Health & Welfare Plans Newsletter

August 2, 2019

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Associate Consultant / Retirement Plan Administration
Spectrum Pension Consultants, Inc.
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Concordia Plan Services
in Saint Louis MO

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Alerus Financial
in Fargo ND / Grand Forks ND / Arden Hills MN / Albert Lea MN

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[Official Guidance]

Text of CMS Summary Report of 2017 Benefit Year Risk Adjustment Data Validation Adjustments to Risk Adjustment Transfers (PDF)

94 pages; Aug. 1, 2019. "CMS is publishing this first annual report on issuers’ HHS-RADV adjustments to risk adjustment transfer results. As the first non-pilot year, the 2017 benefit year HHS-RADV results will generally be used to adjust 2018 benefit year plan liability risk scores, resulting in adjustments to 2018 benefit year risk adjustment transfer amounts."

  • Appendix A: Issuer-Specific 2017 HHS-RADV Adjustments to 2018 Risk Adjustment Transfers for Non-Merged Market States [XLSX]
  • Appendix B: Issuer-Specific 2017 HHS-RADV Adjustments to 2018 Risk Adjustment Transfers for Merged Market States [XLSX]
  • Appendix C: Issuer-Specific 2017 HHS-RADV Adjustments to 2017 Risk Adjustment Transfers for Non-Merged Market States [XLSX]
  • Appendix D: HHS Default Data Validation Charge [XLSX]
  • Appendix E: HHS Default Data Validation Charge Allocation [XLSX]
  • Appendix F: HHS Operated Risk Adjustment Program State-Specific Data for 2018 [XLSX]
  • Appendix G: HHS Operated Risk Adjustment Program State-Specific Data for 2017 [XLSX]

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

[Official Guidance]

Text of Updated CHIP Model Notice for Employers Regarding Premium Assistance Opportunities (PDF)

If you live in one of the States listed in this notice, you may be eligible for assistance paying your employer health plan premiums. The list of States is current as of July 31, 2019.

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Official Guidance]

Text of CMS FAQs Regarding Enhanced Direct Enrollment Audit Submissions for 2020 (PDF)

"[CMS] is releasing these FAQs now to allow EDE Entities and prospective EDE Entities to begin preparing for next year’s audit submission window. [1] When is the audit submission window for EDE Entities that plan to seek approval to use the EDE pathway in calendar year 2020? ... [2] What should EDE Entities do now to prepare for the 2020 audit submission window?"

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

[Guidance Overview]

Westchester County Implements Safe Time Leave

"Starting October 30, 2019, the Safe Time Leave for Victims of Domestic Violence and Trafficking Law (STLL) will entitle employees who work for more than 90 days in Westchester County and are victims of domestic violence or human trafficking to up to 40 hours of paid safe leave per year to [1] attend or testify in criminal or civil court proceedings related to domestic violence or human trafficking, or [2] move to a safe location.... [T]he safe leave provided by the STLL is in addition to the up to 40 hours of sick leave provided by [Westchester County’s Earned Sick Leave Law (ESLL)]."

Fisher Phillips

[Guidance Overview]

California Enacts Individual Mandate and Premium Subsidies (PDF)

"[California SB 78], which is generally effective January 1, 2020, creates an individual mandate requiring California residents to maintain health coverage and imposing a tax on those who fail to do so. It also provides financial assistance for the purchase of health insurance for residents with household incomes at or below 600 percent of the Federal poverty level, raising the income threshold that applies for eligibility for Federal subsidies from 400 percent of the Federal poverty level."

Boutwell Fay LLP

[Guidance Overview]

Puerto Rico Enacts Leave for Victims of Domestic Violence, Sexual Harassment and Assault

"Employees in Puerto Rico may take up to 15 days of unpaid leave each calendar year to address situations related to domestic or gender-based violence, child abuse, sexual harassment in employment, sexual assault, lewd acts, or felony stalking under a new law. The new 'Special Leave' is in addition to any other leave to which the employee might be entitled under law."

Jackson Lewis P.C.

