Health & Welfare Plans Newsletter

June 18, 2019

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[Official Guidance]

Text of CMS Potential HHS-HCC Updates for Risk Adjustment Program (PDF)

51 pages. "The HHS risk adjustment model uses patient diagnoses and demographic information ... to predict plan liability for medical and drug spending.... [This paper describes the CMS] methodology for reviewing and restructuring the HHS-HCC classification to incorporate ICD-10 diagnosis codes, using the 2016 and 2017 benefit years masked enrollee-level External Data Gathering Environment (EDGE) claims data[.]"
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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[Official Guidance]

Text of CMS Blueprint for Approval of Affordable Health Insurance Marketplaces (PDF)

44 pages. "This document includes the Blueprint application for states seeking approval to operate either [a state-based exchange (SBE) or state-based exchange on the federal platform (SBE-FP)] for coverage years beginning on, or after, January 1, 2019, and includes the following application components: [1] Declaration of Intent Letter ... [2] Blueprint Application Part A: Application Attestation, Part B: Exchange Declarations, and Parts C or D: SBE or SBE-FP Application."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Final Rules Impose Requirements on Employers Reimbursing for Individual Coverage

"The new rules take effect January 1, 2020. Until then, employers are still prohibited from reimbursing premiums for individual coverage.... The concept of ICHRA is intended to deliver a new avenue for employers to more flexibly fund employee health coverage.... [T]here are many uncertainties about meaningful marketplace coverage opportunities for workers. Moreover, the new guidance imposes key restrictions and limitations[.]"
HUB International

[Guidance Overview]

More Details on Massachusetts Paid Family and Medical Leave Law Implementation

"[T]he Department announced an increase to the total contribution rate from 0.63 percent to 0.75 percent of employee qualifying earnings ... to offset the shorter period for collections that will result from the three-month delay [and] ensure that full funding will be in place when benefit payments begin in January 2021. The breakdown between medical contributions and family leave contributions remains at 82.5 percent and 17.5 percent, respectively."
Constangy, Brooks, Smith & Prophete LLP

[Guidance Overview]

CMS Releases 2020 Medicare Part D Benefit Parameters

"Increases in the standard benefit parameters range from approximately 4.8% to 5.9%, with the OOP threshold increasing by 24.5%. Plan sponsors that want to remain qualified for the employer retiree drug subsidy will have to determine if their 2020 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage."
Buck

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[Guidance Overview]

Agencies Expand HRA Availability to Provide Coverage

"The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs.... [1] Excepted Benefit HRAs ... There are four requirements that must be satisfied under the regulations for an HRA to qualify as an excepted benefit HRA ... There are no special notice requirements for excepted benefit HRAs, although they will be subject to ERISA's disclosure requirements.... [2] Individually Integrated HRAs ... Current regulatory guidance prohibits employers from offering HRAs that reimburse employees for the cost of individual health coverage ... The regulations ... remove that prohibition if [certain requirements] are satisfied."
The Wagner Law Group

Employers Need to Prepare Now for Washington, DC's Universal Paid Leave (PDF)

"[1] Determine if law applies ... [2] Get ready for quarterly contributions and filings ...[3] Prepare for notice and recordkeeping requirements ... [4] Assess how new law coordinates with other leave ... [5] Prepare for benefits to begin in 2020 ... [6] Update policies and train staff on leave rights ... [7] Monitor compliance to avoid enforcement action.... Employers have limited time to make their initial contribution and file a wage report."
Mercer

Mental Health Parity Litigation: Utah District Court Finds Conclusory Allegations Insufficient to Overcome Motion to Dismiss

"This case demonstrates the current litigation battle lines. Plaintiffs seek to overcome motions to dismiss and get to discovery based on the allegation that the handling of a claim violates the MHPAEA, while plans and plan administrators continue to insist that the plaintiffs must plead a factual basis for their allegations." [Kerry W. v. Anthem Blue Cross and Blue Shield, No. 19-67 (D. Utah June 5, 2019)]
Ogletree Deakins

Takeaways from Congress's Latest Single-Payer Hearing

"[1] The hearing was supposed to address various legislative proposals that would expand coverage ... [but] the debate centered almost entirely on the Medicare for All Act.... [2] The fate of the ACA remains unknown.... [3] Potential for adverse effects on provider rates draws concerns.... [4] Cost of a single-payer system remains unknown."
Healthcare Financial Management Association [HFMA]

Texas Is Latest State to Attack Surprise Medical Bills

"Texas is now among more than a dozen states that have cracked down on the practice of surprise medical billing.... Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment -- and state officials would oversee that process."
Kaiser Health News

[Opinion]

Are You Sure You Actually 'Like' Your Private Health Insurance?

"Four in ten Americans with employer-sponsored health insurance say their family is struggling to pay premiums, medical bills, or out-of-pocket medical costs. Half of us have a family member who is avoiding necessary medical care or prescriptions because of cost.... Thousands of physicians, medical students, nurses, and our colleagues across health care ... are joining the Medicare for All movement because we want our work to be about protecting people's health, not destroying their wealth."
CommonDreams.org

[Opinion]

U.S. Chamber Letter to Senators on the Lower Health Care Costs Act

"[T]he Chamber strongly supports efforts to protect patients from surprise bills while providing certainty for payers and employers. Equally important, any solution should preserve and encourage market-based negotiations."
U.S. Chamber of Commerce

[Opinion]

The Cadillac Tax: It's Time To Kill This Policy Zombie

"[P]olicy makers should incentivize employers to strengthen rather than cut their support for workers' and dependents' health insurance. Lawmakers increasingly realize the need to change direction, as suggested by the bipartisan majority of House members and more than a third of the country's senators who are now co-sponsoring 2019 legislation that would repeal the Cadillac tax. Abundant evidence shows the need for this change."
Stan Dorn, in Health Affairs

Benefits in General

[Official Guidance]

GASB Issues Implementation Guide on Fiduciary Activities

"[GASB] has issued a new Implementation Guide that contains questions and answers about the GASB's recently issued standards on accounting and financial reporting for fiduciary activities. Implementation Guide No. 2019-2, Fiduciary Activities, answers many questions about how to apply the provisions of GASB Statement No. 84, Fiduciary Activities."
Governmental Accounting Standards Board [GASB]

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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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