Health & Welfare Plans Newsletter

May 9, 2019

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HHS Reduces Most Maximum Annual Civil Monetary Penalties for Violations of HIPAA Privacy and Security Rules

"HHS states that its new approach better reflects the language in the HITECH Act.... While lowering most of the annual maximums is a technical change, it is possible that HHS could also lower its demands as part of future resolution agreement settlements."
Segal Consulting

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A National Report Card for Health Insurance Plans That Cover Medications for Autoimmune Diseases (PDF)

"For medicines received through a pharmacy under commercial insurance, there was not a single plan across all conditions that scored an 'A' grade for access, with only 2% achieving a 'B'. Ninety-eight percent of plans received grades of 'C' or worse (50% received a 'C' and 48% received an 'F').... For drugs administered in the doctor's office under commercial insurance, health plans trusted physician decisions and imposed fewer coverage barriers. Across all conditions and health plans, the majority of plans achieved at least a 'B'." [Also available: full study results.]
Let My Doctors Decide

House Subcommittee Hearing: Lowering Prescription Drug Prices -- Deconstructing the Drug Supply Chain

May 9 hearing. Page includes video of hearing, along with Memorandum from Chairman Pallone and testimony from witnesses: [1] Justin McCarthy, Pfizer; [2] Kave Niksefat, Amgen; [3] Jeffrey Hessekiel, Exelixis; [4] Amy Bricker, Express Scripts; [5] Brent Eberle, Navitus Health Solutions; [6] Estay Greene, Blue Cross and Blue Shield North Carolina; [7] Lynn Eschenbacher, Ascension; [8] Jack Resneck, M.D., American Medical Association; [9] Richard Ashworth, Walgreen Co.; [10] Leigh Purvis, AARP.
Energy & Commerce Committee, U.S. House of Representatives

Health Plans Should Prepare for Fallout from HHS Rule Requiring Manufacturers to Disclose Drug Prices

"In addition to impacting existing plan features and their administration, health plans, their fiduciaries, administrators and insurers should prepare for a predictable surge in scrutiny by plan members about health plan prescription drug formularies that in many cases will fuel new appeals and challenges to the plan denials, formularies and other impacted features. Health plan fiduciaries, administrators, PBMs and other vendors, employer and other sponsors should anticipate and begin preparing both to handle these new health plan demands and ideally, to educate patients and their caregivers to use the new information to make better health care choices."
Solutions Law Press

State Family Leave Law Updates: Massachusetts and District of Columbia

"The administrative agency governing the Massachusetts paid family leave program has announced extensions of certain provisions, and the District of Columbia's enforcement agency released guidance in implementing its paid family leave law."
CBIZ

Local Government Paid Sick Leave Updates: City of Minneapolis, Westchester County, NY and City of Dallas

"An appeals court decision clarifies the applicability of the paid sick leave ordinance for the City of Minneapolis. In New York, Westchester County released model notices and guidance applicable to its earned sick leave ordinance. And finally, the City Council in Dallas enacts a paid sick leave ordinance."
CBIZ

[Opinion]

Why the New HHS Drug Rebate Rule Deserves (Cautious) Support

"There are three basic problems with the current Part D financing system. First, because rebate contracts are proprietary, the Part D market lacks sufficient price transparency to incentivize efficient consumer shopping. Second, rebates can create perverse incentives for Part D plans to purchase drugs with high list prices and large rebates even when lower cost alternatives are readily available. Lastly, rebates systematically disadvantage Medicare enrollees who use expensive brand-name medications."
Health Affairs

Benefits in General

Independent Contractor vs. Employee -- The Tug of War Continues

"In contrast with the DOL's and NLRB's loosened standards ... the Supreme Court of the State of California established a new pro-employee standard in the classification battle in 2018, ruling that there is a starting presumption that all California workers are employees. Thanks to a decision of the Court of Appeals for the Ninth Circuit issued on May 1, 2019, we now know that California's new pro-employee standard will apply retroactively. In other words, employers in California may find that once valid and correct classification of workers are now improper." [Vazquez v. Jan-Pro Franchising Int'l, No. 17-16096 (9th Cir. May 2, 2019)]
The Modern Workplace, by Gray Plant Moody

Selected Discussions
on the BenefitsLink Message Boards

Cancellation of Health Insurance Over the Summer Due to Non-Payment of Premium

I'm working with an employer who has employees who do not work over the summer. They will continue to be covered under the employer's group health insurance plan but must pay for their portion of the premiums which would otherwise come out of their paycheck. We are concerned about what happens if the employee does not pay their portion of the premiums. [1] Is it correct that there is a 30 day grace period under the ACA? [2] If so, do you know what statute or regulation requires it? [3] Can state laws require a longer grace period (I believe they can for individual plans but can't find any information on group plans)? [4] Is it correct that they cannot re-enroll until the next open enrollment? Any cite for that?
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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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