Health & Welfare Plans Newsletter

September 19, 2017

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[Official Guidance]

Text of CMS Memo: Creation of the 2018 Benefit Year HHS-Operated Risk Adjustment Adult Models -- Draft Prescription Drug (RXCUIs) to HHS Drug Classes (RXCs) Crosswalk (PDF)
11 pages. "The 2018 benefit year HHS-operated risk adjustment adult models include twelve drug classes, or RXCs, in addition to age-sex, enrollment duration, and diagnostic categories or hierarchical condition categories (HCCs). This memo describes the criteria used to create the RXCs finalized in the 2018 benefit year Payment Notice final rule, including how CMS determined the inclusion criteria for the underlying drugs. This memo accompanies a draft crosswalk for classifying drugs into RXCs for 2018 benefit year risk adjustment for which the underlying drugs will be updated for 2018 benefit year risk adjustment operations based on more current data."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Health Benefits While on Leave: The Rules All Employers Need to Know (PDF)
40 presentation slides. Topics include: [1] What rules apply to maintaining health benefit coverage during a protected leave? [2] When can coverage terminate during a protected leave? [3] How are benefits restored upon return from a protected leave? [4] How does COBRA apply where an employee fails to return from a leave? [5] What happens to health coverage during a non-protected leave? [6] How can company leave policies be more generous with health benefits than the legal requirements without creating carrier issues? [7] What about ACA pay or play issues? [8] What about ADA issues?
ABD Insurance & Financial Services

[Guidance Overview]

ACA Information Returns (AIR) Working Group Meeting (PDF)
Sept. 19, 2017; 36 presentation slides. Topics include: [1] Tax year (TY) 2017 AIR schemas, business rules and crosswalks; [2] Guidelines for software development; [3] TY 2017/FS2018 AATS testing; [4] Filing season 2017 recent error trends; [5] Filing season 2017 new functionality and changes; [6] General information for electronic information returns; [7] Software developer actions for TY 2017.
Internal Revenue Service [IRS]

Annual Notice Requirements for Employer-Sponsored Health Plans for 2018
"The annual open enrollment period is a convenient time for employers to satisfy their annual participant notice obligations. To aid employers with this process, here is a summary of these annual participant notice requirements[.]"
Miller Johnson

What's in the Cassidy-Graham Health Care Bill
"The proposal ... essentially turns control of the health-care markets over to the states. Rather than funding Medicaid and subsidies directly, that money would be put into a block grant that a state could use to develop any health-care system it wants. It also allows states to opt out of many ACA regulations.... [A chart compares the provisions of this proposal with ACA and the prior Senate proposal.] Who would need to be covered ... How they would pay for coverage ... Proposed changes to Medicaid ... Other key elements of the plans."
The Washington Post; subscription required

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How to Navigate the Unlimited Vacation Landscape
"While this may seem like a dream come true for employees, it has employers scratching their heads wondering how this benefit works logistically. The concern is whether or not employees will abuse the privilege and if it brings tangible benefits to the employer.... Here are some suggestions to help you navigate the world of unlimited vacation."
PayScale

Prescription Drug Spending in U.S. Among Highest Worldwide
"Generic drugs make up 84 percent of the total U.S. pharmaceutical market, which is a larger share than in all other countries, excluding the U.K., which is tied with the U.S. with 84 percent. Followed by the U.S. are Germany with 81 percent, Netherlands with 71 percent and Canada with 70 percent of the share of generic prescription drugs. Lower prescription drug prices in the other countries reflect more centralized processes for obtaining pharmaceuticals and setting coverage."
Wolters Kluwer Law & Business

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2016 (PDF)
32 pages. "Enrollment in high-deductible, HSA-eligible health plans was estimated to be between 20.2-22.6 million policyholders and their dependents, and covered nearly 3 in 10 employees in 2016.... [T]here were an estimated 20 million HSAs as of the end of 2016.... Over 90 percent of HSAs with individual or employer contributions in 2016 ended the year with funds to roll over for future expenses. As of the end of 2016, the average HSA balance among account holders with individual or employer contributions in 2016 was $2,532, up from $1,604 at the beginning of the year."
Employee Benefit Research Institute [EBRI]

Private Insurer Steps Up to Advertise Open Enrollment for Obamacare
"Open enrollment for [ACA] insurance doesn't start for another six weeks. But the quirky insurance startup Oscar Health ... is boosting its ad spending after the Trump administration announced it would slash its ACA advertising budget by 90 percent. On Monday morning, commuters in New York City were met with posters blanketing the subway system that showed actual Oscar customers touting the benefits of having insurance coverage."
National Public Radio

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What We Talk About When We Talk About Single Payer
"If you were to look up definitions for single-payer health care, you will get some variations on a theme. In general, these are the most common features: [1] Comprehensive universal coverage ... [2] Funding for that core set of services comes from a single public fund. [3] That single public fund is typically generated through taxation. [4] The single payer administers the program by paying providers for health care services from that single public fund. [5] The single-payer entity may be the federal government, the state, a province, or even a quasi-governmental agency. There are some additional features that vary across several single-payer systems[.]"
Signe Peterson Flieger, via Health Affairs

[Opinion]

AHIP Statement on Single Payer Proposals
"The most effective way to ensure affordable care and coverage is to strengthen the private market's ability to serve the American people, whether it's building upon private plans serving nearly 180 million people who get their coverage through their employer or the tens of millions who depend on private plans that partner with public programs.... [G]overnment-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation, and place an even heavier burden on hardworking taxpayers."
America's Health Insurance Plans [AHIP]

[Opinion]

The Love-Hate Relationship with HDHP-HSAs
"The complexities of our often-dysfunctional healthcare system need not victimize the patient if employers support these 'consumer-driven' health plans (CDHPs) with key investments -- in education, cost and quality decision-support tools, and advocacy to help with navigating the confusing system. Without correlating resources, poorly managed plans are nothing more than a cost shift, with the lowest socioeconomic groups too often paying the highest price in insufficient or inappropriate care[.]"
Conduent

Benefits in General

[Guidance Overview]

More Hurricane Relief and Expansion of DOL Relief for Irma Victims
"Leave donation program was extended [by IRS] to assist victims of Hurricane Irma ... [The DOL] extended the Harvey guidance to victims of Hurricane Irma ... Deposit of payroll deductions ... Blackout notice requirement relief ... ERISA plan claim procedure deadlines and COBRA election deadlines."
Winstead PC

Executive Compensation
and Nonqualified Plans

Support for Say-on-Pay Remains Strong
"Average support for say-on-pay resolutions reached 91% during this just completed proxy season, up slightly from 90% in 2016, with an accompanying decline in the failure rate to 1% from last year's 2%. In fact, 93% of companies received more than 70% support in 2017 for their say-on-pay resolutions."
Willis Towers Watson

Discussions
on the BenefitsLink Message Boards

The Buzz Over Student Loan Repayment Programs
"A lot of recordkeepers are starting to talk about Student Loan Repayment Programs. Clients seem to get excited about them but I can't figure out what they do/how they work."
BenefitsLink Message Boards

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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