Retirement Analyst / Senior Retirement Analyst Montgomery County, MD Employee Retirement Plans Rockville MD
	Litigation Associate Robinson & Cole LLP Hartford CT

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[Official Guidance]

Text of CMS Final Regs: ACA Exchange Program Integrity

144 pages. "This final rule revises standards relating to oversight of Exchanges established by states and periodic data matching frequency. This final rule also includes new requirements for certain issuers related to the collection of a separate payment for the portion of a plan's premium attributable to coverage for certain abortion services." [Also available: CMS Fact Sheet]

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

CMS Announces Enhanced Program Integrity Efforts for the Exchange

"The final rule focuses on strengthening oversight of State-based Exchanges (SBE) and implementing a new requirement that Exchanges conduct regular eligibility verifications with outside data sources at least twice a year. In addition, the rule aligns federal regulations with the statutory requirements of the [ACA] to help ensure consumers understand the coverage they are buying and also requires Qualified Health Plan (QHP) issuers to send a separate bill and attempt to collect separate payments for the portion of consumers' premiums attributable to certain abortion services for which public funding is prohibited."

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

Repeal of the Tax on Qualified Transportation Fringe Benefits Provided by Nonprofits

"With the rescission of ... Section 512(a)(7), the tax will be treated as though it was not enacted; to begin with, and taxpayers will be entitled to refunds of taxes paid for 2018 and estimates for 2019 unless they are applied to other unrelated business income taxes owed."

WithumSmith+Brown, PC

[Guidance Overview]

City of Pittsburgh Publishes New Information Regarding the Paid Sick Days Act

"[T]he Act will take effect on March 15, 2020.... [T]he City published a sample notice that employers can use to comply with the general notice requirements under the Act.... [T]he City also published guidelines to assist employers in understanding how the Act will be administered and enforced."

ReedSmith

Has DOL Put Final Nail in Coffin of 'Substantial Compliance' Doctrine for Disability Claims? (PDF)

"It is not difficult to foresee how an administrator, caught up in extensive back-and-forth discussions with a claimant regarding new or additional evidence or rationales considered by the administrator, could easily miss the deadline for the appeal decision. The administrator would have the unenviable choice of risking a violation of the Regulations by deciding the appeal before the claimant gets around to submitting his response, or by delaying its decision until receipt of the claimant's response beyond the deadline for its decision. The Regulations provide no guidance or offer any relief in such a scenario."

Jackson Lewis P.C.

Insurer's Objective Pain Defense Doesn't Hurt Fibromyalgia Claim

"The court's discussion of the FCE results was particularly instructive since it is often the case that functional capacity evaluations can produce misleading results in fibromyalgia cases due to the nature of the disease. While functional capacity evaluations may be useful to an extent in assessing neuromuscular conditions, such testing has limited utility in evaluating employability for claimants with fibromyalgia." [Krysztofiak v. Boston Mutual Life Ins. Co., No. DKC 19-0879, 2019 WL 6528609 (D. Md. Dec. 4, 2019)]

DeBofsky Sherman Casciari Reynolds P.C.

How Millennials Approach Health Care

"89% have some form of health insurance ... 54% reported [that] at some point in their lives, [they did not have] health insurance, and 47% had received help from their parents in paying for medical bills.... 79% said they would search for what ails them before visiting a doctor's office.... 63% thought that they should be able to text their doctor directly.... 45% said they would use telemedicine before visiting a doctor."

HealthPocket

Fifth Circuit Rules Individual Mandate Unconstitutional; Fate of Rest of ACA Remains in Doubt

"The immediate practical effects of the Fifth Circuit's opinion are negligible. The 2017 amendment to the individual mandate provisions already took away any consequence that might arise from a failure of an individual to obtain health coverage. The bigger stakes come with respect to the effect on other ACA provisions. Although this issue has now been remanded to the district court, there is speculation that it may be taken up by the Supreme Court before the lower court undertakes any further review." [Texas v. U.S., No. 19-10011 (5th Cir. Dec. 18, 2019)]

Ballard Spahr LLP

Busy Week for ACA: Court of Appeals Finds Mandate Unconstitutional, Spending Bills Include ACA Changes

"Even with this [Fifth Circuit] decision, there is no immediate effect for employers. There is no nationwide injunction and the ACA remains the law of the land for the time being.... Congress passed, and the President is expected to sign, a pair of government funding bills that made changes to the ACA. Most of the changes are positive for employers."

