Health & Welfare Plans Newsletter

February 20, 2019

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[Official Guidance]

Text of CMS FAQ: Medicare Periodic Data Matching (PDF)

"Who will receive a Medicare PDM notice? ... Which parts of Medicare are considered qualifying coverage? ... What are the impacts to a consumer's premium if they're dually enrolled in Medicare and Exchange coverage? Does it matter if they also get APTC? ... How is Medicare PDM changing in 2019? ... How often will the Exchange send the Medicare PDM notice? ... How can consumers avoid financial penalties if they want to enroll in Medicare Part B? ... Can a consumer appeal if they believe they're still eligible for financial assistance (i.e., APTC/CSR) or that their Exchange plan coverage was incorrectly terminated?"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Join ECFC Members in Washington DC

Sponsored by ECFC [Employers Council on Flexible Compensation]

38th ECFC Annual Conference in Washington will feature congressional speakers, in-depth briefings by the ECFC lobbying team, inside the beltway keynote speakers, regulatory agency and technical panels. Includes scheduled meetings on Capitol Hill. Join Us!


[Guidance Overview]

Why Your Group Health Plan Should Keep Its Grandfathered Status, and How to Do So

"A grandfathered group health plan is NOT subject to some of the more cumbersome requirements of the ACA.... To maintain grandfathered status, the plan must maintain records documenting the terms of the plan in connection with the coverage in effect on March 23, 2010, and any other documents necessary to verify, explain, or clarify its status as a grandfathered health plan. It must make these records available for examination on request."
ERISA Lawyer Blog

Insurance Brokers Get Paid More to Sell More, Fueling High Health Care Costs

"Human resource directors often rely on independent health insurance brokers to guide them through the thicket of costly and confusing benefit options offered by insurance companies. But what many don't fully realize is how the health insurance industry steers the process through lucrative financial incentives and commissions. Those enticements, critics say, don't reward brokers for finding their clients the most cost-effective options."
National Public Radio [NPR]

Lowering Drug Costs: New Proposed Rule Targets Drug Rebates

"Employers with self-funded plans, or who sponsor retiree plans, especially those providing plans in place of Medicare Part D for whom they receive a subsidy, should begin discussions with their PBMs to understand the potential implications to their plan and contracts. Others should monitor communications from their carriers and brokers to determine any cost shifting that may transfer over to the private market."
OneDigital Health and Benefits

Supreme Court Deals a Fatal Blow to Maryland Drug 'Price Gouging' Law

"The law, which the Maryland General Assembly passed in 2017, would have prohibited generic drug manufacturers from raising prices in a manner the state deemed 'unconscionable.' It was nullified in April 2018, when an appeals court held it was unconstitutional because it regulated commerce beyond Maryland's borders. The Supreme Court on Tuesday formally declined to hear the appeal from the state's Democratic attorney general[.]"
STAT

Administration Tried to Make It Easier for States to Waive ACA Rules: Will Any Take the Plunge?

"A discussion paper released by the administration highlights states' new waiver options, but doesn't resolve a host of difficult policy choices and operational hurdles that states must address before proceeding with an untested waiver plan. There are also serious legal questions that seem destined for the courts ... Given these issues, this year we may continue to see the type of waiver actions seen in 2018: largely nonideological efforts by states to implement programs shown to be both workable and beneficial for people and health insurance markets."
The Commonwealth Fund

New Jersey's New Paid Family Leave Law Provides Greater Benefits for Employees

"As of June 30, 2019, the definition of a covered employer would include those with 30 employees, as opposed to 50 employees, for each calendar day of 20 or more calendar workweeks. The definition of 'parent' is now expanded to include foster parents and those who became parents via a gestational carrier.... The definition of 'family member' is now expanded ... Employees are now eligible to take leave ... to care for any of the aforementioned individuals in the event of a domestic violence or sexually violent incident."
Proskauer

[Opinion]

Plan Sponsors Siding with Insurers in Hospital Network Negotiations

"We have all lived through the negotiation process of the big bad insurance company informing the public that a certain hospital's status was changing to non-participating based on the egregious demands of the hospital for higher fees upon contract renewal.... [T]he plan sponsor community is now siding with many of the insurers in these disputes, resulting in approval for carriers to be combative in their negotiations and potentially remove a hospital system from their network."
Frenkel Benefits

[Opinion]

American Academy of Actuaries Comment Letter to CMS on Proposed Notice of Benefit and Payment Parameters for 2020 (PDF)

"Comments are organized by provisions related to risk sharing, as well as on additional items the Department of Health and Human Services (HHS) specifically requested comments on such as automatic re-enrollment, cost-sharing requirements, the exchanges, silver loading, premium adjustment percentage, and treatment of brand drugs."
American Academy of Actuaries

Benefits in General

ERISA Preemption of State Slayer Statutes: Does It Matter?

"Over the last decade, courts around the country have been asked to decide whether ERISA preempts ... state laws that prohibit a murderer from collecting benefits as the beneficiary of the victim's estate or as the surviving spouse of the victim under an insurance policy or benefit plan. Courts have come down on both sides of the issue ... And some courts have decided that the question is moot because, even if the state's slayer statute is preempted, federal common law prohibits a killer from being rewarded for their crime as a beneficiary so the outcome is the same."
Verrill Dana LLP

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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 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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