainey has signed an amendment to Pittsburgh’s Paid Sick Days Act (PSDA)—that effective January 1, 2026—accelerates employees’ accrual of sick leave and increases usage and carry-over caps. The amendment increases the accrual of paid sick time from one hour of leave for every 35 hours worked, up to one hour for every 30 hours worked (this applies to all employers in Pittsburgh, regardless of size). For employers with 15+ employees—employees must be allowed to accumulate (through accrual or frontloading) and carry over (if accruing) up to 72 hours of paid sick leave per year, up from the current 40 hours. For employers with 14 or fewer employees—employees must be allowed to accumulate (through accrual or frontloading) and carry over (if accruing) up to 48 hours of paid sick leave each year, up from the current 24 hours. Prior to this amendment, the paid sick leave laws in Pittsburgh and Allegheny County used the same accrual rate and permitted employees to accumulate and annually use the same amount of paid sick leave. But now, Pittsburgh employees will have faster accrual and higher accumulation and usage caps than employers elsewhere in Allegheny County. Employers with facilities both in the City of Pittsburgh and other locations in Allegheny County should account for these differences. Also, it is important to remember that PSDA applies to employers operating within the geographic boundaries of the City of Pittsburgh as well as to employers that may not be physically present in the city but have employees who perform work within its geographic boundaries for at least 35 hours in a calendar year.
Tennessee
Supreme Court upholds Tennessee law banning transgender treatment for minors. On June 18, the Supreme Court of the United States (SCOTUS) in United States v. Skrmetti upheld a Tennessee law banning certain medical treatments for transgender minors—ruling the law does not violate the equal protection clause of the 14th amendment.
- The Tennessee law (which is similar to laws in about half the states) prohibits all medical treatments intended to allow “a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex” or to treat “purported discomfort or distress from a discordance between the minor’s sex and asserted identity.” Such medical treatments may include surgery, puberty blockers, and hormone therapy. Those treatments are permitted for other medical purposes besides treating gender dysphoria, gender identity disorder, or gender incongruence.
- SCOTUS reasoned that the law classifies on the basis of age and medical use—both of which are subject to rational basis review—and not on the basis of sex which would trigger heightened scrutiny by the Court. Chief Justice Robert wrote that while the law’s “prohibitions reference sex, the Court has never suggested that mere reference to sex is sufficient to trigger heightened scrutiny. And such an approach would be especially inappropriate in the medical context, where some treatments and procedures are uniquely bound up in sex.” The Court distinguished this case from Bostock (the 2020 SCOTUS ruling finding that Title VII of the Civil Rights Act prohibits an employer from firing workers for being gay or transgender) because Bostock held that firing individuals for being gay/transgender is sex discrimination because the individual’s sex is a “but-for” cause of differing outcomes. Here in Skrmetti, SCOTUS found that sex is not a “but-for” cause because neither a boy nor a girl would have access to the prohibited treatment for gender dysphoria or certain conditions under the law.
- The majority found the law was constitutional under the rational basis standard due to the legitimate interest of the Tennessee legislature in preventing harm associated with using puberty blockers to treat gender dysphoria in minors. The Court reached this holding while acknowledging that under Tennessee law puberty blockers remain a legal treatment of minors for conditions other than gender dysphoria. The Court found this distinction did not create an unlawful sex-based distinction.
Utah
Utah amends stop-loss insurer standards.
Utah has passed HB 23 that amends Utah Code Section 31A-43-301 (Stop-loss insurance standards) so that effective July 1, 2025, a stop-loss insurer: (a) may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees and (b) may not enter into a small employer stop-loss insurance contract with a small employer with less than 10 enrolled employees. Also, small employer stop-loss must now have an annual specific attachment point that is at least $25k (up from $10k) and have an annual aggregate attachment point that may not be less than 90% of expected claims (up from 85%). These changes will not apply to a small employer stop-loss insurance contract entered into before July 1, 2025, unless the insurance provider changes under the small employer’s health plan during the contract period.
Vermont
Vermont enacts new telehealth legislation.