Congress and Administration Consider Significant Drug Pricing Policy Changes

"In both chambers of Congress, passing legislation to bring down drug prices is a policy priority -- and the savings from such possible legislation is slated to offset other healthcare legislative proposals (such as addressing impending Medicaid Disproportionate Share Hospital (DSH) allotment reductions). Nonetheless, gaining traction on changes designed to bring down drug pricing is proving challenging, for Congress and the administration."

Manatt, Phelps & Phillips

Self-Insured Health Plans: Recent Trends by Firm Size, 1996-2018

"Between 2013 and 2017, the self-insurance trend for large establishments continued to decline, falling from 83.9 percent to 75.9 percent. A rebound may have started in 2018, as the percentage offering a self-insured plan increased to 78.7 percent.... Between 2017 and 2018, the percentage of enrollees fell from 59.4 percent to 58.7 percent. The percentage of workers in self-insured plans fell in every establishment size except for those in firms with 1,000 or more employees."

Employee Benefit Research Institute [EBRI]

Roundup of Selected State Health Developments, Second-Quarter 2019

"[S]ome states have already begun to tackle balance-billing practices, overall drug spending, prescription importation and regulation of pharmacy benefit managers (PBMs).... [A] number of states are pursuing telehealth expansion. Other jurisdictions ... are continuing to implement existing healthcare initiatives or considering whether to pursue [ACA] innovation waivers. Several states have also enacted individual coverage mandates to prevent a spike in uninsured residents after rollback of federal mandate’s penalty."

Mercer

Pittsburgh Paid Sick Leave Update

"On July 17, 2019, the Supreme Court of Pennsylvania overturned the lower courts’ rulings, and ruled that the Ordinance could stand. This means that employers in Pittsburgh will be required to provide a paid sick leave benefit, however, the date the law becomes effective is unknown at this time."

CBIZ

Benefits in General

[Official Guidance]

Text of EBSA Request for Nominations to ERISA Advisory Council

"The terms of five Council members expire at the end of this year. The groups or fields they represent are as follows: [1] employee organizations; [2] employers; [3] accounting; [4] insurance; and [5] the general public.... Nominations must be received on or before [September 19], 2019."

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

District Court Rules Exhaustion of Administrative Remedies Is Mandatory Only if Required by Plan Document

"Claims procedure descriptions in plan related documents should use mandatory language ... In particular, special care should be taken with the model statement of ERISA rights, which some plan sponsors incorporate verbatim from the DOL's SPD regulations and which provides that a plan participant 'may file suit in Federal court' when a benefit claim is denied." [Greiff v. Life Ins. Co. of North America, No. 18-496 (D. Ariz. Jul. 5, 2019)]

Thomson Reuters / EBIA

Starting August 16, Electronic Filing Required for Top-Hat Statements and Apprenticeship and Training Plan Notices

"Beginning August 16, 2019, electronic filing for any apprenticeship and training plan notice or top-hat statement will be required. With respect to an apprenticeship and training plan, the changes do not alter the requirements that the employer must take steps that are reasonably designed to ensure that the information required to be contained in the notice is disclosed to eligible employees and to also make the notice available upon request."

Hodgson Russ LLP

Federal Judge Dismisses ERISA Fiduciary Breach Claim against University for Lack of Standing

"The Court found that Stanley released her claims under the agreement from the release’s plain language. The release included 'any and all claims' for violation of any federal statute, 'including but not limited to' statutes listed in the release. The Court rejected Stanley’s broader interpretation of 'claims for vested benefits,' stating that the language only referred to a contractual claim under the plans themselves and not a broader statutory claim under ERISA." [Stanley v. George Washington Univ., No. 18-878 (D.D.C. Mar. 29, 2019)]

Williams Mullen

Press Releases

PCS Retirement Acquires Aspire Financial Services
Professional Capital Services, LLC

Most Popular Items in the Previous Issue

The Expense of Providing Qualified Transportation Fringe Benefits to Employees
Poyner Spruill LLP, via Journal of Pension Benefits

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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