Health & Welfare Plans Newsletter

August 20, 2019

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[Guidance Overview]

DOL Confirms FMLA Covers IEP Meetings with Therapists at School

"The opinion letter does not appear to be a significant departure from the FMLA regulations because the child received medical services at school, such as speech, physical, and occupational therapy. The opinion letter nonetheless may trigger an increase in FMLA leave requests in connection with other types of school meetings that are tied less clearly to a child's medical needs. Even in the context of an [Individualized Education Program (IEP)] meeting, a child may not be receiving medical services through the school district."

Ogletree Deakins

[Advert.]

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Defining the Limits of Broad, Complete ERISA Preemption in Health Care Excessive Fee Cases

"[W]ithout the preemption defense, health care providers will be forced to battle breach of contract suits in state courts ...  Second, the K.B. decision -- that excessive cost of healthcare services provided does not involve a denial of coverage or benefits -- could be extended to apply to other fact sets where insureds challenge the cost of healthcare services provided in connection with an ERISA health care plan."  [K.B. v. Methodist HealthCare - Memphis Hospitals, No. 18-6128 (6th Cir. Jul. 11, 2019)]

The Wagner Law Group

Employer Investment in Health Benefits has Minimal Impact on Employee Health

"58% of survey respondents report that employees are unaware of the company-provided health benefits to which they are entitled; and 63% say employees don't know enough about how to leverage their benefits.... Just 28% of respondents say employees actively engage with all of the health benefit programs they are offered, and only 27% of organizations say employees use the full range of their health benefits."

BioSpace

Integrated Health Reimbursement Arrangements Transfer Risk Off Employers, Allow for Predictable Costs

"The major barriers to growth now likely have to do with weaknesses in the individual market in many geographies -- plans are more expensive on the individual market and have a narrower network that may not be appealing to employers utilizing traditional group plans now. However, if some return to market, does that draw some of the major carriers back to the individual market? What if they design plans that do compete or are on par with small group plans?"

Wolters Kluwer; free registration required

Could Next Year Be the Beginning of the End of Traditional Employer-Sponsored Health Insurance?

"Employers will be permitted to fund 'health reimbursement arrangements' (HRAs) for employees to buy individual market health insurance.... Will employees accept jobs that don’t guarantee them particular health benefits but instead offer defined contributions to an HRA that may or may not be sufficient to buy equivalent coverage on the individual market? Many employers would love not to have to bear the administrative burdens of running a traditional health plan, and all are looking for ways to keep health costs down. How many will be willing to test the labor market in this way?"

The Hill

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Editor's Pick The Cadillac Tax Do-Over Challenge

"The Cadillac tax would be levied on health plans, which are legal entities through which employers and unions provide benefits to employees. Its impact on employees would be indirect and depend on how firms and health plan managers respond to the tax in offering and designing benefits. Many of the alternatives to the Cadillac tax that have been proposed instead involve curtailing the tax exemption received by employees, which would impact them more directly."

Health Affairs

Employers' Health Plan Costs Could Rise 6% in 2020

"Large U.S. employers are predicting that their health care costs for 2020 will rise a median of 6 percent if they don't make any cost management adjustments, and by 5 percent if they adopt cost management initiatives, such as alternative network models, or renegotiate their contracts, a new survey shows. Roughly 41 percent of large employers plan to use cost-management tactics to reduce projected health plan cost increases."

Society for Human Resource Management [SHRM]; membership may be required to view article

Editor's Pick Benefits Outside the Box: Using a Charitable Foundation to Enhance Your Culture and Community

"If your Company leadership is looking for an innovative employee benefit - something outside the standard employee benefit package of retirement, health, and welfare benefits, a Company-sponsored charitable foundation might be your answer. A charitable foundation not only can further your Company culture while serving the community, but it also has tax benefits to boot."

Jackson Lewis P.C.

Florida Medical Board to Do Away with Telehealth Guidelines

"The new law adds definitions for telehealth, including for asynchronous and store-and-forward services, while maintaining Florida's prohibition of the use of e-mail, fax, and audio-only visits. Probably the most surprising thing about the new law, though, is the loophole it creates for out-of-state providers."

Center for Telehealth and e-Health Law

New Hampshire Opening the Door Wider for Telehealth

"New Hampshire Governor Chris Sununu just signed a bill into law that changes what the state's Medicaid program covers in regards to telehealth services. More specifically, the new law expands coverage to telehealth services delivered by primary care providers and pediatricians; previously, state law had constrained telehealth service coverage to those provided by specialists."

Center for Telehealth and e-Health Law

CMS Plans 2021 'Update' for Hospital Quality Star Ratings

"Although the methodology had typically been updated every six months, the ratings have been updated only once since 2017 amid long-running complaints over their accuracy. Stakeholders have raised concerns that the ratings are too complex, or oversimplified, imprecise, and provided without proper context for more direct 'apples-to-apples' comparisons."

HealthLeaders Media

Selected Discussions
on the BenefitsLink Message Boards

Full Pay During Intermittent FML But No Pay During Continuous FML -- OK?

Any legal issues with an employer policy that pays employees full pay when they take intermittent Family and Medical Leave, but no pay for employees taking continuous FML?

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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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