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News Items, by Subject

Health plans - design

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Court Reconsiders Application of Colorado State Ban on Discretionary Clauses Based on Disability Policy Amendments and SPD
"Here, the court found that a document prepared by the policyholder impacted the rights the insurance company attempted to grant to itself in the policy that it drafted. But we've also seen the reverse play out in the context of state bans on discretionary clauses; specifically, in cases where courts have found that a grant of discretion in a Plan document overrides a state ban on discretionary clauses in disability policies." [Ellis v. Liberty Life Assurance Co. of Boston, No. 15-090 (D. Colo. Jan. 15, 2019)] (Kantor & Kantor)
California Prescription Drug Purchasing Initiative Raises Numerous Questions
"Would [the California Department of Health Care Services (DHCS)] really be able to negotiate better rebates for Medi-Cal than managed care organizations? ... Is the program permissible under federal law, and if so, does it require Trump Administration approval? ... Are changes in California law required? ... Is the initiative permissible under the antitrust laws? ... How would 'the self-insured' receive the benefit of the negotiated discounts?" (Reed Smith LLP)
Cross-Plan Offsetting Case Triggers Legal Concerns for Plan Sponsors
"[P]lan sponsors should ... fully understand the way in which offsets are occurring under their plan, especially with respect to how this practice could impact their plan participants. Plan sponsors should endeavor to reach a compromise that would allow the TPA to seek overpayment recoveries on behalf of the plan without authorizing the TPA to engage in cross-plan offsets.... Keep in mind that prudent overpayment recovery activities are a legitimate fiduciary requirement under ERISA." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (Winston & Strawn LLP)
Evolving the Benefit Mindset: Responding to Employee Expectations for Choice and Personalization
"70% of employees who were offered the maximum level of choice in benefits (a true flex fund plus voluntary benefits) stated they were satisfied with their benefits. However, adding decision support technology to that that same level of choice increased the number of satisfied employees by 15%. This suggests that employers can fully realize the value of choice leading to increased employee satisfaction and engagement when they provide tools to help employees understand and appreciate those choices." (Willis Towers Watson)
State Efforts to Protect Consumers from Balance Billing
"In 2017 and 2018, states continued taking steps to protect consumers. Four states -- Arizona, Maine, Minnesota, and Oregon -- created balance-billing consumer protections for the first time, and two states -- New Hampshire and New Jersey -- substantially expanded existing protections. We now classify New Hampshire, New Jersey, and Oregon as states offering comprehensive protections against balance billing. As of December 2018, 25 states have laws offering some balance-billing protection to their residents, and nine of them offer comprehensive protections." (The Commonwealth Fund)
CMS Proposes Changes to ACA Premiums, Reducing Tax Credits
"CMS is proposing ... to seek to end the practice of silver loading, end automatic re-enrollment in individual exchange plans, and raise premiums by 1% ... In addition, the [2020 payment notice] proposes allowing individual, small group, and large group market health insurance issuers to allow mid-year formulary changes to encourage more use of generic drugs.... CMS also wants to raise the out-of-pocket maximum that those with employer-sponsored coverage would pay to $8200 annually, up $200. The maximum for family coverage would increase by $400." (American Journal of Managed Care)
[Guidance Overview] Text of CMS Value-Based Insurance Design Model (VBID) Fact Sheet CY 2020
