Health & Welfare Plans Newsletter

December 27, 2016

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[Official Guidance]

Text of CMS Manual for Reconciliation of the Cost-Sharing Reduction Component of Advance Payments for 2016 Benefit Year (PDF)
48 pages. "The manual provides information on the process for reconciling the cost-sharing reduction component of the advance payments that QHP issuers have been paid to reflect the cost-sharing reduction amounts those issuers provided to eligible Marketplace enrollees. The manual also provides QHP issuers with general instructions on using the standard, simplified, and actuarial value methodologies ... for the purpose of determining the value of cost-sharing reduction amounts provided to eligible Marketplace enrollees, and describes the data elements issuers are required to submit when the annual cost-sharing reduction reconciliation process begins in April 2017."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS FAQ on Compliance Safe Harbor for Issuers Affected by Extension of the Enrollment Deadline to December 19, 2016 (PDF)
Unnumbered document, dated Dec. 23, 2016. "The extension of the HealthCare.gov enrollment deadline to December 19, 2016, for coverage effective January 1, 2017, may have presented additional temporary operational challenges that have prevented QHP issuers participating in the FFMs from complying with certain FFM standards. To address this concern and recognize reasonable issuer efforts, CMS is extending the compliance safe harbor to cover issues attributable to any substantial increase in enrollment as a result of the December 19, 2016, extension."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

How COBRA Intersects with Medicare and Retiree Health Plans
"If an employer offers retiree health coverage that is a non-COBRA alternative to COBRA coverage for eligible retirees, then the retirees are still considered 'covered employees' for COBRA purposes. Furthermore, the Medicare statutory rules allow employer-sponsored group health plans to reduce or terminate coverage if retired employees become entitled to Medicare. Thus, if a covered retiree becomes entitled to Medicare, and that entitlement would cause a loss of coverage for his or her spouse and dependents under the terms of the employer's retiree coverage, then a qualifying event has occurred."
HR Daily Advisor

Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model That Harms Patients, Taxpayers, and the U.S. Health Care System (PDF)
131 pages. "[A] bipartisan Senate Special Committee on Aging investigation of abrupt and dramatic price increases in prescription drugs whose patents had expired long ago ... centered on ... [four] companies that acquired decades-old, off-patent affordable drugs and then raised the prices suddenly and astronomically.... This Report closely examines the business model used by these companies; provides case studies of the four companies; explores the influence of investors; assesses the impacts of price hikes on patients, payers, providers, hospitals, and governments; and discusses potential policy responses."
Special Committee on Aging, U.S. Senate

Spending on U.S. Health Care, 1996-2013
"From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion ... in spending, including 57.6% ... spent on pharmaceuticals and 23.5% ... spent on ambulatory care.... Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion ... spending on emergency care and retail pharmaceuticals increased at the fastest rates[.]"
The JAMA Network

Employees Show Interest in Student Loan Repayment Benefit
"87.7% of respondents believe employer-sponsored student loan contribution programs are significant. Furthermore, nearly two-thirds (65.4%) reported difficulty in paying student loan debt, and nearly one-third (32.4%) lack the confidence to complete payments."
planadviser

Failure to Notify Worker That Proper Medical Release Needed to Return to Work Was FMLA Interference
"[B]ecause the hospital undisputedly failed to advise him that his failure to provide a release would result in denial of job restoration, it interfered with his FMLA rights as a matter of law. It was irrelevant whether this failure was due to its mistaken belief that his leave was not covered by the FMLA since it had a duty to make a correct FMLA-eligibility determination and to notify him of its requirements and consequences for failing to meet them." [Casagrande v. OhioHealth Corp., No. 15-3292 (6th Cir. Dec. 20, 2016; unpub.)]
Wolters Kluwer Law & Business

Use of PTO Plans Continues to Increase
"[E]mployers report that many employees do not use all of the days available to them: 44 percent report that their employees take less than 80 percent of their allotted PTO time. And for the growing number of employees who work remotely, time off may not truly be time away from work.... While for most employers, disability benefits are still the only official company-sponsored paid leave for new moms that are provided, 24 percent of employers provide paid parental leave for bonding to the birth parent. In addition, 25 percent of employers reported providing a paid parental leave benefit to the non-birth parent."
Wolters Kluwer Law & Business

DC Council Approves Generous Paid Family and Medical Leave Measure
"The measure would provide private-sector employees, and self-employed individuals who opt in, with up to six weeks of family medical leave, eight weeks of parental leave, and two weeks of qualifying personal medical leave within a 52-work-week period."
Wolters Kluwer Law & Business

ACA Repeal Proposals Could Jeopardize Crucial Funding for Coverage
"The GOP, in the partial repeal bill that passed in January and was vetoed by President Barack Obama, proposed to cancel the tax increases in the health law, as well as the health premium subsidies and Medicaid expansion.... Because the benefits that would be repealed cost more than the revenue being lost through the repeal of the taxes, the result would have been net savings to the federal government -- to the tune of about $317.5 billion over 10 years, said CBO.... If Republicans follow that playbook again, their plans for replacement could be hampered because they will still lose access to tax revenues. That means they cannot fund equivalent benefits unless they find some other source of revenue."
Healthcare Finance News

Press Releases

DOL Lawsuit Seeks Funds Owed to Retirement Plan of Maryland Company
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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