HUB International

IRS Issues Q&As on the ACA's Individual Shared Responsibility Provisions

"[T]he Q&As: [1] define minimum essential coverage; [2] explain how an individual can determine if their plan meets the minimum essential coverage requirements; [3] explain who is subject to the minimum essential coverage requirements; and [4] provide a list of statutory exemptions from the general coverage requirement rules. These Qs&As are written in relatively understandable terms and may be distributed to employees who wish to learn about their current obligations under the ACA."

The Wagner Law Group

Answers to Questions for the Record on Key Design Components and Considerations for Establishing a Single-Payer Health Care System (PDF)

29 pages. "On May 22, 2019, the House Committee on the Budget convened a hearing at which [current and former officials in the Congressional Budget Office] testified about the agency's report Key Design Components and Considerations for Establishing a Single-Payer Health Care System. After the hearing, [House Committee on the Budget] Ranking Member Womack and Congressman Roy of the Committee submitted questions for the record. This document provides CBO's answers."

Congressional Budget Office [CBO]

[Opinion]

An Appeals Court Rules Against Obamacare -- Here's What Lawmakers Should Do Next

"In the near term, this court decision does nothing to change our health care system. Nothing changes for people enrolled in Obamacare as this case continues to wind its way through the legal system. But this legal fight reminds us that the law has been on shaky ground since its creation -- and underscores that we need a better health care solution for the millions of Americans affected by the program."

The Heritage Foundation

[Guidance Overview]

Year-End Challenges and Opportunities: Congress Passes SECURE Act, Cadillac Tax Repeal, and More

"The SECURE Act includes almost thirty provisions aimed at encouraging the adoption of employer-sponsored plans and lifetime income options, altering plan distribution rules, easing administrative requirements, improving certain types of defined benefit plans, and more.... [A]number of the provisions are effective with the New Year ... The Act also includes a number of other retirement and health and welfare provisions of interest to employers and service providers."

Groom Law Group

ERISA Class Actions Under Section 502(a)(2) (PDF)

"Courts in Georgia, New York, North Carolina, and South Carolina in the past months have provided some insights on certification of proposed classes with claims on behalf of a plan arising under ERISA Section 502(a)(2). While courts readily certify classes where the plaintiffs seek recovery on behalf of the plan in which the plaintiffs are participants, they do not uniformly grant certification without analysis."

Jackson Lewis P.C.

What Sport is Your Benefits Business Playing?

"With firms like Fidelity entering the benefits business, others like Zenefits and Gusto raising tens to hundreds of millions of dollars, and the national firms continuing their rapid pace of acquisitions, one must wonder whether the benefits game is changing in a bigger way.... The bar will get raised and raised again, in a way that the price to compete is more resources and more specialized skills.... This benefits game may no longer be a golf event where a single skilled player can compete. It may not even be a basketball or baseball game where 5 and 9 players are adequate. It may require the army of a professional football team with 53 highly skilled players."

Joe Markland

Press Releases

Schwab Announces Launch of Schwab Intelligent Income™ to Modernize How Investors Can Pay Themselves From Their Portfolios
Charles Schwab Corporation

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Most Popular Items in the Previous Issue

Congress Set to Repeal 40 Percent Excise Tax on High-Cost Health Plans, Pass SECURE Act
Sibson Consulting

Proposed Rule Would Require Transparency of Cost-Sharing and Pricing Information
Segal Consulting

Continued Uncertainty as Fifth Circuit Strikes Individual Mandate, Remands on Rest of ACA
Katie Keith, in Health Affairs