Health & Welfare Plans Newsletter

March 12, 2019

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Jobs

Retirement Plan Administrator
Prime Benefits
in Phoenix MD / DC / PA / VA / Telecommute

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Wespath Benefits and Investments
in Glenview IL

Employee Benefits (ERISA) Associate
Stinson Leonard Street LLP
in Saint Paul MN

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Webcasts, Conferences

Managing the Runaway Cost of Chronic Conditions in a Self Funded Health Plan
April 24, 2019 WEBCAST
Worldwide Employee Benefits Network [WEB]

ERISA Basics National Institute
June 5, 2019 in DC
American Bar Association Joint Committee on Employee Benefits [JCEB]

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[Official Guidance]

CMS List of Enhanced Direct Enrollment Approved Partners (PDF)

"Enhanced direct enrollment ... allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker ... The Public List of third-party entities approved to use an enhanced direct enrollment pathway is provided [in this document]. This list is current as of December 13, 2018[.]" [Unnumbered document, Mar. 11, 2019]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

Overview of Section 1332 State Relief and Empowerment Waiver Concepts (PDF)

19 presentation slides. "CMS released four waiver concepts for states' use to promote more affordable, flexible health insurance coverage options through State Relief and Empowerment Waivers. CMS is providing states with these waiver concepts in an effort to spur innovation, reduce burden for states with potentially limited policy resources or legislative schedules, and to illustrate how states might take advantage of new f lexibilities provided in recently released guidance."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Amendments to New Jersey Family Leave Laws

"Beginning June 30, 2019, ... the law will become applicable to employers employing 30 or more employees. Further, employers with 30 or more employees will become subject to the non-discrimination and non-retaliation provisions of the law, as well as job reinstatement obligations once employees return from leave.... Employees eligible for Family Leave Insurance benefits ... must have worked a minimum of 20 weeks, earning $172 or more per week; or earned a minimum of $8,600 in the past 12 months prior to the leave."
CBIZ

'Telemental' Health Benefits: Traps for Employers

"The marketplace has [developed] a host of mobile applications that can ... provide users with direct access ... to health coaches and other mental health care professionals, often referred to as telemental health benefits.... If the mobile health app provides access to mental health counseling services and treatment, i.e. medical care, and those services are funded by the employer, the benefit is likely a group health plan subject to ERISA.... If properly designed, [an] EAP/telemental health benefit can be carved out of many of the legal requirements applicable to group health plans under the ACA.... Telemental health benefits also implicate HIPAA and other state privacy laws ... [E]mployers need to address certain legal issues in the licensing and services agreement with telemental health providers[.]"
Winston & Strawn LLP

Accelerating the Shift of Care to Lower Cost Settings

"The migration of care from inpatient (IP) to outpatient (OP) and ambulatory surgery center (ASC) settings ... is good news for consumers and employers as it promises to lower costs, improve access and convenience, and, if done right, deliver better outcomes. Payers who can accelerate this change can deliver better value and gain competitive advantage. But a strategic approach is needed to avoid antagonizing key stakeholders."
American Journal of Managed Care

[Advert.]

Wellness Programs: EEOC Enforcement Actions and Complying with Federal and State Laws

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Apr. 11 webinar. Review design and taxation of incentives, laws that prohibit discrimination based on health factors, and exceptions for certain wellness and supplemental plans. BenefitsLink discount.


Administration Budget Proposal Includes ACA Repeal, Medicaid Cuts In Budget

"The [ACA] would be replaced with grants that states could use to subsidize private insurance coverage, and Medicaid would be replaced with a block grant instead of the current open-ended federal commitment. Future federal spending increases would be tied to the rate of general inflation, which is lower than health care inflation."
InsuranceNewsNet.com

ACA and Medicaid Expansion Had No Effect on Labor Supply of Older Americans

"[I]nsurance coverage of Americans ages 50 through 64 increased significantly after the ACA, with the uninsured rate dropping from 16 percent in 2013 to 12 percent in 2014 and 10 percent in 2015 and 2016.... [The authors] find no changes in labor supply of older Americans either in response to subsidized marketplace coverage, which became available nationally in 2014, or in response to the expansion of Medicaid eligibility in some states but not others."
Michigan Retirement and Disability Research Center, Univ. of Michigan

[Opinion]

The Pros and Cons of Single-Payer Health Plans

"[T]his brief presents both a general picture of the most frequently mentioned single-payer proposal, and [delineates] the advantages and disadvantages of the approach without taking a position on its advisability.... The authors first make five contextual points that are critical to better understanding the debate around single-payer plans, as well as a list of pros and cons."
Urban Institute

[Opinion]

Reducing Individual Market Premiums to Expand Access to Coverage and Care (PDF)

"The individual market ... should be strengthened to make coverage more affordable while protecting those with pre-existing conditions. To achieve this, BCBSA recommends that policymakers take three critical steps: [1] Revise federal assistance to help more people afford coverage; [2] Enact policies to lower costs and remove financial barriers to accessing care. [3] Improve outreach to encourage people to obtain and maintain insurance Taken together, ... these three actions would reduce the average individual market premium by 33 percent, while enabling an additional 4.2 million people to obtain ACA coverage."
BlueCross BlueShield Association

Benefits in General

MIT 401(k) Plan Participants Not Entitled to Jury Trial of ERISA Breach of Fiduciary Duty Claims

"The court followed the 'great weight of authority' in ruling that there is no right to trial by jury in ERISA actions for breach of fiduciary duty.... The MIT decision is notable because it may seal the small crack plaintiffs made in the wall of cases rejecting a jury-trial right in ERISA fiduciary-breach cases." [Tracey v. Mass. Inst. of Tech., No. 16-11620 (D. Mass. Feb. 28, 2019)]
McDermott Will & Emery

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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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