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[Official Guidance]

CMS Issues the Proposed Payment Notice for 2020 Coverage Year

"This rule proposes regulatory and financial parameters applicable to qualified health plans (QHPs) on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. These changes proposed in the rule would further the Trump Administration's goals of lowering premiums, enhancing the consumer experience, increasing market stability, reducing regulatory burdens, and protecting taxpayers."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]


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[Guidance Overview]

CMS Announces New Model to Lower Drug Prices in Medicare Part D and Transformative Updates to Existing Model for Medicare Advantage

"Under the new model, which takes effect for the 2020 plan year, participating plans will take on greater risk for spending in the catastrophic phase of Part D, creating new incentives for plans, patients, and providers to choose drugs with lower list prices. Based on plan year performance, CMS will calculate a spending target for what governmental spending would have been without plans taking on this additional risk. Participating Part D plans will share in savings if they stay below the target but will be accountable for losses if they exceed the target. For the first time, the model also introduces a Part D rewards and incentives program to align this model with the changes to VBID, and to provide Part D plans with additional tools to control drug costs and help enrollees in choosing drugs with lower list prices."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Text of CMS Value-Based Insurance Design Model (VBID) Fact Sheet CY 2020

"For the CY 2020 VBID application period, which is open now through March 1, 2019, eligible Medicare Advantage organizations may apply to test one or more of the following new interventions: [1] Value-Based Insurance Design by Condition, Socioeconomic Status, or both ... [2] Medicare Advantage and Part D Rewards and Incentives Programs ... [3] Telehealth Networks ... [4] Wellness and Health Care Planning."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

HHS Requests Public Input on Potential Changes to HIPAA Privacy and Security Rules

"The RFI includes questions about various aspects of the privacy rule's disclosure provisions, with the goal of promoting information sharing for treatment and care coordination.... The RFI notes anecdotal evidence suggesting that some covered entities are reluctant to disclose PHI to relatives of individuals facing health crises for fear of violating HIPAA.... The RFI asks whether the requirements for Notices of Privacy Practices can be made less burdensome, whether the model notices are being used, and whether there are better ways to inform individuals of their HIPAA rights."
Thomson Reuters / EBIA

CMS Proposes Changes to ACA Premiums, Reducing Tax Credits

"CMS is proposing ... to seek to end the practice of silver loading, end automatic re-enrollment in individual exchange plans, and raise premiums by 1% ... In addition, the [2020 payment notice] proposes allowing individual, small group, and large group market health insurance issuers to allow mid-year formulary changes to encourage more use of generic drugs.... CMS also wants to raise the out-of-pocket maximum that those with employer-sponsored coverage would pay to $8200 annually, up $200. The maximum for family coverage would increase by $400."
American Journal of Managed Care

Eighth Circuit Dials Back Cross-Plan Offsetting

"The court reasoned, however, that nothing in the plan documents "even comes close" to authorizing cross-plan offsetting. The court rejected the TPA's argument that plan language giving it "broad authority" to interpret the plan authorized cross-plan offsetting. Otherwise, the court noted, it would essentially be adopting a rule under which anything not expressly prohibited by the plan is allowed." [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)]
Thomson Reuters Practical Law

2018 Year in Review: Plus What Lies Ahead in 2019 (PDF)

54 presentation slides. Topics include: [1] ACA Marches On During Appeals; [2] Appealing Employer Exchange Notices; [3] 2018 ACA Reporting Deadline Extended; [4]Insured Nondiscrimination Rules Indefinite Delay; [5] Association Health Plans; [6] Individual Policy and Excepted Benefit HRAs; [7] Tax Cuts and Jobs Act; [8] California Leave Law Updates; [9] San Francisco Ordinance Updates.
ABD Insurance & Financial Services

State Efforts to Protect Consumers from Balance Billing

"In 2017 and 2018, states continued taking steps to protect consumers. Four states -- Arizona, Maine, Minnesota, and Oregon -- created balance-billing consumer protections for the first time, and two states -- New Hampshire and New Jersey -- substantially expanded existing protections. We now classify New Hampshire, New Jersey, and Oregon as states offering comprehensive protections against balance billing. As of December 2018, 25 states have laws offering some balance-billing protection to their residents, and nine of them offer comprehensive protections."
The Commonwealth Fund

Demonstrating and Rewarding Value in Health Care

"Despite the growing interest in these programs, there are strategic and operational barriers that exist today that are preventing wide spread adoption of [value-based contracts (VBCs)]. Survey participants cited the top three barriers as collecting, linking, and analyzing the necessary patient data; gaining alignment on the contract structure; and assigning how value is measured."

Evolving the Benefit Mindset: Responding to Employee Expectations for Choice and Personalization

"70% of employees who were offered the maximum level of choice in benefits (a true flex fund plus voluntary benefits) stated they were satisfied with their benefits. However, adding decision support technology to that that same level of choice increased the number of satisfied employees by 15%. This suggests that employers can fully realize the value of choice leading to increased employee satisfaction and engagement when they provide tools to help employees understand and appreciate those choices."
Willis Towers Watson


Forget Washington -- Here's How States Can Improve Health Care

"While the State Relief and Empowerment Waivers focus on providing states with additional flexibility and relief from Obamacare, the administration has also encouraged states to request reforms to their Medicaid programs through the Section 1115 waiver demonstrations.... Some have already seized the opportunity, but many states have not and more can be done. Moreover, states should oppose initiatives to roll back or undermine efforts that bring much-needed reforms and changes to these programs."
The Heritage Foundation

Benefits in General

More Pay? Nah. Employees Prefer Benefits

"By a four-to-one margin (80 percent to 20 percent), workers would choose a job with benefits over an identical job that offered 30% more salary with no benefits ... Employed adults estimated that their benefits represented 40% of their total compensation package ... The Bureau of Labor Statistics, though, states that benefits average 31.7 percent of a compensation package."

Press Releases

Mercer's Neil Lloyd Appointed EBRI Research Committee Chair
EBRI [Employee Benefit Research Institute]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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, 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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