Health & Welfare Plans Newsletter

March 13, 2019

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Retirement Services Officer
Old Point Trust & Financial Services
in Newport News VA

Qualified Plan Consultant
Newport Group
in Lake Mary FL

Relationship Manager / Vice President
Union Bank and Trust
in Lincoln NE

Director, Product Management/Development
Ascensus
in Madison WI / Madison MN

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[Guidance Overview]

HHS Proposed Rule Could Significantly Impact Drug Manufacturers, PBMs, and Other Stakeholders

"The proposed rule ... adds a new safe harbor for point-of-sale price reductions ... [which] requires that the following criteria be met: [1] The reduced price must be set in advance with a plan sponsor under Medicare Part D, a Medicaid MCO, or the PBM acting under contract with either; [2] the sale does not involve a rebate unless the full value of the reduction in price is provided to the dispensing pharmacy through a chargeback or series of chargebacks, or is required by law; and [3] the reduction in price must be completely applied to the price of the prescription drug charged to the beneficiary at the point of sale."
Wilson Sonsini Goodrich & Rosati

[Advert.]

Register for a Free Webcast on Building Resilience

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

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UnitedHealthcare Will Expand a Drug Discount Program Aimed at Lowering Consumer Costs

"UnitedHealthcare said Tuesday that it will expand a program that passes drug discounts directly to consumers ... United said the plan would take effect next year and would be required for all new employer clients, although existing clients would be permitted to continue under the older system."
The New York Times; subscription may be required

Time Limit for Appeal Started Upon Notice of Termination of LTD Benefits

"The First Circuit held that a plaintiff failed to timely exhaust her administrative remedies under a long-term disability plan because the plan's 180-day time limit for submitting appeals commenced on the date the plaintiff received notice of the decision that it was going to terminate her long-term disability benefits, not the actual date her benefits were terminated.... [T]he Court rejected plaintiff's argument that the doctrine of substantial compliance and the state's notice-prejudice rule somehow excused her late-filed appeal." [Fortier v. Hartford Life & Accident Ins. Co., No. 18-1752 (1st Cir. Feb. 20, 2019)]
Proskauer's ERISA Practice Center

Paying Patients to Switch: Impact of a Rewards Program on Choice of Providers, Prices, and Utilization

"For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider's price and service. In the first twelve months of the program we found a 2.1 percent reduction in prices paid for services targeted by the rewards program. The reductions in price resulted in savings of $2.3 million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures."
Health Affairs; purchase required for full article

Is Your Company a Good Fit for Onsite Wellness?

"[1] Does your organization already have a health strategy in place? ... [2] What are your organization's goals? ... [3] Is there a culture of trust and employee engagement? ... [4] Where do employees work? ... [5] What is the size and demographic of the eligible population? ... [6] What medical services are needed? ... [7] Is your organization self-insured and looking for ways to stabilize the upward trend of medical cost? "
Marathon Health

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House Committee Hearing on Lowering the Cost of Prescription Drugs: Reducing Barriers to Market Competition

March 13 hearing. Page includes description and links to text of seven bills directed at controlling prescription drug prices, along with video of hearing, Chairman's briefing memo, and written testimony of invited witnesses.
Energy & Commerce Committee, U.S. House of Representatives

Public-Option Proposal Would $774 Billion in Hospital Revenue

"The [KNG Health] analysis projected 40.7 million would enroll in such a public option starting in 2024, and about 90 percent of enrollees would come from those who have coverage in the nongroup market or through employer-sponsored insurance (ESI).... [O]nly 5.5 million of the 29 million people currently uninsured were projected to sign up for the public option. The Medicare-X plan was projected to cut healthcare spending by $1.2 trillion (or 7 percent) over the 10-year period from 2024 to 2033. The bulk of those savings would come from $774 billion in hospital spending reductions stemming from the use of Medicare rates instead of higher commercial insurance rates."
Healthcare Financial Management Association [HFMA]

The 'Medicare for All' Continuum: A New Comparison Tool for Congressional Health Bills Illustrates the Range of Reform Ideas

"[A] closer look at recent congressional bills introduced by Democrats reveals a set of far more nuanced approaches to improving the nation's health care system than the term 'Medicare for All' suggests.... [A] new Commonwealth Fund interactive tool ... illustrates the extent to which each of these reform bills would expand the public dimensions of our health insurance system, or those aspects regulated or run by state and federal government."
The Commonwealth Fund

Cadillac Tax Repeal on the Horizon?

"Senator Martin Heinrich introduced the Middle Class Health Benefits Tax Repeal Act of 2019 [S.684] in the Senate on March 6, which has already secured 23 co-sponsors (12 Republican, 11 Democrat). Comparable legislation [H.R.748] has been pending in the House since January 2019, with similar bi-partisan support (of the 238 co-sponsors, 110 are Republicans and 128 are Democrats)."
Mayer Brown

Selected Discussions
on the BenefitsLink Message Boards

Cafeteria Plan Participant Doesn't Receive Bill Until After 'Run Out' Period

Cafeteria (section 125) plan says claims must be submitted within 45 days after end of plan year. But the provider doesn't even send bill until the end of February. Would you: [1] Pay the otherwise allowable claim, as soon as possible but within 45 days of the participant's receipt of the bill; [2] Amend the plan (retroactively?) to provide a longer run out period; [3] Deny the claim, since not received by the deadline; or [4] Do something else?
BenefitsLink Message Boards

Press Releases

Kaitlin Smith Awarded QPA Designation by ASPPA
Steidle Pension Solutions, LLC, [SPS]

Most Popular Items in the Previous Issue

Overview of Section 1332 State Relief and Empowerment Waiver Concepts (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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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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