Health & Welfare Plans Newsletter

December 4, 2019

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[Official Guidance]

Text of 2019 Instructions for IRS Form 8994: Employer Credit for Paid Family and Medical Leave (PDF)

"An eligible employer uses Form 8994 to figure the employer credit for paid family and medical leave for tax years beginning in 2018 and 2019. The credit ranges from 12.5% to 25% of certain wages paid to a qualifying employee while the employee is on family and medical leave. You can claim or elect not to claim the employer credit for paid family and medical leave any time within 3 years from the due date of your return on either your original return or an amended return." [Also available: 2019 IRS Form 8994]

Internal Revenue Service [IRS]

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[Guidance Overview]

Proposed Rules Require Health Plans and Insurers to Provide Cost Transparency

"Employers that sponsor self-funded plans might find these requirements difficult to meet with their current claim payment arrangements and the confidentiality provisions in their network contracts. Such employers likely would need to pay third parties, like their claims administrators, to provide the services required by the proposed rule. Costs may also increase, at least initially, for employers with insured plans, as the proposed rule states an insured plan would comply and have no liability only if the insurer is contractually required to provide the information."

Reinhart Boerner Van Deuren s.c.

[Guidance Overview]

Form 1095 Benefit Statement Issuance Date Delayed

"Several states have imposed an individual shared responsibility requirement wherein residents must maintain minimum essential coverage (MEC) or pay a state tax.... Employers and insurers providing MEC are subject to annual reporting obligations to the relevant state tax department, and are required to provide written documentation to individuals attesting to coverage. Some of the state revenue departments have indicated that employers using the federal 1094/1095 forms would satisfy the state-required reporting obligation. At this time, this means that entities who are obligated to accomplish MEC reporting in these states will likely not be able to avail themselves of the simplified posting method [provided by IRS Notice 2019-63]."

CBIZ

[Guidance Overview]

IRS Again Grants ACA Reporting Relief

"As a practical matter, this relief may lead insurers to suspend all of their affirmative ACA reporting. However, large employers may find it easier to provide Forms 1095-C to their covered part-time employees at the same time that they are issued to their full-time employees -- as opposed to generating these forms at a later date (upon a part-time employee's request)."

Spencer Fane

[Guidance Overview]

2020 ACA Reporting Deadline for 2019 Forms Extended by 30 Days (Again)

"This relief with respect to insurance carriers furnishing coverage information to individuals on the Form 1095-B does not apply to ALE employers reporting on the Form 1095-C.... Employers sponsoring a self-insured medical plan are still required to complete Part III of the Form 1095-C for any full-time employee enrolled in that plan in 2019 (even though that information is related to the Section 6055 reporting requirements)."

ABD Insurance & Financial Services

Hospital Groups File Lawsuit Challenging Price Transparency Rule

"The plaintiffs -- the American Hospital Association (AHA), the Association of American Medical Colleges (AAMC), the Children's Hospital Association (CHA), and the Federation of American Hospitals (FAH), along with three individual hospitals -- have asked that a federal judge to impose a preliminary and permanent injunction to prevent the government from enforcing the rule, which is set to take effect January 1, 2021." [American Hospital Assoc. et al. v. Azar, No. 19-3619 (D.D.C. complaint filed Dec. 4, 2019)]

HealthLeaders Media

Hospital Groups Sue to Block Price Transparency Rule

"The groups say the disclosure under the rule would be compelled speech in violation of the First Amendment.... The lawsuit, while expected, highlights the scope of industry concern over the regulatory burden associated with the rule, which was completed last month. The legal standoff could complicate other White House initiatives to expand price disclosure throughout the $3.5 trillion health-care industry." [American Hospital Assoc. et al. v. Azar, No. 19-3619 (D.D.C. complaint filed Dec. 4, 2019)]

The Wall Street Journal; subscription may be required

Court Permits Health Plan's Equitable Lien Claim to Proceed Against Participant's Attorneys

"[A] medical negligence action ... settled, and the funds were housed in a designated structured settlement account established by [the attorneys].... Publix sought a constructive trust or equitable lien by agreement on the funds as reimbursement for the Plan's payment.... [The court held that] the claims against the Attorney Defendants were cognizable because they held the settlement proceeds in trust or possess the funds." [Publix Super Markets, Inc. v. Figareau, No. 19-545 (M.D. Fla. Nov. 25, 2019)]

Kantor & Kantor

Labor Unions Team Up with Drug Makers to Defeat Drug Price Proposals

"[A] coalition that includes major drugmakers like Pfizer and Johnson & Johnson as well as large construction-industry unions whose members help build pharmaceutical plants and research labs, has been buying print advertisements in local newspapers, mailing fliers to voters in vulnerable Democratic districts, and hiring former labor officials and well-known union lobbyists to deliver their message. It aligns closely with the talking points of drug companies, which claim that Ms. Pelosi's bill would stifle innovation and damage a vital American industry."

The New York Times; subscription may be required

Vetting Relationships for Telemedicine Collaborations

"Like any collaboration, finding the right partner is crucial for success, particularly at the highly-scrutinized intersection of healthcare and technology. This post explores the factors to address when evaluating service providers and vendors for your next telemedicine collaboration."

McDermott Will & Emery

Editor's Pick 50-State Survey of Telehealth Commercial Payer Statutes (PDF)

150 pages. "[C]urrently 42 states and DC maintain some sort of telehealth commercial payer statute.... [T]he quality and efficacy of these laws varies significantly from state to state.... And while telehealth coverage has widely expanded, the same cannot be said for reimbursement/payment parity.... This survey contains pinpoint citations to the governing statutes or rules, but includes only commercial health insurance laws and does not include Medicaid fee for service rules or Medicaid managed care organization laws and rules, which also vary on a state-by-state basis. "

Foley & Lardner LLP

HHS Adjusts HIPAA and Other Civil Monetary Penalties for Inflation

"The maximum penalty for each violation of a particular HIPAA requirement or prohibition increases to $58,490 (up from $57,051), with a calendar-year cap of $1,754,698 (up from $1,711,533) for all violations of an identical provision. Curiously, the inflation adjustments do not incorporate the enforcement discretion HHS announced in April 2019, which significantly reduced calendar-year penalty caps for most HIPAA violations[.]"

Mercer

Benefits in General

Judicial Trend Away from Recognizing Equitable Remedies for Benefit Claims Under ERISA

"A court in Florida has declined to expand the remedies available under a claim for benefits due under 29 U.S.C. Section 1132(a)(1)(B) of ERISA.... The court dismissed the plaintiff's claim for 'equitable estoppel by silence' under that provision of ERISA's civil remedies. This supports the trend in other courts following the U.S. Supreme Court's 2011 decision in CIGNA Corp. v. Amara, which marked firm boundaries for litigation of claims under Section 1132(a)(1)(B) versus under Section 1132(a)(3) of ERISA." [Keys v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 18-2098 (M.D. Fla. Nov. 12, 2019)]

Jackson Lewis P.C.

Press Releases

Most Popular Items in the Previous Issue

DOL Inspector General Semiannual Report to Congress (PDF)
Office of Inspector General, U.S. Department of Labor [DOL]

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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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