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Health & Welfare Plans Newsletter June 28, 2019 |
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Webcasts, Conferences Reporting and Disclosure Requirements for Health and Welfare Plans
Is Your Plan Affected by the Proposed Changes to Section 1557's Nondiscrimination Rules?
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Guidance Overview]
Connecticut Passes Paid Family and Medical Leave "This Connecticut statute ... appears to be among the most generous paid family leave laws in the country. All private sector employers (and their employees who work in Connecticut) are covered. Connecticut's 'Paid Family and Medical Leave' act funds a paid family leave program by assessing a mandatory payroll tax on employees of 0.5% of income, commencing in January 2021."
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[Advert.]
Health Reimbursement Arrangement Plans Update
July 23 webinar will review the benefits of establishing an individual coverage HRA or an excepted benefit HRA and provide you with what you need to know to establish one or both of them. BenefitsLink discount. |
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[Guidance Overview]
Paid Sick Leave in Dallas and San Antonio Takes Effect on August 1 "Although the Dallas and San Antonio ordinances have minor differences, their similar requirements include: [1] Employers with more than five employees must provide paid sick leave effective August 1, 2019. [2] Employers with five or fewer employees must provide paid sick leave but the effective date is August 1, 2021. [3] Full- and part-time employees are eligible if they work 80 hours a year within the respective city limits. [4] Employees accrue one hour of paid sick time for every 30 hours worked inside the city limits."
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HHS Proposal Revises Nondiscrimination Regs for Health Plans "The proposed rule would eliminate ... [t]ranslated taglines in significant consumer communications, the requirement to post information about Section 1557 and nondiscrimination at a covered entity's locations and website, use of language access plans, and certain video standards for individuals with limited English proficiency (LEP)... OCR specifically states that the proposed rule would not apply to self-funded plans and that health insurers are not principally engaged in the business of providing health care."
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Fifth Circuit Questions Standing of Parties Defending ACA "On June 26, 2019, the Fifth Circuit Court of Appeals asked the parties in Texas v. United States to respond to three questions ... [relating] to whether the Democratic attorneys general and House have standing to intervene in the case and, if not, what that means for the appeal.... To appeal a decision that the primary party (in this case, the Trump administration) does not challenge, an intervenor must independently demonstrate standing. If intervention is found to be improper, there will no longer be a party defending the ACA." [Texas v. Azar, No. 19-10011 (5th Cir. req. for supplemental briefs Jun. 26, 2019)]
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New Texas Law Mandating Drug Price Transparency Considered Among Strongest in Nation "HB 2536 requires pharmaceutical manufacturers to disclose to the Texas Health and Human Services Commission (HHSC) when a drug's price increases 15% or more compared to the previous year, or 40% or more over three calendar years. The new law also requires annual reporting of detailed price information by manufacturers, pharmacy benefit managers, and health benefit plans, and charges the HHSC with making this information available online to the public."
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Pelosi Aims for Feds to Negotiate Drug Prices, Even for Private Insurers "A draft plan spearheaded, but not yet released, by [House Speaker Nancy Pelosi] and other House Democratic leaders would ensure that prices negotiated on the most expensive drugs would apply not only to the government but to all payers, including employers and insurers ... But first, Democrats must agree on how best to muscle drug companies to the negotiating table, as well as how to prevent Americans from paying more or even losing access to the other drugs they take."
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HIPAA-Regulated Entities Take Notice: States are Teaming Up on Enforcement "In addition to wielding their statutory authority to enforce HIPAA, the state AGs also brought claims under their respective data breach and personal information protection statutes. The effect was that of a full-court press -- the EHR Provider was accused of 38 separate counts of state law violations all stemming from the same breach. Notably, the settlement with the state AGs was finalized about one month after the EHR Provider agreed to pay $100,000 to the Office of Civil Rights[.]"
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HHS Addresses Health Plan Uses and Disclosures of PHI and Care Coordination "The FAQ guidance includes an example illustrating permitted sharing of PHI [involving] a situation in which Plan A discloses PHI about an individual to Plan B (a separate CE). In this situation, Plan B does not need the individual's authorization to send communications to the individual about Plan B's health plan options that may replace the individual's current plan ... However, this assumes that Plan B: [1] Does not receive remuneration for sending the communication to the individual. [2] Complies with any controlling HIPAA business associate agreement[.]"
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"Over the past few years, employers have scored victory after victory where they have implemented a two-phone call notice requirement and the employee has, in turn, not followed the procedure.... [N]umerous federal appellate courts have upheld the employer's right to maintain this rigorous notice obligation. Not this court.... Specifically, the court held that an employer can maintain a 'two call-in' requirement only if this approach applies across the board for all leave requests. In other words, this court determined that an employer cannot deny FMLA leave based on an FMLA notice requirement that includes more procedural hurdles than what the employer requires for other types of leave." [Moore v. GPS Hospitality Partners IV,
LLC, No. 17-500 (S.D. Ala. Jun. 3, 2019)]
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Benefits in General |
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Seventh Circuit: Substantial Compliance with Disability Claims Deadlines Is Not Enough "[T]he court takes a stringent view of when noncompliance with the claims regulations' regulatory deadlines results in de novo review of a decisionmaker's benefit denial. Because loss of the more deferential standard of review can make the difference in whether a decisionmaker's denial will be upheld on review, the Seventh Circuit's ruling underscores the need for timely benefit claims decisions." [Fessenden v. Reliance Standard Life Ins. Co., No. 18-1346 (7th Cir. Jun. 25, 2019)]
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124 pages. "Impact of low growth on insurance and pension assets would include lower real returns on all asset types ... This would increase the cost of benefits, increase the likelihood of product feature changes, and potentially change how interest-rate guarantees on liabilities are determined. Low growth would be expected to adversely affect mortality and morbidity rates, with adverse effects to insurance companies for life/health insurance liabilities and potential benefits to pension and annuity liabilities."
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Press Releases |
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Most Popular Items in the Previous Issue |
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COBRA Continuation Coverage Issues for Employers (PDF)
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Text of CMS FAQs: HIPAA and Health Plans -- Uses and Disclosures for Care Coordination and Continuity of Care
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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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