Health & Welfare Plans Newsletter

November 20, 2019

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[Guidance Overview]

Proposed Regs Address Transparency in Health Plan Coverage Costs

"Much of this information is already disclosed in general terms by employers in ERISA required documents, such as the summary plan description, summary of benefits and coverage and pre-service and post-service benefit claim determinations. However, the proposed rules would take these disclosure requirements a step further by requiring individually tailored cost-estimates prior to the receipt of services."

Winston & Strawn LLP

[Guidance Overview]

HHS Announces Final Price Transparency Rules for Hospitals

"Hospitals will be required to make public a machine-readable file online that includes all standard charges for all hospital items and services (including the gross charges, payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges).... Hospitals will also be required to make public payer-specific negotiated charges for 300 'shoppable' services that are displayed and packaged in a consumer-friendly manner."

Holland & Knight

[Guidance Overview]

New HHS Hospital Price Transparency Rules Revealed

"The Final Rule ... builds on the previously implemented requirement that hospitals make public a chargemaster with standard charges. In addition, the Final Rule ... [1] [clarifies] which facilities and systems are considered 'hospitals' for the purposes of this requirement; [2] defines five types of 'standard charges'; [3] specifies which 'items and services' must be included in the published list; and ... [4] discusses the requirements for making the contents of the list public[.]"

Morris, Manning & Martin, LLP

[Guidance Overview]

Understanding Mental Health Parity: Insurer Compliance and Recent Litigation

"There have been more than 100 lawsuits in the past several years, concentrated in California, Utah, Illinois, New York, Pennsylvania and New Jersey, most arising from ERISA and concerning coverage for residential and other treatment facilities. There also have been several cases around medical necessity criteria and guidelines, and more recently, around payment rates to providers. Most lawsuits test the scope of treatment limitations that could fall within the scope of parity -- specifically with respect to NQTLs. So far, courts have seemed inclined to explore new theories."

Manatt Phelps & Phillips LLP

Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement (PDF)

140 pages. "From 2013 to 2017, the disparity between how often behavioral inpatient facilities are utilized out of network relative to medical/surgical inpatient facilities has increased from 2.8 times more likely to 5.2 times more likely, an 85% increase in disparities over five years.... Spending for mental health treatment (excluding prescription drugs), as a percentage of total healthcare spending, has been consistent, between 2.2% and 2.4% in the study period. Spending for [substance use disorder] treatment (excluding prescription drugs), as a percentage of total healthcare spending, has increased from 0.7% in 2013 to 0.9% in 2017."

Milliman

Federal Agencies Propose Expansive Health Plan Price Transparency Rules

"[The proposed regulations] would be the most dramatic expansion of disclosure obligations for group health plans since ERISA was passed in 1974.... If the rule is finalized as proposed, the disclosure will be handled by the insurers, so employers with insured plans need not worry. Self-funded plans that use an insurance carrier's network should be able to rely on that carrier's network."

HUB International

Here Are the Top Wellness Benefits Sought by Employees

"Wellness resources and information ... On-site seasonal flu vaccinations ... CPR/First-aid training ... 24-Hour nurse line ... Annual Health Risk Assessment (HRA) ... Financial rewards for wellness participation ... Smoking cessation programs ... Health and lifestyle coaching ... Health fairs ... Preventive programs for chronic health issues."

MassMutual

ACA Statistics: Credit for Small Employer Health Insurance Premiums

"[T]ables present information from samples of corporation income tax returns, which represent the population of forms in the Forms 1120 series, including electronic returns. Also included are data from Historical Table 20, which contains ACA taxes and fees reported to the IRS.... [Additional] data present estimates of frequencies of taxpayer entries recorded on the applicable lines of the forms and schedules filed with partnership returns, Forms 1065 and 1065-B. They also contain corresponding population estimates of dollar amounts recorded on those lines (as applicable)."

Internal Revenue Service [IRS]

When They Need to Take FMLA Leave, Who Should Workers Be Told to Tell?

"The answer may depend partly on when the leave is requested (e.g., initial notice versus subsequent time off) and can vary from organization to organization.... But even when a company has a policy requiring employees to notify HR about foreseeable FMLA leave ... and the worker instead tells a supervisor, that request may put the employer on notice about FMLA leave."

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

The Case of the ACA's Disappearing Taxes

"[President Barack Obama said] 'It is paid for. It is fiscally responsible,' ... as he signed the ACA into law in 2010. But not so much anymore. Many of those 'pay-fors,' particularly the taxes, 'have been eliminated, delayed or are in jeopardy,' said Marc Goldwein of the Committee for a Responsible Federal Budget, a nonpartisan budget watchdog group. 'All this stuff, it turns out, is very unpopular,' he said."

Kaiser Health News

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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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