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October 28, 2019 logo logo
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[Guidance Overview]

A Breakdown of ACA Risk Adjustment Validation (PDF)

"On August 1, 2019, HHS released the results of the first impactful issuer level ACA risk adjustment data validation (RADV) audit. Many in the market are still digesting what happened and what it means to their businesses going forward. In this article, [the authors] break down the purpose and technical details of ACA RADV."


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[Guidance Overview]

Federal Health Insurance Exchange 2020 Open Enrollment

"Key updates and enhancements to for the 2020 Open Enrollment: [1] Quality rating information displayed in states ... [2] Expanded streamlined application ... [3] Visual refresh of consumer shopping experience... [4] Enhanced direct enrollment (EDE) expanded... [5] New resources about Health Reimbursement Arrangements (HRAs)."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

U.S. Employers Shifting to Innovative Strategies to Make Healthcare More Affordable for More Employees

"Health benefit cost will top $13,000 per employee this year ... The average total health benefit cost per employee grew 3.0% to reach $13,046, following a rise of 3.6% in 2018. This is the eighth consecutive year of health benefit cost growth in the low single digits, and employers expect cost to rise at a similar pace next year. Still, cost increases continue to outpace overall inflation, and health benefit cost management remains an imperative for most organizations."

New HRA Rules Allow Employers to '401(k)-Ize' Workers' Health Benefits

"A major reason why companies might want to sign on is that healthcare is at the heart of nearly every labor dispute.... Other analysts are less certain whether HRAs will have much of an impact, at least in the near future. One reason, they say, is employees usually are not as knowledgeable as employers when it comes to finding the best health plans. Another is that such a move may make companies less appealing to prospective employees."

Real-Time Benefit Tools for Drug Prices

"Real-time benefit tools (RTBTs) are intended to provide [physicians with the price of medications and their alternatives] by drawing on information from pharmacy benefit plans and displaying patient-specific price information to clinicians at the time a prescription is written. ... [CMS] recently finalized a rule that Medicare Part D plan sponsors implement 1 or more RTBTs capable of integrating with at least 1 prescriber's electronic prescribing system or electronic health record (EHR) by January 1, 2021."
JAMA Network


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How to Save Money During Health Insurance Open Enrollment

"Many companies that offer HSAs contribute funds to them. On average, companies contributed $572 to individuals' HSAs and $1,062 to families' HSAs last year ... That can go a long way toward helping a worker pay down a high deductible, should that worker get sick or injured."
Chicago Tribune; subscription may be required

The Long-Term Effects of California's 2004 Paid Family Leave Act on Women's Careers: Evidence from U.S. Tax Data

"[The authors] find little evidence that [California's 2004 Paid Family Leave Act (PFLA)] increased women's employment, wage earnings, or attachment to employers. For new mothers, taking up PFLA reduced employment by seven percent and lowered annual wages by 8 percent six to ten years after giving birth. Overall, PFLA tended to reduce the number of children born and, by decreasing mothers' time at work, increase time spent with children."
National Bureau of Economic Research [NBER]; purchase required for full document

Disciplining Employees Who Exceed the Frequency on Their FMLA Medical Certification: Have the Courts Finally Given Us an Answer?

"When an employee's absences significantly exceed the frequency identified in the certification, the employer should recertify (usually along with a letter explaining the pattern). If the physician does not change the frequency despite the clear opportunity to do so, the employer arguably has the right to issue discipline for the excessive absences. Now, I have a court case to support my counsel, as the above case gives us the authority we need to discipline employees in these situations." [Evans v. Cooperative Response Center, No. 18-302 (D. Minn. Jun. 18, 2019)]
FMLA Insights

Social Media Disclosure of NFL Player's PHI Leads to $2.15 Million in HIPAA Penalties

"The [HHS] Office for Civil Rights (OCR) announced that a Florida hospital system must pay more than $2.15 million in civil money penalties for violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Among other violations, the action resulted from employees' improper access to an NFL player's protected health information (PHI). The player's PHI was then leaked to multiple media outlets and posted on Twitter by a reporter, causing financial and reputational harm to the player."
Thomson Reuters Practical Law

Benefits in General

Justices Show Supreme Reluctance When They Get ERISA Assignments

"Former Justice Sandra Day O'Connor called ERISA cases 'tedious,' counseling a colleague to 'just do it' and to take steps to reduce the risk of being assigned another one by the chief justice. Her colleague was Justice Ruth Bader Ginsburg, who said ERISA is a 'candidate for the most inscrutable legislation Congress ever passed.' During her first year on the court in 1993, Ms. Ginsburg recalled hoping to receive as her first opinion-writing assignment an 'uncontroversial, unanimous opinion,' a common practice for newcomers. Instead, she was 'dismayed' to receive 'an intricate, not at all easy' ERISA case decided by a 6-3 vote. That's when she asked Ms. O'Connor for advice."
Pensions & Investments

Press Releases

Most Popular Items in the Previous Issue

Text of CMS Final Regs Rescinding the Adoption of the Standard Unique Health Plan Identifier and Other Entity Identifier
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS], Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2019, 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, 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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