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[Official Guidance]

CMS Announces HIPAA Compliance Review Program

"[CMS] is launching the Compliance Review Program to ensure compliance among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions. In April 2019, HHS will randomly select 9 HIPAA-covered entities -- a mix of health plans and clearinghouses -- for Compliance Reviews. Any health plan or clearinghouse -- not just those who work with Medicare or Medicaid -- may be selected.... [P]roviders will be able to participate in a separate pilot program on a voluntary basis."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Proposed Change to Risk Adjustment Holdback for the 2018 Benefit Year and Beyond (PDF)

"Beginning with the 2018 benefit year and beyond, there are two new aspects to the HHS-operated risk adjustment program that can be appealed: risk adjustment data validation (RADV) results and the high-cost risk pool (HCRP) transfers.... [F]or the 2018 benefit year and beyond, CMS proposes to change its holdback policy and release holdback amounts in the next applicable fiscal year without regard to any pending appeals and make any necessary post-calculation adjustments in the event an appeal is successful." [Unnumbered document, Apr. 4, 2019]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Bulletin: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or After January 1, 2020 (PDF)

"[CMS] is releasing this bulletin establishing the submission deadlines ... for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets effective on or after January 1, 2020. This bulletin also provides the dates on which CMS will provide public access to information regarding proposed rate changes and final rate changes for single risk pool coverage, as well as the deadline for States with Effective Rate Review Programs to post proposed rate increases subject to review. It also provides the CMS web address that States with an Effective Rate Review Program can use if they elect to provide public access from their website through a link to the CMS website."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Editor's Pick Section 125 Cafeteria Plans: Top Issues for Employers (PDF)

44 presentation slides. "Employees generally take for granted the fact that they can contribute to health and welfare benefits on a pre-tax basis through payroll. This is actually the product of a tangled web of cafeteria plan rules that permit employees to avoid constructive receipt -- a concept most have never considered. The election rules in Section 125 are very strict, and there is no corrections program to prevent a full loss of tax-advantaged status for failure to follow. This makes understanding and complying with the Section 125 rules more important than most appreciate[.]"
ABD Insurance & Financial Services

How Many Are Enrolled in HSA-Eligible Health Plans, and How Is It Changing? (PDF)

"Growth in HSA-eligible health plans continues, but at a slower rate than in the past. Several factors -- such as the delay in the Cadillac tax, low insurance premium increases, and low unemployment -- may be holding back growth in HSA-eligible health plan enrollments."
Employee Benefit Research Institute [EBRI]

Employers Get Choosier About Workers' Doctors

"Many big companies are mining data from their own health plans and public records and working with consultants to compare physicians, searching for those with the best results and competitive costs. Top doctors earn favored spots in health insurance offered to workers; poor performers are more costly for patients or excluded entirely.... Results convinced Walmart executives that choosing top doctors is vital[.]"
The Wall Street Journal; subscription may be required

Benefits in General

Sixth Circuit Reverses District Court, Says American Fidelity Insurance Agents Are Not 'Employees' Under ERISA

"[T]he Sixth Circuit reversed the district court and held that a putative class of insurance agents for American Family Insurance Co. were properly classified as independent contractors under ERISA and, therefore, not entitled to ERISA benefits. The ruling helped to quell insurance industry uproar resulting from the district court's decision in 2017, much to the dismay of the several thousand current and former American Family agents who had argued the insurer misclassified them as independent contractors to avoid paying them ERISA-required benefits." [Jammal v. American Family Ins. Co., No. 17-4125 (6th Cir. Jan. 29, 2019]
Carlton Fields

Press Releases

Most Popular Items in the Previous Issue

Fiduciary Litigation Update (PDF)
Employee Benefits Committee [EBC], American Bar Association

SDNY Hands Self-Insured Health Plans a Total Win
Kilpatrick Townsend, via Lexology; free registration required

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David Rhett Baker, J.D., Editor and Publisher
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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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