"For the CY 2020 VBID application period, which is open now through March 1, 2019, eligible Medicare Advantage organizations may apply to test one or more of the following new interventions: [1] Value-Based Insurance Design by Condition, Socioeconomic Status, or both ... [2] Medicare Advantage and Part D Rewards and Incentives Programs ... [3] Telehealth Networks ... [4] Wellness and Health Care Planning." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
2018 Year in Review: Plus What Lies Ahead in 2019 (PDF)
54 presentation slides. Topics include: [1] ACA Marches On During Appeals; [2] Appealing Employer Exchange Notices; [3] 2018 ACA Reporting Deadline Extended; [4]Insured Nondiscrimination Rules Indefinite Delay; [5] Association Health Plans; [6] Individual Policy and Excepted Benefit HRAs; [7] Tax Cuts and Jobs Act; [8] California Leave Law Updates; [9] San Francisco Ordinance Updates. (ABD Insurance & Financial Services)
More Pay? Nah. Employees Prefer Benefits
"By a four-to-one margin (80 percent to 20 percent), workers would choose a job with benefits over an identical job that offered 30% more salary with no benefits ... Employed adults estimated that their benefits represented 40% of their total compensation package ... The Bureau of Labor Statistics, though, states that benefits average 31.7 percent of a compensation package." (Voya)
[Opinion] Forget Washington -- Here's How States Can Improve Health Care
"While the State Relief and Empowerment Waivers focus on providing states with additional flexibility and relief from Obamacare, the administration has also encouraged states to request reforms to their Medicaid programs through the Section 1115 waiver demonstrations.... Some have already seized the opportunity, but many states have not and more can be done. Moreover, states should oppose initiatives to roll back or undermine efforts that bring much-needed reforms and changes to these programs." (The Heritage Foundation)
Demonstrating and Rewarding Value in Health Care
"Despite the growing interest in these programs, there are strategic and operational barriers that exist today that are preventing wide spread adoption of [value-based contracts (VBCs)]. Survey participants cited the top three barriers as collecting, linking, and analyzing the necessary patient data; gaining alignment on the contract structure; and assigning how value is measured." (Deloitte)
[Official Guidance] CMS Issues the Proposed Payment Notice for 2020 Coverage Year
"This rule proposes regulatory and financial parameters applicable to qualified health plans (QHPs) on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. These changes proposed in the rule would further the Trump Administration's goals of lowering premiums, enhancing the consumer experience, increasing market stability, reducing regulatory burdens, and protecting taxpayers." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] Is the Drug Industry an Existential Threat to the Private Health Insurance Business?
"Because of the impact health insurance costs are having on take home income, we are at risk that the historical attractiveness employees and their families have had for employer-based health insurance will be lost. If the health insurance industry loses the support of employer-plan participants it will have lost the firewall that has made voters reluctant to support government-run health care.... [T]he primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs." (Bob Laszewski's Health Care Policy and Marketplace Review)
Stats That Could Make You Re-Evaluate Your Benefit Administration Strategy
"[1] Benefits account for 31.7% of total compensation costs, on average.... [2] Four out of five employees enroll in the wrong health plan.... [3] Nearly 90% of employees feel technology improves their understanding of benefits.... [4] 26% of employees report having left a job or rejecting a job offer due to the benefits offered.... [5] 37% of employers say the ability to integrate benefits technology with HR functions is the most valuable outcome of implementing a benefits administration platform." (Benefitfocus)
Is the New Association Health Plan (AHP) Rule Providing New Opportunities for Employers?
