Health & Welfare Plans Newsletter

June 3, 2019

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Jobs

Senior Pension Administrator - Combo DB / DC Plans
Primark Benefits
in Burlingame CA / Telecommute

Retirement Plan Administrator
Nicholas Pension Consultants
in Rancho Cordova CA / Corona CA

Health Insurance Specialist
Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services
in Bethesda MD / Telecommute

Recent Graduate - Auditor
Employee Benefits Security Administration, U.S. Department of Labor
in Kansas City MO / Telecommute

Specialist, Retirement Education & Enrollment
Nationwide Financial
in CA / CO / MA / NJ / PA / WA

Senior Pension Administrator
Scholz & Friends Enlightened Retirement Group, Inc.
in San Antonio TX

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[Official Guidance]

Text of CMS Memo on 2016 HHS-RADV Results (PDF)

23 pages. "The 2017 benefit year HHS-RADV results will be used to adjust 2018 benefit year risk adjustment plan liability risk scores, resulting in an adjustment to 2018 benefit year risk adjustment transfer amounts. This memo ... contains an overview of the HHS-RADV error rate methodology, a summary of the 2017 benefit year HHS-RADV results, and information to assist issuers in understanding their results. On August 1, 2019, CMS anticipates releasing a report reflecting how these results will adjust 2018 benefit year risk adjustment transfers."

  • Appendix A: Program Benchmark Metrics 2017 Benefit Year HHS-RADV [XLSX]
  • Appendix B: Estimated 2018 RA Market Weighted Average Risk Score Adjustment from 2017 RADV [XLSX]
  • Appendix C: Estimated 2017 RA Market Weighted Average Risk Score Adjustments from 2017 HHS-RADV (Exiting Issuers) [XLSX]
  • Appendix D: 2017 Benefit Year HHS-RADV HCC Group Definition [XLSX]

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS Change to Risk Adjustment Holdback Policy 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.... CMS is finalizing the proposed change and, beginning with the 2018 benefit year, will release the holdback amounts without regard to any pending appeals and make any necessary post-calculation adjustments in the event an appeal is successful."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Massachusetts FMLA Deadlines Nearing

"Although many of the specifics regarding MFMLA's implementation are still uncertain, a few deadlines are fast approaching: [1] June 30, 2019: All employers in Massachusetts must provide employees with a notice of rights under the new law. [2] July 1, 2019: Employers must begin making deductions from wages or payments for services to fund quarterly contributions to the department. [3] September 20, 2019: Employers interested in obtaining an exemption from the MFMLA's contribution requirements must file for the exemption."
Wilmer Hale

[Guidance Overview]

Westchester County, NY Enacts Standalone Paid Safe Leave Law

"[O[nly weeks after its new Earned Sick Leave Law (ESLL) took effect, Westchester County, NY enacted the Safe Leave Time Law (SLTL). Effective approximately October 30, 2019, the SLTL requires employers to provide all eligible employees with 40 hours of paid leave that can be used for certain reasons relating to domestic violence or human trafficking. The SLTL's 40 hours of paid leave will be in addition to any sick leave provided by the ESLL."
Seyfarth Shaw LLP

[Guidance Overview]

Maine Becomes First State to Enact Paid Time Off Law

"[T]he Earned Employee Leave Act requires employers to allow employees to use earned paid leave for any reason and could have a ripple effect on how Maine and multi-state employers structure their employee paid leave benefits. The law goes into effect on January 1, 2021."
Seyfarth Shaw LLP

[Advert.]

Association Health Plans, Time to See Them From a Whole New View Point

Sponsored by Lorman and BenefitsLink

June 11 webinar will reintroduce you to Association Health Plans (AHPs) and Multiple Employer Welfare Arrangements (MEWAs) and help you weigh the pros and cons of these programs. BenefitsLink discount.


[Guidance Overview]

New Jersey Individual Mandate Will Require Extra Reporting Starting in February 2020

"the State of New Jersey enacted its own Individual Mandate beginning in 2019 which mimics the ACA's Individual Mandate prior to it being reduced to $0. From an employer's perspective the New Jersey Individual Mandate will create additional reporting requirements in February 2020 for employers who have employees who reside in New Jersey.... From an employer's perspective the most important part of the New Jersey Individual Mandate is the new reporting requirement."
Accord

Recent Court Decisions Highlight FMLA Issues (PDF)

"[T]his article presents three lessons learned from recent court cases. The first involves notice of the need for leave, the second lesson teaches when to designate leaves, once there is notice, and the third teaches how to avoid statements which mistakenly afford FMLA rights to employees that are otherwise unentitled, or in legal parlance, understanding estoppel in the FMLA context."
Dechert LLP

To Pay or Not to Pay Parental Leave?

"Paid parental leave probably is most important to lower-wage workers -- particularly those who are paid hourly -- and who are less likely to be able to afford a day without pay. Working mothers, who usually are responsible for staying home with sick children and family members, benefit greatly from having paid sick leave."
Employee Benefits Report

Forfeiture of Transportation Benefits

"In Information Letter 2019-002, the IRS has confirmed that unused transportation benefits will be forfeited when an employee terminates employment.... [E]mployees are permitted to change their transportation benefit contribution elections every month, and do not require a 'status change' event to make the change, so the amounts forfeited in transportation benefit elections should be substantially smaller than the potential loss in FSAs, where employees are generally required to make annual elections."
The Wagner Law Group

Health Plan Participation in the Employer Stop Loss Market (PDF)

"Over the past decade, submitted financial filings suggest the employer stop-loss (ESL) market has nearly tripled, growing from roughly $7 billion in premium in 2008 to over $21 billion in 2018. As this growth has occurred, a significant share of it has accrued to health plans rather than traditional ESL carriers. While there can be hurdles for a health plan to overcome when trying to enter the ESL market or grow an existing stop-loss block, the market can provide meaningful opportunities."
Milliman

Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading

"Under a scenario in which CSR payments are restored, the authors estimate that the total number of insured and the number of individual market enrollees would fall relative to the status quo, but that enrollment would be higher than under a broad loading scenario.... Broad loading leads to higher premiums for bronze, gold, and platinum plans and decreases premiums for silver plans relative to silver loading. With broad loading, nonsilver plans with relatively few enrollees must pay CSR costs formerly covered by silver plans with many more enrollees. That means the per capita cost increases for the former are relatively large, while the per capita savings of the latter are relatively small."
RAND Corporation

[Opinion]

Transparency Is Just One Piece of the Drug Pricing Puzzle

"Public reporting can provide valuable information ... public around excessive launch prices and price increases, but on its own, transparency will not solve the drug pricing problem.... A common refrain from the drug industry is that high prices are necessary to cover the cost of researching and developing new drugs. But industry experts are not buying it."
Arnold Ventures

Press Releases

Most Popular Items in the Previous Issue

PCORI Fee Due by July 31
Willis Towers Watson

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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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