Health & Welfare Plans Newsletter

August 22, 2019

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[Guidance Overview]

A Shift in Health Care Pricing Transparency

"[P]roposed rules were published by [CMS] ... [which would] require hospitals to make public via the internet a description of each item and service the hospital provides with all corresponding payer specific negotiated charges in both 'machine readable' and 'user friendly' formats. ... If adopted, the proposed rules will create significant compliance requirements for all hospitals, and impose civil monetary penalties for those found to be in noncompliance."

Jones Day

[Advert.]

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Projected 2020 Commuter, Health FSA and Archer MSA Limits

"These unofficial 2020 limits are determined using the Internal Revenue Code’s cost-of-living adjustment methods, chained Consumer Price Index for All Urban Consumers (chained CPI) values through July and Mercer’s projected chained CPI for August.... Limits for qualified transportation fringe benefits and health FSAs are expected to increase slightly in 2020. "

Mercer

The State of State Legislation Addressing Health Care Costs and Quality

"Health care was a major topic in governors’ 2019 state of the state addresses; governors highlighted the need for reform in behavioral health care, the importance of Medicaid expansion and reform, the desire to address high and rising provider and pharmaceutical costs, and issues related to the health care workforce. State laws might be grouped into five categories: price transparency, benefit design, provider payment, provider networks, and market power."

Health Affairs

Health Plan Confusion and Bad Decisions

"A popular idea for reducing healthcare costs is to arm consumers with detailed information about the prices of drugs and medical procedures so they can make smarter decisions. But the academic community is reaching the opposite conclusion: people don’t understand the information they already have and are making bad decisions based on these misconceptions. The latest example is a survey of Wisconsin state workers who sometimes defer care because they are under the mistaken impression that they can’t afford it."

Squared Away Blog, by the Center for Retirement Research at Boston College

Congressional Efforts to Develop Surprise Medical Bill Legislation

"Legislators appear to agree that surprise billing should be prohibited even in instances where the patient received scheduled rather than emergency care, and therefore had greater opportunities to discover that a provider from whom they were to receive care was out-of-network. Despite this broad consensus, however, lawmakers disagree over the proper payment dispute resolution mechanism for non-contracted providers, leaving a legislative solution very much in-flux. At issue is a choice between three payment dispute resolution models."

Epstein Becker Green, via Lexology; free registration required

[Advert.]

Employee Benefits During Leave of Absence

Sponsored by Lorman and BenefitsLink

August 28 webinar. It is critical for employers to understand when and how they are required to continue employee benefits while an employee is out on leave, and when they are not required -- or even permitted -- to do so. BenefitsLink discount.


Oregon Governor Signs Paid Family and Medical Leave Law

"Oregon [becomes] the eighth state to adopt legislation requiring paid family and medical leave for eligible employees. Oregon's program is the most generous and inclusive state law passed to date, with low-income workers receiving 100 percent of their wages while on eligible leave. Benefits are capped at 120 percent of the state average weekly wage (currently, approximately $1,200 a week)."

Jackson Lewis P.C.

Medi-Cal Expands Telehealth Reimbursement

"The Department of Health Care Services (DHCS), the agency that administers Medi-Cal benefits for over 13.5 million California residents, finalized guidelines that significantly expand telehealth reimbursement in the Golden State.... [T]he new policy encourages Medi-Cal providers to use telehealth as a modality to serve the state's Medicaid beneficiaries."

Nixon Peabody LLP

Shopping Abroad for Cheaper Medication? Here's What You Need To Know

"Americans routinely skirt federal law by crossing into Canada and Mexico or tapping online pharmacies abroad to buy prescription medications at a fraction of the price they would pay at home. In some cases, they do it out of desperation. It’s the only way they can afford the drugs they need to stay healthy -- or alive."

Kaiser Health News

Benefits in General

Fourth Circuit Finds Plan Administrator May Have Triggered Fiduciary Status

"The Fourth Circuit ... cited precedent that established that when a plan administrator is responsible for verifying employee eligibility for participation in an employee benefit plan, that administrator acts in a fiduciary capacity with regard to that obligation. Further, a plan administrator also acts in a fiduciary capacity when it conveys (or fails to convey) material information to a plan participant concerning the retention of eligibility for a benefit plan when that administrator is aware that the participant wishes to maintain his participation in that plan." [Dawson-Murdock v. National Counseling Group, Inc., No. 18-1989 (4th Cir. Jul. 24, 2019)]

Winston & Strawn LLP

Prominently Displayed, Fundamental Discrepancy In Benefit Calculation Triggered Contractual Limitations Period

"The Fifth Circuit concluded that a plan’s three-year contractual limitations period began to accrue when a beneficiary received a letter in 2008 that prominently displayed on the first page the monthly earnings used to calculate his long term disability benefits." [Faciane v. Sun Life Assurance Co. of Canada, No. 18-30918 (5th Cir. Jul. 25, 2019)]

Proskauer

The Time Between Disability Onset and Application for Benefits: How Variation Among Disabled Workers May Inform Early Intervention Policies

"Using Social Security administrative data, the authors find that the median period from onset to application is 7.6 months. Younger applicants tend to have waited longer, particularly those diagnosed with back impairments or arthritis. Among both younger and older applicants, individuals diagnosed with intellectual disability or other mental disorders are potential targets for early intervention programs because those groups wait the longest to apply and are the most likely to continue working in the interim."

Matt Messel and Alexander Strand, via SSRN

Press Releases

Most Popular Items in the Previous Issue

An Update on Health Reform Lawsuits
Timothy Jost, for The Commonwealth Fund

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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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