"The range of responses and feasibility to this new rule hinges on the state, the insurance carriers, and each association itself. The summary [in this article] shows the opportunities and challenges for the various stakeholders[.]" (OneDigital Health and Benefits)
Long-Awaited 'Cross-Plan Offsetting' Case Increases Risk for Employers, Insurers
"[To recover disputed overpayments from an out-of-network provider,] an alleged overpayment relating to one health plan from one employer is 'offset' by modifying the amount which is paid by a different health plan of a different employer.... The court noted that nothing in the plan documents allowed UHC to conduct cross-plan offsetting.... Then, the court strongly hinted that the practice violated ERISA's fiduciary duty rules, including the requirement that plan assets of one plan be used for the 'exclusive purpose' of benefiting individuals covered by that plan." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (Quarles & Brady LLP)
Federal Appeals Court Sides with Out-Of-Network Doctors Against UnitedHealth
"[This] decision ... should act as a wake-up call to all self-insured health plans for potential rewards in the trillions of dollars in plan assets recovery for all self-insured ERISA plans nationwide, from cross plan overpayment recoupments and offsets done by all plan TPAs.... The appeals court [stated]: 'To adopt United's argument that the plan language granting it broad authority to administer the plan is sufficient to authorize cross-plan offsetting would be akin to adopting a rule that anything not forbidden by the plan is permissible.' " [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)] (AVYM Healthcare Revenue Consultants)
Drug-Pricing Transparency, Vertical PBM Deals Are Top of Mind for Employers in 2019
"As they look to win over employer clients this year, PBMs should be prepared to face stiff competition and embrace emerging trends such as value-based formularies and rebate-free models ... Companies are also considering how the vertical integration in the PBM space is 'reshaping the landscape' ... [M]any of the same themes that employers are focused on will apply, including greater transparency around drug pricing and rebates, and even rebate-free models[.]" (AISHealth)
Two District Courts Block Trump Administration's Final ACA Contraceptives Rules
"Although the two district court injunctions put a hold on the Trump Administration's final regulations for the time being, they will not be the final word on the exemptions. Both orders have already been appealed -- to the Ninth and Third Circuits, respectively -- so entities that were planning to take advantage of the expanded exemptions must wait and see how the litigation plays out in the courts." (Thomson Reuters Practical Law)
Bringing 'Transparent Thinking' to PBM Management (PDF)
50 presentation slides. Topics: [1] What is a PBM? [2] Who are the parties to a PBM contract? [3] Why do PBMs have so much power? [4] How do PBMs make money? [5] Contract terms -- the need for solid terms in a contract. [6] A push for transparency. [7] Policy news. [8] A real life example: PBGH's Waste-free formulary study. (Trucker Huss)
Starting an Onsite Clinic Program: Questions to Consider
"Is now the right time? ... What is my workplace trying to improve? ... How do I choose the right vendor? ... How do I know my vendor will deliver?" (Healthstat)
Considerations for Comprehensive Employee Wellness Programs
"[1] Stress relief ... [2] Mental health ... [3] Emotional self-care ... [4] Lifestyle wellness ... [5] Flexible work ... [6] Financial health." (HR Daily Advisor)
Lower-Wage Workers Pay More Than Higher-Wage Workers for Employer-Provided Medical Care Benefits
"In March 2018, private industry workers earning an average wage in the lowest 10 percent paid an average of $151.78 per month for medical care plans for single coverage. That was $25 more than the average monthly contributions of private industry workers with an average wage in the highest 10 percent ($126.82)." (U.S. Bureau of Labor Statistics [BLS])
Second U.S. Judge Blocks Trump Administration Birth Control Rules
"U.S. District Judge Wendy Beetlestone in Philadelphia issued a nationwide injunction preventing the rules from taking effect, a day after another judge issued a more limited ruling blocking their enforcement in 13 states and the District of Columbia. The rules would let businesses or nonprofits lodge religious or moral objections to obtain exemptions from the Obamacare mandate that employers provide contraceptive coverage in health insurance with no copayment." [Pennsylvania v. HHS, No. 17-4540 (E.D. Penn. Jan. 14, 2019)] (Reuters)
ACOs Should Plan for Shorter Path to Greater Risk in CMS' Overhauled Medicare Shared Savings Program
