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IRS Releases Early Drafts of ACA Employer Reporting Forms and Instructions

"These draft instructions and forms reflect only minor changes, such as a few formatting modifications and the reflection of indexed penalty amounts for reporting failures. Additionally, the draft instructions for Forms 1094-B and 1095-B also now state that health insurance issuers and carriers are encouraged (but not required) to report coverage in catastrophic health plans enrolled in through the Marketplace for months in 2018."
Fraser Trebilcock

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Behind Your Rising Health Care Bills: Secret Hospital Deals That Squelch Competition

"Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost."
The Wall Street Journal; subscription may be required

FMLA-Related Updates from the DOL: New Opinion Letters and (Kind of) New Forms

"[T]he DOL addressed the question of whether leave resulting from organ donation, including post-operative treatment, could qualify for FMLA leave. The brief answer: Yes ... [T]he reason for the organ donation -- e.g., the fact that the organ donor is in good health before the donation or chooses to donate the organ solely to improve someone else's health -- played no bearing in the DOL's response."
Bryan Cave Leighton Paisner LLP

New York Prepares to Expand Paid Family Leave

"While the majority of private sector employers in New York currently allow employees to use personal time off to grieve, such time off is generally limited to a few days and is not always paid. This amendment would create a significant expansion, allowing workers to take up to 10 weeks of leave in 2020 and up to 12 weeks of leave in 2021 to grieve following the death of a family member."
Foley & Lardner LLP

Parental Leave Benefits Are Under Scrutiny -- Be Sure Yours Don't Discriminate!

"[I]n July 2018, the [EEOC] settled a massive class action lawsuit against a national employer for $1.1 million over disparate parental leave practices.... [T]he EEOC argued that providing longer leave time for 'primary caregivers' than for 'secondary caregivers,' and allowing different return-to-work policies, amounted to sex discrimination ... [S]tate law claims alleging sex, sexual orientation, and familial discrimination are conceivable for adoptive and same-sex parents who do not have a naturally born child."
Foley & Lardner LLP

Sixth Circuit: Pecuniary Loss Not Required to Establish Standing in Benefit Claim

"The Court explained that even though the ambulance service had not directly billed the plan participant, the participant's allegation that the plan breached its promise to pay all medical transportation expenses constituted an injury-in-fact sufficient to confer standing." [Springer v. Cleveland Clinic Employee Health Plan Total Care, No. 17-4181 (6th Cir. Aug. 14, 2018)]
Proskauer's ERISA Practice Center

Justice Department Approves Cigna-Express Scripts Merger

"These combinations of powerful health insurance companies with the country's dominant pharmacy benefit managers ... represent a recognition by established companies that they need to change their business model in response to customer demands that prices are better controlled.... The decision by federal antitrust officials to allow Cigna to buy Express Scripts signals an acceptance of so-called vertical mergers in which companies, although in the same broad line of business, do not directly compete."
The New York Times; subscription may be required

ACA Round-Up: New House Legislation, Litigation Over the Heath Insurance Tax

"The House of Representatives is considering legislation that would suspend the [ACA's] employer mandate as well as some of the law's other taxes. The proposal would increase the federal deficit by an estimated $58.5 billion over 10 years. In other news, a district court judge ruled that the [IRS] must repay six states for what they paid Medicaid managed care companies to account for the ACA's health insurance tax. Although the amount is disputed, the states could be owed as much as $839 million."
Katie Keith, in Health Affairs

Remarks by CMS Administrator about Burden Reduction Proposed Rule

"By 2026 one in every five dollars spent in our economy will be on healthcare.... The answer is not to ration care, or limit access. But to continue to innovate, reduce inefficiency and to drive to a system that delivers value, one that delivers high quality care and better outcomes for patients at the lowest possible cost."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Press Releases

Wagner Law Group Welcomes Attorneys Candace L. Quinn and Michael Burwick
Wagner Law Group P.C.

OneDigital Health and Benefits Southern California Office Expands Consulting Team
OneDigital Health and Benefits

Federal Court Orders Maryland Business Owner to Pay $354,175 in Restitution, Serve Prison Term for Theft from Employee Benefit Plan
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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Most Popular Items in the Previous Issue

ACA Numbers and Limits 2014-19: Reference Guide (PDF)
Kaufman & Canoles, P.C.

2019 Premium Tax Credit Quick Reference Chart (PDF)
Kaufman & Canoles, P.C.

Leading PBMs Unveil Excluded Drugs
AISHealth