Health & Welfare Plans Newsletter

November 26, 2019

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[Guidance Overview]

Get Ready for 2019 ACA Reporting

"The IRS recently released draft instructions for the Forms 1095 and the forms have not significantly changed from prior years.... [A]lthough the penalty for individuals who do not have health coverage has been repealed, insurers and self-insured employers must still report monthly coverage by family member. This means that self-insured employers must continue to complete Part III of the Form 1095-C."

Keller Benefit Services

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[Guidance Overview]

Employers May Need to Provide Cost Data Under Proposed ACA Rules

"The proposed rule seeks comments on a number of issues, including whether all required cost information should be made available in an application-programming interface (that software developers could access) in addition to machine-readable files and an Internet tool. It also requests suggestions for how healthcare-quality information can be published alongside the required cost information."

Ogletree Deakins

[Guidance Overview]

Texas Paid Sick Leave Update: San Antonio, Dallas, Austin

"Dallas remains the only city in Texas to have a paid sick and safe leave law in effect, although that too could change any day as a result of a legal challenge pending in federal court in the Eastern District of Texas. City of Dallas has deferred enforcement of the ordinance, other than for claims of retaliation, until April 1, 2020. The Texas Supreme Court likely will address the legality of the Austin ordinance in early 2020. Any action by the Texas Supreme Court in that case will have implications for the Dallas and San Antonio ordinances."

Jackson Lewis P.C.

[Guidance Overview]

Price Transparency Rules: Key Takeaways for Hospitals and Group Health Plans

"Key themes emerging from the hundreds of pages of price transparency rules impacting hospitals, health plans, and third-party payers include major changes in how health plans, consumers, and providers will interact over the coming years. Whether these changes will lead to price transparency and downward pressure on healthcare pricing or to further confusion is unknown, and it will be left to the courts to determine whether the price transparency rules have gone too far under other legal constructs."

Morgan Lewis

FCC Telehealth Barriers Report: Almost Half of U.S. Counties Face 'Double Burden'

"Almost half of U.S. counties face a 'double burden' of chronic disease and a need for greater broadband connectivity, according to ... an advisory committee that was set up to identify barriers to telehealth and recommend solutions.... [The 42-page report] identifies six areas where regulatory or policy barriers [to telehealth] exist, including: [1] Reimbursement; [2] Licensing; [3] Health information exchanges; [4] Insurance parity and malpractice coverage; [5] Privacy-information sharing and HIPAA; [6] Establishing a doctor/patient telehealth-based relationship."

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HHS Rescinds Health Plan Identifier Under HIPAA (PDF)

"HHS rescinded its unique identifier for health plans -- the HPID. HHS took this action based on industry feedback that the HPID does not serve a valid purpose and its implementation would be disruptive. The health care industry may continue to use the Payer ID to identify the payer in HIPAA transactions."

Cowden Associates, Inc.

[Opinion]

Stimulating Consumerism in Health Care by Revealing Costs

"Assuming the Hospital Cost Transparency rules survive the inevitable legal challenges and the Transparency in Coverage rule is finalized, will more information about the cost of health care result in better personal health decision-making? ... More information may not necessarily result in the decision-making changes the Trump administration expects ... but there's always room for healthy optimism."

Jackson Lewis P.C.

[Opinion]

It's Time for Congress to Protect Patients from Surprise Medical Bills

"The No Surprises Act will not only save consumers money by lowering health care premiums, but according to the Congressional Budget Office, it will also save the federal government more than $20 billion over the next 10 years. These tremendous savings could be used to reinvest in our nation's health care system and cut costs for consumers."

Reps. Frank Pallone Jr. (D-NJ) and Greg Walden (R-OR), via The Hill

Benefits in General

Understanding Attorney-Client Privilege in the Benefits Claims Process

"[A] plan fiduciary must act solely in the interests of participants and beneficiaries. Therefore, when a plan fiduciary speaks with a lawyer about matters relating to plan administration, the 'real client' ... is the participant or beneficiary who is impacted by the issue and not the plan fiduciary.... [T]he fiduciary exception is not without its limits."

Proskauer

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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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