"In an analysis of Medicare data for 560 [Medicare Shared Savings Program (MSSP)] ACOs to estimate where they would fall in CMS' new two-prong model, two out of three ACOs had the shorter window before they would be expected to take on greater risk." (FierceHealthcare)
Judge Freezes Trump Administration Contraception Rule
"U.S. District Judge Haywood Gilliam, Jr. ruled the policy would cause harm to the Democratic states suing over the rules, and he issued an order staying the rules from going into effect while the lawsuit proceeds. His temporary block is limited to just the 13 states plus the District of Columbia involved in the lawsuit. However it's possible that a court in Pennsylvania, considering a similar request for an injunction, could issue a broader national order." [California v. Azar, No. 17-5783 (N.D. Cal. Jan. 13, 2019)] (Politico)
[Opinion] Public Retirees Being Shifted to Private Insurance Exchanges
"Instead of paying a 70 percent premium subsidy towards the government-sponsored health plan, Memphis is paying into the HRAs an amount that reduces their post-employment benefit obligation by $300 million, a savings for Memphis of 42 percent! That's great for their city budget, but what does that do for the retirees?" (Physicians for a National Health Program [PNHP])
Democrats Roll Out Big Health Care Proposals in the States
"The Democratic proposals fall short of providing universal health care, a goal of many Democrats but also an elusive one because of its cost. In recent years, California, Colorado and Vermont have all considered and then abandoned attempts to create state-run health care systems. Still, many Democrats are eager to take steps that get them closer to that." (ABC News)
CMS Releases 2016 Public Use File for the Medicare Current Beneficiary Survey (MCBS)
"The MCBS 2016 public use file (MCBS PUF) provides a publicly available MCBS file for researchers interested in the health, health care use, access to and satisfaction with care for Medicare beneficiaries, while providing the very highest degree of protection to the Medicare beneficiaries' protected health information.... The MCBS PUF is prepared from data collected in 2016 from 12,852 community dwelling Medicare beneficiaries representing a population of 53 million and contains standard demographic variables, such as age categories, race/ethnicity and gender, as well as information about health conditions, access to and satisfaction with care, type of insurance coverage, and information on utilization, such as the number of fee-for-service claims per beneficiary for certain health care event types." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
The State of Employee Benefits: Findings From the 2018 Health and Workplace Benefits Survey
"Despite a tight labor market, fewer employees report that their employers are offering benefits: Health insurance remains the most frequently offered at 78 percent, followed by dental insurance at 68 percent and retirement savings plans at 67 percent.... [F]ewer workers received benefits from their employers in 2018 compared to 2017.... The percentage of employees accessing voluntary benefits is only 12 percent. Of that, 61 percent say they do so because it is less expensive to buy it through their employer than on their own -- more than the 51 percent who cited this reason in 2017." (Employee Benefit Research Institute [EBRI])
Is Health Club Membership an ERISA Benefit?
"In relatively rare situations, membership in a health club or access to an on-site fitness center may be offered to employees as part of an arrangement, such as a disease-management program, that includes diagnostic, therapeutic, or preventive care or "coaching" for specific health conditions or risks. This type of health club arrangement may be considered to provide a medical benefit, potentially making it subject to ERISA and applicable group health plan rules either on its own or as an element of a larger plan, depending on how the arrangement is structured." (Thomson Reuters / EBIA)
Health Care in 2019: Five Key Trends to Watch
"Not only will the push to value-based care continue, it will accelerate.... 2019 will likely be the year where physicians more actively participate in these programs.... More than half [of consumers surveyed] expressed a willingness to receive care in a non-traditional setting if the care was less costly and more convenient.... [M]any health systems have embarked on integration efforts of their own to expand their networks, often across a broad geographic area ... [T]echnology is bringing profound change to the health care experience." (Health Affairs)
[Guidance Overview] Is the Proposed Expansion of Health Reimbursement Arrangements a Game Changer for Employers?
