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[Guidance Overview]
EEOC Issues Final Regulations on Workplace Wellness Programs
"With respect to meeting the final regulations' confidentiality requirements, employers are advised to take the following action steps: [1] Adopt and communicate clear confidentiality policies. [2] Train employees who handle confidential information. [3] Encrypt health information. [4] Provide prompt notification to employees (and family members) if a breach occurs."
(The Wagner Law Group)
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[Guidance Overview]
Workplace Wellness Programs: Their Characteristics and Requirements
"Questions remaining to be answered about the future impact of these rules include: Will expanding permitted use of financial incentives in participatory wellness programs promote the use of health-contingent wellness programs? ... Will expanding permitted use of financial incentives in all workplace wellness programs change information collection practices by workplace wellness programs?"
(Henry J. Kaiser Family Foundation)
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When Might a TPA Be Liable for COBRA Penalties?
"Generally, a third-party administrator (TPA) will not be directly liable for statutory COBRA penalties unless the TPA is designated by a plan as its plan administrator. But, depending on the circumstances, [a TPA] might have excise tax, contractual, or other liability."
(Thomson Reuters / EBIA)
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Ensuring Access to Quality Behavioral Health Care: Health Plan Examples (PDF)
28 pages. "Beyond meeting the parity requirements of MHPAEA, health plans have demonstrated strong leadership in pioneering innovative programs to meet the health care needs of patients with mental health and substance use disorders, often through partnerships with behavioral health care organizations."
(America's Health Insurance Plans [AHIP])
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HHS Sued Over Out-of-Network Emergency Room Reimbursement Policy
"The American College of Emergency Physicians [ACEP] is asking the U.S. District Court in Washington D.C. to overturn a rule adopted by [HHS] ... The plaintiffs allege that the rule does not meet the standards required by the [ACA] for transparency of data and fair insurance coverage for emergency patients who are 'out of network' because of a medical emergency.... ACEP says the final rule allows insurance companies to arbitrarily set their own rates and shift costs to patients. The new rule says 'minimum standards of payment are not necessary' in states that have banned balance billing."
(HealthLeaders Media)
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Paying for Value: Progress and Obstacles (PDF)
"For the most part, ... programs that combine quality measures and incentives for cost control and prudent resource use -- paying for value -- have not been in operation long enough to measure their effectiveness. Experimentation is increasing through approaches such as shared savings and bundled payment, but many questions remain about how best to define and measure value."
(AcademyHealth)
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Evaluating the CARE Act: Implications of a Proposal to Repeal and Replace the ACA
"[The Patient Choice, Affordability, Responsibility, and Empowerment (CARE)] Act addresses many of the criticisms of the ACA raised by those wishing to repeal and replace the law, including capping federal Medicaid funding allotments, providing premium-support subsidies for low-income individuals, and relaxing health insurance rating regulations to allow age variation in premiums along the lines of variation in spending. The CARE Act would also eliminate the individual and employer mandates. To incentivize people to obtain health insurance, the CARE Act imposes a 'continuous coverage' provision that would allow insurers to charge higher premiums or deny coverage to individuals who have not remained continuously enrolled."
(The Commonwealth Fund)
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House Subcommittee Hearing: Is There a Better Way Than the ACA?
"Lawmakers considered health care reforms to improve pre-existing condition protections, lower patient costs, and encourage plan innovation at a hearing held by the House Committee on Energy and Commerce, Subcommittee on Health. The hearing included testimony from health reform experts on the ways the [ACA] has aided or hindered the advancement of health care and experts offered recommendations for how the health reform law can be advanced or altered to improve the industry."
(Wolters Kluwer Law & Business)
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Benefits in General
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Second Circuit Applies Stricter Rules for a Plan Administrator's Noncompliance with Benefit Claims Regulations
"The Second Circuit held that, under [ERISA]: [1] When denying a claim for benefits, a plan administrator's failure to comply with the [DOL] claims procedure regulations ... will result in the plan administrator's claim determination receiving no deference on review in federal court, unless the plan's claims procedures fully conform to regulatory requirements and the plan administrator can establish that any failure was inadvertent and harmless; ... and [2] A plan administrator's failure to comply with the DOL's claims procedure regulations could warrant the introduction of additional evidence outside the administrative record if the claim determination is challenged in litigation." [Halo v. Yale Health Plan,
No. 14-4055 (2d Cir. Apr. 12, 2016)]
(McDermott Will & Emery)
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David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager
BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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