Health & Welfare Plans Newsletter

February 7, 2019

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Jobs

Retirement Plan Administrator
Noble-Davis Consulting, Inc.
Telecommute

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Webcasts, Conferences

What's Up In Washington: Employee Benefits Legal and Regulatory Update
March 14, 2019 in OH
Worldwide Employee Benefits Network [WEB] - Greater Cincinnati Chapter

Annual Employee Benefits Seminar
May 2, 2019 in DC
Groom Law Group

2019 Onsite Employee Health Clinics Forum
June 27, 2019 in IL
World Conference Forum

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►See 1477 Recorded Webcasts


Discussions

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[Guidance Overview]

HHS Aims to Reduce Prescription Drug Prices Through Proposed Changes to the Anti-Kickback Statute's Safe Harbors

"HHS proposes to create a new safe harbor ... [which] would require that any reduction in price: [1] Be set in advance... [2] Not involve a rebate, unless the full value of the reduction in price is provided to the dispensing pharmacy through a 'chargeback'; and [3] Be completely reflected in the price the pharmacy charges to the beneficiary at the point of sale.... [T]his new safe harbor would exclude from protection price reductions offered to one payor but not to Medicare or Medicaid."
Vorys

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Administration Salutes Parade of Generic Drug Approvals, But Hundreds Aren't Yet on the Market

"The administration's aggressive push to approve more generics is designed to spur more competition with expensive brand-name drugs, and drive prices lower... The [FDA] has approved more than 1,600 generic drug applications since January 2017 -- about a third more than it did in the last two years of the Obama administration. But more than 700, or about 43 percent, of those generics still weren't on the market as of early January[.]"
Kaiser Health News

Editor's Pick Changes in Individual and Small Group Behavioral Health Coverage Following the Enactment of Parity Requirements

"[ASPE] assessed the degree to which behavioral health coverage and medical/surgical coverage in individual and small group plans changed after federal parity requirements in coverage took effect in 2014. The results focus on changes in scope of coverage (what conditions and services are covered) and level of coverage (quantitative restrictions, such as the co-payment and limits on visits). The findings suggest that parity legislation may have had the intended effect."
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

How Employers Can Use Employee Benefits to Address Climate Change

"[HR] professionals will need to make the case for modifications to employee benefit packages that promote environmentally conscious behavior on the part of employees.... Recruiting and retaining millennials, for whom the environment is a high priority, provides another important rationale for enhancing the employee benefit package in this manner."
Thompson Coburn

First Multistate HIPAA Data Breach Lawsuit May Signal Increased State Interest in Data Security Enforcement

"The AGs have brought their claims under HIPAA and a variety of state statutes, i.e., state data breach and unfair or deceptive trade acts and practices laws. They argue that the Company failed to protect its computer systems adequately, take steps to prevent the breach, disclose material facts to consumers, and provide timely and adequate notice[.]" [Indiana v. Med. Informatics Engineering, Inc., No. 18-969 (N.D. Ind., complaint filed Dec. 3, 2018)]
Data Matters, Sidley Austin LLP

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North Carolina: The New Frontier For Health Care Transformation

"Thanks to a convergence of public and private-sector health care leadership, ... North Carolina is now on the verge of ... a set of reforms that would create an unprecedented, accelerated shift in how health care is paid for in the state, and the way social risk factors are incorporated in health care payment and delivery systems. Over the next five years, the state is poised to make an estimated 70 percent or more of health care payments through alternative payment models."
Health Affairs

Health Care Spending in the U.S. and Taiwan

"[This article offers] some insights on health spending in the single payer health system of Taiwan as a sharp contrast to the high-spending US system, focusing on the role of prices and administrative costs in the two systems. These two factors play a central role in containing health care costs in Taiwan and help make the system economically and politically sustainable.... [I]nternational data on prices of health care services and goods [show] how the US is truly exceptional among nations in that sphere."
Tsung-Mei Cheng, in Health Affairs

CMS' ACA Guidance, Oversight Under Scrutiny

"Top Congressional Democrats [asked GAO] to determine if guidance issued by CMS in October 2018 in relation to the Section 1332 waivers states can pursue is subject to legislative oversight. Meanwhile, a report said none of the 8 states that have approval to create a work requirement for their Medicaid expansion pool of beneficiaries have plans to track whether enrollees find jobs or improve their health."
American Journal of Managed Care

Health Insurance Coverage Eight Years After the ACA

"Compared to 2010, many fewer adults are uninsured today, and the duration of coverage gaps people experience has shortened significantly.... [T]he adult uninsured rate was 12.4 percent in 2018 in this survey ... More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans."
The Commonwealth Fund

Court Upholds Denial of Insurer's Disability Benefits Due to Pre-Existing Condition

"This opinion has troubling implications. The court looked at only part of the exclusion and ignored the fact that Holzman sought advice and received treatment for facial paralysis, not cancer. The cancer was unsuspected and was thus undiagnosed and untreated until after the coverage went into effect." [Holzman v. Hartford Life & Accident Ins. Co., No. 17-11436 (D. Mass., Jan. 14, 2019)]
DeBofsky, Sherman & Casciari, P.C.

Benefits in General

ERISA and Awards of Attorney Fees: What Does 'Some Degree of Success on the Merits' Really Mean?

"[W]hat happens when the Court remands the claim for further consideration by the administrator, and on remand the claim is still denied? Is the Claimant still entitled to attorney fees, even though the remand failed to change the outcome of the claim denial? Yes." [Host v. First Unum Life Ins. Co., No. 13-11578 (D. Mass. Jan. 28, 2019)]
Lane Powell PC

Developing an Effective Strategy for Employee Retention

"[W]hen budget constraints exist, [a retention strategy] should be designed with key employees and positions in mind.... Ensure that your managers are quality managers.... Create a pay for performance culture.... Verify that your total rewards package is competitive.... Foster employee engagement.... Communicate to employees (repeatedly) the organization's value proposition."
Findley

Selected Discussions
on the BenefitsLink Message Boards

Health Plan with Classes Having Different Requirements for Eligibility?

I have a client who has a radiology practice, and offers medical benefits to all employees and radiologists, but they need to work the equivalent of 30 hours per week to be eligible for the benefits. It is only one class. They have a radiologist who's dropping to 65% working time. She is currently on medical benefits and wants to stay on. Can they create a class that would allow "radiologists only" to be eligible for benefits if they work at least 60% of the time (24 hours per week or more). I think the answer is yes, but does that in your opinion create a potential discrimination problem?
BenefitsLink Message Boards

Press Releases

PSCA Launches First Annual HSA Benchmarking Survey
PSCA [Plan Sponsor Council of America]

TRA Hires a Texas Regional Sales Consultant
The Retirement Advantage [TRA]

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Lois Baker, J.D., President  loisbaker@benefitslink.com
David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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