"The proposed regulations may be especially useful for small and medium-sized companies that want to be able to define the costs that they are willing to pay towards employee health insurance coverage by using HRAs with a fixed annual employer contribution and that have a small enough workforce to satisfy some of the consistency requirements of the proposed regulations." (Epstein Becker Green)
[Opinion] Not Your Grandmother's Risk Adjustment
"Developing an equitable risk-adjustment model in the ACA realm is a challenging endeavor, as is projecting a relative risk score for a participating health plan. This is primarily due to the dynamic population, the multitude of factors in the transfer formula and the budget neutrality requirement that necessitates the average risk being determined prospectively by the enrolling population." (The Actuary Magazine)
EEOC Removes Incentive Rules Under ADA and GINA
"[T]he rules being removed only apply under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). The separate rules under [HIPAA] continue to apply. The EEOC is now saying that new proposed rules on incentives under the ADA and GINA will not be released until June 2019, at the earliest. Even that date could shift." (HUB International)
Outlook 'Stable' for Health Insurers in 2019 Despite ACA Uncertainty
"A robust job market bolstering employer-sponsored plans, Baby Boomers transitioning to Medicare Advantage, and ACA exchanges attracting new payers are good signs for health plans in the coming year." (HealthLeaders Media)
A Brief Comparison of MEWA and AHP Requirements
"Both MEWAs and AHPs may be considered ERISA plans but it is not a given.... Though the primary purpose of an AHP can be providing health care coverage, the AHP must also have a viable business purpose. MEWAs are not held to the same group/association standard.... A MEWA is also not held to any commonality of interest standards. While AHP members do need to have someone in common, the new DOL regulations offer more flexibility." (Hall Benefits Law)
[Opinion] Can The Market Deliver Affordable Health Insurance Options In Rural Areas?
"Policies that would encourage or require states to consolidate rating areas would expand the size of risk pools (including statewide risk pools), helping insurers spread risks across a greater number of people and perhaps discouraging insurers from exiting rating areas with small populations.... State insurance commissioners could consider requiring plans to offer insurance across an entire rating area if the plan is offered anywhere in a rating area, essentially requiring that rating areas and service areas align." (Health Affairs)
New York City Launches $100 Million Universal Health Insurance Program
"New York City has launched a $100 million health insurance program to cover 600,000 uninsured residents, including those unable to afford coverage and those living in the United States illegally ... The NYC Care plan, which de Blasio said would be funded without tax increases, is an expansion of the city's existing MetroPlus plan that covers hospital bills for low-income residents. The new plan provides insurance for visits to doctors outside of hospitals." (Reuters)
Millennials Prefer On-demand Healthcare to Primary Care
"45% of 18- to 29-year-olds say they don't have a primary care physician. Instead, they're opting for on-demand healthcare.... For employers, it's important to understand the reasons behind the shift to on-demand healthcare and educate employees to ensure they can get appropriate medical attention when they need it." (Corporate Synergies)
Will More Services Under One Roof Boost Telehealth Utilization?
"As major players like Teladoc Health continue to scoop up smaller telehealth fish, the ultimate beneficiaries may be employer-sponsored health plan members. Integrated telehealth platforms will, in theory, provide easier access to a wider range of telehealth services and, as a result, lead to increased usage of such benefits." (BenefitsPro)
New State Laws Require More Preventive Services From Insurers
"A bevy of new state laws pertaining to health insurers took effect Jan. 1. It all adds up to a year of potentially higher costs for plans, with some states entering 2019 by protecting various [ACA] provisions by statute -- and even more of them eying how to take advantage of the ACA's state innovation waivers as the year progresses." (AISHealth)
Democrat States, DOJ Appeal Texas ACA Case to Fifth Circuit
"[T]he case is expected to live or die based on what the Fifth Circuit, and ultimately the Supreme Court, decide on the constitutionality of the mandate and severability. This likely makes the House's motion to intervene in the district court case largely symbolic ... In any event, this part of the lawsuit is stayed until after the appeal on the first claim and will not be at issue until at least 2020." (Katie Keith, in Health Affairs)