Governor Scott has signed 30 that effective September 1, 2025, will require health insurance plans to provide coverage for healthcare and dental services delivered through telemedicine to the same extent as if the services were provided through in-person consultations. Health insurance plans must also provide the same reimbursement rate for services billed using equivalent procedure codes and modifiers, subject to the terms of the health insurance plan and provider contract, regardless of whether the service was provided in person or through telemedicine.
Vermont expands unpaid family leave protections.
Governor Scott has signed legislation extending protections under Vermont’s unpaid family leave law. The amendments (that are effective July 1, 2025) extends safe leave, bereavement leave, and qualifying exigency leave to employees of employers with ten or more employees. The amendments also broadens the definition of “family member” to extend benefits for qualifying events related to the employee’s spouse or civil union or domestic partner, biological, adopted, or foster child, stepchild or legal ward, a child of the employee’s spouse or domestic partner, a legal guardian of the employee or the employee’s spouse, or a person to whom the employee stands (or stands for the employee) in loco parentis or stood in loco parentis prior to the person turning 18, regardless of legal documentation. The law also covers any individual for whom the employee provides caregiving responsibilities similar to those of a parent-child relationship as well as grandparents, grandchildren, or siblings of the employee or the employee’s spouse.
Vermont passes two bills with the goal of cutting healthcare costs.
Governor Scott has signed 266 and S.126 in an effort to control healthcare costs, improve transparency, and enhance access to quality care. H.266 introduces a cap on the price hospitals can charge for physician-administered drugs (such as infusions and injections) in outpatient settings, limiting charges to 120% of the average sales price. S.126 will establish reference-based pricing for certain hospital services and expand oversight of hospital budgets.
Washington
Amendments made to Washington Paid Family & Medical Leave to expand job and benefit protections.
Governor Ferguson has signed HB 1213 that effective January 1, 2026, expands job and benefit protections under Washington’s Paid Family and Medical Leave (PFML) program.
- Job protection. Currently, Washington PFML generally does not provide job protection to employees who do not qualify for federal FMLA—that is, Washington PFML only requires employers with fifty or more employees in Washington to provide job protection, and employees do not qualify for job protection unless they have worked for their employer for at least twelve months and for 1,250 hours in the year before the start of their leave. Effective January 1, 2026, job protection will be extended to all individuals, regardless of hours worked, so long as they have been employed 180 days and the employer has 25 or more employees. This size threshold decreases to 15 employees for calendar year 2027, and 8 employees for 2028.
- Benefit continuation. Currently, benefit continuation protection is only available to individuals who have at least a one-day overlap between Washington PFML and federal FMLA leave. As of January 1, 2026, any employee on Washington PFML entitled to job protection under these new rules will also be entitled to continued health benefits, regardless of federal FMLA status.
Washington expands paid sick time for use in immigration proceedings.
Washington has amended their Paid Sick Leave Act (effective July 27, 2025) to allow eligible employees to use their paid sick time to prepare for, or participate in, any judicial or administrative immigration proceeding involving the employee or employee’s family member.
- Washington to require unpaid leave and safety accommodations for victims of hate crime. Effective January 1, 2025, SB 5101 will require employers to provide leave and safety accommodations to employees who are victims of a hate crime or have a family member who is a victim of a hate crime. Under Washington’s existing Domestic Violence Leave Law, which applies to all Washington employers with one or more employee, an employee who is a victim or a family member of a victim of domestic violence, sexual assault, or stalking may take a reasonable amount of unpaid leave from work for reasons such as seeking legal or law enforcement assistance, treatment or counseling for physical or mental injuries, or social services. Absent undue hardship, employers must also provide reasonable safety accommodations, which may include a transfer, reassignment, modified work schedules, changes to a work telephone number or email address, and other adjustments. The law also includes protection from discrimination and retaliation relating to actual or perceived victim status and the exercise of rights to leave and accommodation. Beginning January 1, 2026, the law will cover victims of a hate crime, which is defined as the commission, attempted commission, or alleged commission of (1) assault, (2) physical damage to or destruction of property, or (3) threats to a specific person or group of persons that place such person(s) in reasonable fear of harm to person or property where the act is committed based on actual or perceived race, color, religion, ancestry, national origin, gender, sexual orientation, gender expression or identity, or mental, physical, or sensory disability. For purposes of leave and accommodation, “hate crime” will explicitly include offenses that are committed through online or internet-based communication.
