Health & Welfare Plans Newsletter

May 17, 2019

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Private
in New York NY

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Employee Benefits Security Administration, U.S. Department of Labor
in Washington DC / Telecommute

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Infosys McCamish Systems LLC
in Atlanta GA

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Pension Associates Retirement Planning LLC
in Stamford CT

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Pension Benefit Guaranty Corporation
in Washington DC / Telecommute

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Long Island, NY, Company
in NY / Telecommute

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[Official Guidance]

Text of CMS Final Regs: Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

201 pages. "This final rule amends the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to support health and drug plans' negotiation for lower drug prices and reduce out-of-pocket costs for Part C and D enrollees.... These regulations are effective on January 1, 2020, except for the amendments to Sections 422.629, 422.631, 422.633, 423.128, and 423.160, which are effective January 1, 2021."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Guidance Overview]

CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency

"After an implementation period, Part D plans will be required to ... provide clinicians with access to price information for different prescription drugs.... To further promote transparency, after an implementation period [this] rule will also require the Explanation of Benefits document that Part D enrollees receive each month to include information on drug price increases and lower-cost therapeutic alternatives."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

DOL Announces Statement of Temporary Non-Enforcement Following AHP Ruling

"The Department's policy statement and FAQ are intended to allow employers [who were] participating in insured AHPs before the district court's decision to keep their coverage through the end of the plan year or contract term ... Employers that have purchased health insurance coverage through an AHP maintained by an association of unrelated employers after the district court's decision should immediately explore other options."
Winston & Strawn LLP

[Guidance Overview]

Just as Its Earned Sick Leave Law Goes Into Effect, Westchester County Enacts Another Paid Leave Law

"Beginning October 30, 2019, the Safe Time Leave Law will require employers within Westchester County [New York] to provide employees who are victims of domestic violence or human trafficking with to up to 40 hours of paid safe time leave (PSTL) per year. This paid leave benefit is in addition to any other paid leave to which an employee may be entitled ... [U]nlike the Earned Sick Leave Law, PSTL is not 'earned' or accrued; rather, a covered employee may use the maximum of 40 hours annually, regardless of how many hours he or she has worked."
Epstein Becker Green

[Guidance Overview]

Editor's Pick Health Apps and HIPAA: Recent FAQs Highlight Importance of Covered Entities and Business Associates Scrutinizing their Relationships with App Developers

"OCR's new FAQs extend upon this discussion of the business associate relationship between a covered entity and app developer, and highlight the vicarious liability faced by a covered entity if and when an impermissible use or disclosure of ePHI involves the app. The new FAQs reiterate that if the app was not provided by or on behalf of the covered entity, then the covered entity will not be liable for a breach of any information later experienced by the app. However, if the app was developed for, or provided for or on behalf of, the covered entity, then the covered entity could be held responsible for an impermissible use or disclosure of the ePHI in the app."
ReedSmith

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FMLA Leave: When Can Employers Prorate Bonus Payments?

"The key ... is treating FMLA absences and non-FMLA absences the same for goal-based bonus purposes.... The Second Circuit rejected Clemons's argument that the prorated bonus payment interfered with his rights under the FMLA. The court recognized that Moody's prorates payments under the incentive bonus program based on the length of an employee's leave, regardless of the reason for the leave. " [Clemens v. Moody's Analytics, Inc., No. 18-1283 (2d Cir. May 3, 2019)]
Ogletree Deakins

Savings Medicare Beneficiaries Need for Health Expenses in 2019: Some Couples Could Need as Much as $363,000

"For a 50 percent chance of having enough to cover health care expenses in retirement, a couple with median prescription drug expenses needs $183,000 in savings. For a 90 percent chance of having enough, the couple needs $301,000 in savings. At the extreme -- a couple with drug expenses at the 90th percentile throughout retirement who wants a 90 percent chance of having enough money for health care expenses in retirement by age 65 -- targeted savings are $363,000 in 2019. This $363,000 amount is lower than the nearly $400,000 required in 2018[.]"
Employee Benefit Research Institute [EBRI]

IRS Information Letter Addresses Code Section 213 Medical Care Requirements

"According to [IRS Information Letter 2019-005], factors to consider when determining whether a personal expense was incurred for medical care include: [1] the motive or purpose for the expense, [2] whether a physician has diagnosed a medical condition and recommended the item as treatment or mitigation, [3] the relationship between the treatment and the illness, [4] the treatment's effectiveness, and [5] the proximity in time to the onset or recurrence of a disease. A personal expense generally will be considered an expense for medical care only if the taxpayer would not have incurred the expense but for the taxpayer's disease or illness."
Thomson Reuters / EBIA

Editor's Pick Observations on the Employer Stop-Loss Market: 2019 Survey (PDF)

"[T]he stop-loss market stands at approximately $20 billion in premium... [W]hile premium is relatively evenly spread across deductibles ranging from $75,000 to $500,000, a significant number of policies are sold with deductibles below $75,000, and some with deductibles as high as $1 million."
Milliman

[Opinion]

Why Employers Pay Too Much for Health Care

"[As] recently as 2000, private payers were paying only 10% more than Medicare. Since then, the gap has been growing by leaps and bounds. What makes this especially surprising is that it has happened at a time when employers have been getting increasingly aggressive about controlling health care costs. So, what's going wrong? And who's to blame?"
John C. Goodman, in Forbes

Press Releases

Gordon Hartogensis Sworn in as PBGC Director
PBGC [Pension Benefit Guaranty Corporation]

Six New Members Appointed to the 2019 ERISA Advisory Council
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Most Popular Items in the Previous Issue

DOL Issues Additional Guidance on AHPs
Katie Keith, in Health Affairs

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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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