Digital Health Promises Remain Unfulfilled for High-Need, High-Cost Populations
"[Of] the studies conducted on digital health products and services, most enrolled healthy volunteers. Few enrolled high-burden, high-cost patients ... Healthy volunteers made up 32% of the studies, followed by patients with amyotrophic lateral sclerosis (14%) and those with multiple sclerosis 12%. Mental health was the most common high-burden condition category studied ... There were no studies for lung cancer or smoking." (American Journal of Managed Care)
[Guidance Overview] CMS Finalizes Proposed Redesign to Medicare Shared Savings Program
"Low-revenue ACOs are permitted to stay in one-sided risk-sharing models for a longer period ... Any ACO determined to be experienced with Risk Models however, is required to take on risk immediately.... CMS is also cutting the shared savings rate that will be available for ACOs until they enter a Risk Model.... CMS finalized modifications to its calculation of the regional adjustment to an ACO's performance benchmark[.]" (K&L Gates)
[Guidance Overview] 'Pathways to Success' Update: CMS Issues Final Rule on Changes to the ACO Program
"On December 21, 2018, CMS issued the final rule for the redesign of the [Medicare Shared Savings Program (MSSP) which] includes the following: [1] Greater savings for one-sided risk models.... [2] Qualification as a low revenue ACO.... [3] Additional year of one-sided risk for new low revenue ACOs.... [4] High revenue ACO participation in BASIC Track Level E.... [5] Repayment mechanism for two-sided risk.... [6] Benchmarking methodology." (Sheppard Mullin)
How Well Do Employees Understand and Engage with Their Health Accounts?
"Even the most financially literate employees struggle to understand the value of and differences between health accounts. While encouraging long-term saving to HSAs is important, employers cannot lose sight of the fact that HSAs are largely used as a spending account by most employees. Employees look to account providers for excellent customer service, enhanced decision support, personalized online tools and other services to help them better understand and use their health accounts." (Willis Towers Watson)
Two Hundred Years of Health and Medical Care: The Importance of Medical Care for Life Expectancy Gains
"There is a stronger case that personal medicine affected health in the second half of the twentieth century than in the preceding 150 years.... [The authors] consider whether medical care productivity decreases over time, and find that spending increased faster than life expectancy, although the ratio stabilized in the past two decades." (National Bureau of Economic Research [NBER])
[Opinion] Why a 'Passive' Health Approach Can Produce the Most Action
"A $100 billion dollar health care package was proposed by congressional Republicans this past summer, and afterward endorsed by some Democrats. It aims to save money by encouraging you to make big life changes. But the package will probably fail to achieve its goals for a simple reason: scarcity. Chances are you don't have the time, money or bandwidth to follow through." (The New York Times; subscription may be required)
Texas v. U.S. ACA Decision Could Impact Employer-Sponsored Health Plans
"Given the District Court's decision to stay the ruling, it is unlikely that consumers, insurers or employers will see changes to the ACA in the short term. The entry of a final judgment on December 30 paves the way for reconsideration by the U.S. Court of Appeals for the Fifth Circuit. However, during the pendency of any appeals, the future of the ACA remains uncertain not only for the public, but also for employer-sponsored plans that are subject to the ACA's group health plan provisions." [Texas v. U.S., No. 18-167 (N.D. Tex. Dec. 14, 2018; order granting stay and partial final judgment filed Dec. 30, 2018)] (Eversheds Sutherland)
Workers with High Deductibles Curb Health Care Spending
"Those enrolled in plans with deductibles of at least $1,350 for self only and $2,700 for families were more likely to take costs into account when making health care decisions ... HDHP enrollees also were more likely to take preventive measures to preserve health, including enrolling in wellness programs." (Society for Human Resource Management [SHRM])
Texas Ruling Invalidating ACA Is Appealed to the Fifth Circuit; U.S. House Moves to Intervene
"The plaintiffs -- Republican attorneys general from 19 states, the Governor of Maine, and two individual plaintiffs from Texas -- sought a declaration (in Count I of their amended complaint) that the ACA's individual mandate was no longer constitutional because it no longer triggers a tax.... [T]he U.S. House of Representatives, under Democratic control as of January 3, submitted a motion to intervene in the litigation -- as to the plaintiffs' claims other than Count I.... The House acknowledged, however, that it cannot intervene as to Count I, because the intervenor states' notice of appeal to the Fifth Circuit means the district court can no longer grant intervention concerning Count I." (Thomson Reuters Practical Law)
