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[Guidance Overview]
HHS Proposes to Scale Back ACA Nondiscrimination Rules
"The proposed rules adopt a statutory reading that is much more limited than that reflected in the existing regulations, both in terms of the entities subject to the nondiscrimination requirements and in the breadth of those requirements."
Ballard Spahr LLP
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Sixth Circuit Rejects HIV/Genvoya Claim Under ACA Section 1557
"In class action litigation, the US Court of Appeals for the Sixth Circuit rejected a health plan participant's claim that an insurer's coverage policy regarding HIV medication violated the nondiscrimination rules of [ACA] (ACA) Section 1557. In analyzing the participant's claim, the Sixth Circuit resolved an open question by holding that Section 504 of the Rehabilitation Act of 1973 does not prohibit disparate-impact discrimination." [Doe v. BlueCross BlueShield of Tenn., Inc., No. 18-5987 (6th Cir. June 4, 2019)]
Thomson Reuters Practical Law
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Considerations for the Self-Insured Health Plan Sponsor When Negotiating a Trend Guarantee in Your Next TPA Selection
"Provider discount analyses are generally thought to do a reasonable job of estimating the expected change in discount upon switching TPAs, but there are several caveats to consider when interpreting the results ... Though employers may intuitively expect that the use of [medical] trend guarantees will make the analysis simpler (i.e., take the bidding TPA that guarantees the lowest trend), there are many issues to consider for the self-funded employer ... TPAs offering trend guarantees will also attempt to control their exposure via reference to [certain listed] issues[.]"
Milliman
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Why Is Active Open Enrollment Becoming the Popular Choice?
"Some employers have adopted a hybrid active-passive enrollment approach, which can provide the best of both worlds -- higher visibility into the benefits being offered while still giving employees the ease of defaulting to the previous year's benefits. The hybrid approach also helps avoid the conflict many benefit teams face with active enrollments when employees 'forget' to elect their benefits and lose their coverage."
Benefitfocus
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[Advert.]
Reach the right candidate for your company's job opening! Put your job ad in front of our 24,000+ newsletter readers and on our web site -- the employee benefits community's job board over 20 years. Place your job ad now.
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Can the World's Biggest Companies Save Health Care?
"Can the frictionless consumer experience we now have in banking, retail, and entertainment be achieved in health care? Can the data generated by our digital devices -- combined with greater penetration of electronic health records (EHRs) -- lead to better patient outcomes and improved efficiencies? ... Aligning incentives could improve clinical trials ... Consumers could become more closely connected to their health data ... Web searches could lead to patient-specific insight."
Deloitte
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HIPAA Breach Settles for $1M in First Settlement Involving State Attorneys General
"Indiana-based Medical Informatics Engineering, Inc. (MIE) agreed to pay $100,000 to the [HHS] Office for Civil Rights (OCR). MIE provides electronic health record and related services to healthcare entities. MIE also committed to a two-year corrective action plan to resolve potential violations of the [HIPAA] Privacy and Security Rules. Separately, MIE agreed to pay $900,000 to 16 states whose attorneys general had sued the company over a related data breach. The suit was the first of its kind premised on a HIPAA violation."
Poyner Spruill LLP
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[Opinion]
Employer Coalition Comments on Senate HELP Health Costs Draft Legislation (PDF)
"We support the draft proposal to prohibit balance billing for all emergency services.... We support requiring providers to give patients receiving scheduled care written and oral notice at the time of scheduling about the provider's network status and any potential charges for out-of-network care ... We believe the best option for resolving surprise medical bills is through a benchmark payment system.... We support the proposition that all providers in an in-network facility must accept the in-network rate.... We oppose the utilization of an arbitration system to settle payment disputes."
Partnership for Employer-Sponsored Coverage [PESC]
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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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