Health & Welfare Plans Newsletter

March 17, 2017

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District Court Bars Cigna from Recouping Self-Insured Plan Assets
"Judge Alfred V. Covello ruled in favor of surgical center defendants and against Cigna, barring Cigna from recouping self-insured plan assets based on alleged 'overpayments' which were predicated on Cigna's 'legally incorrect' interpretation of ERISA plans 'exclusionary language.' This decision offers clear guidance on critical issues such as cross-plan offsetting, Cigna's fee forgiveness protocol, SIU practices and ERISA disclosure requirements[.]" [Connecticut General Life Ins. Co. v. True View Surgery Center One, LP, No. 14-1859 (D. Conn. Mar. 8, 2017)]
AVYM Healthcare Revenue Consultants

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$89,000 Orphan Drug Gets a New Owner -- and Likely a New Price
"Marathon Pharmaceuticals' controversial $89,000-a-year drug ... is getting a new owner.... PTC Therapeutics announced plans ... to buy the Duchenne muscular dystrophy drug Emflaza from Marathon for $140 million in cash and stock. The drug's new price was not announced.... For years, many American patients have imported the generic version at a cost averaging from $1,000 to $1,600 annually. The cost typically was not covered by insurers."
Kaiser Health News

U.S. Could Drive Down Drug Prices By Exercising Patent Rights
"When the federal government -- through an agency like the National Institutes of Health -- pays for medical research that leads to an invention that can be patented, federal law gives the government a license to use that intellectual property ... as a check, to ensure that the medicines are available to the public on 'reasonable terms.' But ... the government has never used [that] authority."
National Public Radio

Putting Telehealth to Work
"90% of employers reported they will provide telehealth benefits in states where they can this year. Yet ... of the employees who had access to telehealth services in 2016, only 3% used the benefit.... Employers need a well-executed and consistent communication strategy promoting the benefit that will educate employees about the existence and process for using telehealth services and to address any barriers to utilization. This strategy will help employees' knowledge and trust in the benefits that telehealth services offer."
Grooms Benefit Solutions

Q&A on Proposed Legislation for Voluntary Employee Wellness Programs
"Regulatory clarity is needed due to a number of enforcement actions and regulatory steps taken by the [EEOC] in recent years. The EEOC's actions contradict the ACA and the rules promulgated by the Obama administration implementing the ACA. As a result, employers and employees who want to participate in these programs are caught in a regulatory Catch-22: Either follow the ACA guidelines and be in violation of the EEOC rules, or vice versa. By reaffirming the policies outlined in the ACA, H.R. 1313 will provide private-sector employers the legal certainty they need to continue offering these voluntary programs."
Committee on Education and the Workforce, U.S. House of Representatives

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CRS Report: The American Health Care Act (PDF)
18 pages. "This report includes three tables that, together, provide an overview of the AHCA provisions. Table 1 includes provisions that apply to the private health insurance market, Table 2 includes provisions that affect the Medicaid program, and Table 3 includes provisions related to public health and taxes. Each table contains a column identifying whether the AHCA provision repeals or amends an ACA-related provision." [Report R44786, Mar. 14, 2017)
Congressional Research Service [CRS]

Many Provisions in the American Health Care Act Affect Plan Sponsors (PDF)
Presented as a 7-page chart. Columns include a description of the provision, its background, its location in the AHCA, and its potential effect on plan sponsors. Provisions include the Cadillac Tax, over-the-counter medications, HSA tax, FSA limit, annual fee on health insurance providers, prescription drug fee, medical device tax, deduction for retiree prescription drug costs, remuneration paid by health insurance providers, and six more.
Eversheds Sutherland

House Panel Calls for Medicaid Work Requirement, Tax Credit Changes in Health Bill
"Three of the motions, which passed along party lines, were aimed at establishing requirements for Medicaid enrollment, while a fourth would allow more generous tax credits to help low-income people afford insurance. The motions were nonbinding recommendations that could be proposed on the House floor as amendments or incorporated into the bill, the American Health Care Act, when it goes before the Rules Committee ... The recommendations came after the committee at the outset of the meeting narrowly voted to advance the bill, 19-17[.]"
U.S. News & World Report

[Opinion]

The Economic Effects of Repealing the ACA
"[CBO] recently analyzed the effect of repealing and replacing the [ACA] on federal revenues and the uninsured. There was much hype about their conclusions that 24 million people would be added to the ranks of the uninsured (although about 14 million of those would choose not to buy insurance because they would no longer be forced to). Also, federal deficits would fall by $337 billion over 10 years. However, the CBO did not measure the economic effects of repealing some of the most burdensome aspects of Obamacare, which would create hundreds of thousands of jobs and increase Americans' personal incomes."
National Center for Policy Analysis [NCPA]

Benefits in General

State Retirement Savings Initiatives Can Enhance Retirement Security for Private Sector Workers and Offset the Cost of Medicaid (PDF)
"The result of the analysis showed a positive correlation between increased retirement savings, sufficient to remove a percentage of currently vulnerable households from the poverty rolls by the time they retire, and a reduction in Medicaid spending. [A table] shows estimated savings in Medicaid payments by states and the District of Columbia for the first 10 years after a retirement savings program is introduced. Over that period, 15 states would save more than $100 million each, with total projected savings if available in all states approaching $5 billion in the first 10 years."
Segal Consulting

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 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 those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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