How Employers Are Controlling Health Care Costs
"[E]mployers are focusing on a short list of top priorities: [1] Concentrating on clinical conditions to reduce high-cost claims ... [2] Improving management of pharmacy costs ... [3] Encouraging greater use of high-performance networks, centers of excellence and telemedicine ... [4] Considering the addition of low-point-of-care cost plans as an option ... [5] Improving employee total wellbeing ... and connecting these efforts to corporate culture and the employee value proposition (EVP)." (Willis Towers Watson)
Activating Employees in Discussions of Health Care Trade-Offs: It Can Be Done
"[E]mployers must also consider trade-offs pertaining to which health care products and services their employer-sponsored health benefits will cover -- but notably, these decisions are often made with little or no input from employees. [A] recent case study ... explored how an employer could engage employees in an open and constructive dialogue related to both the population level and coverage-level trade-offs that must be considered when designing an organization's health care benefit." (Health Affairs)
States Appeal ACA Ruling to Fifth Circuit
"A growing coalition of Democratic state attorneys general that stepped in to defend the [ACA] against a legal challenge filed an appeal Thursday ... Colorado is the 17th state to join the California-led coalition ... Nevada ... is expected to join the ... coalition with backing from the incoming Democratic governor ... Democrats elected as attorneys general in Michigan and Wisconsin could be limited in their ability to join the lawsuit, due to actions by Republican-controlled legislatures in each state." (HealthLeaders Media)
Taking the Pulse of New Association Health Plans
"States have reacted to the final rule in dramatically divergent ways. Some states believe that AHPs will make it finally possible for small employers to offer affordable healthcare options for their employees. Other states worry that AHPs will destabilize the individual insurance marketplace. They predict that healthy people will join AHPs because they are less expensive than other insurance options, and this shift will leave sicker people in a smaller pool with higher premiums." (Crowell & Moring LLP)
ACA Litigation Round-Up: CSRs, Risk Adjustment, AHPs, and Short-Term Plans
"January 2019 ... will bring at least two hearings over whether insurers are entitled to unpaid reimbursements for the cost-sharing reductions they are required to provide lower-income Marketplace enrollees under the ACA, as well as a hearing on the multi-state challenge to the Trump administration's rule on association health plans. The federal government will appeal a challenge to its risk adjustment methodology to the Tenth Circuit Court of Appeals, and it received a temporary stay in litigation over the final rule on short-term plans (where a hearing is currently scheduled for February)." (Katie Keith, in Health Affairs)
2015 Medicare Current Beneficiary Survey Annual Chartbook and Slides
The MCBS 2015 Chart Book is now updated to include two new sections with information on the use and cost of health care services reported by survey beneficiaries. This release will supplement the information in Version 1 of the MCBS 2015 Chart Book which included information on beneficiaries' satisfaction with care, usual source of care, functional status, and health and well-being. (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] American Benefits Council Comment Letter to IRS on Proposed Regs for HRAs and Other Account-Based Group Health Plans
16 pages. "We support the Proposed Rule's goal of expanding the availability of HRAs and permitting their use in combination with policies purchased on the individual insurance market and welcome the increased flexibility it provides for both employees and employers.... In order for the Proposed Rule to achieve its goals, it is vital that the individual market be stable and well-functioning, otherwise, employers will be unwilling to utilize this expanded flexibility." (American Benefits Council)
Judge OKs CVS Plan to Keep Aetna Separate Pending Review
"CVS said it is currently operating Aetna's health insurance business separately from CVS's retail pharmacy and PBM business units, with Aetna maintaining control over pricing and product offerings. Aetna personnel will also retain their current compensation and benefits, and CVS will maintain a firewall to prevent the exchange of competitively sensitive information between the two companies." (AISHealth)
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