Health & Welfare Plans Newsletter

January 13, 2020

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[Official Guidance]

Method for Calculation of Section 1332 Reinsurance Waiver 2020 Premium Tax Credit Pass-Through Amounts (PDF)

"This paper describes Treasury's methodology for modeling health insurance coverage and PTC at the state level, for evaluating Section 1332 waiver applications and calculating pass-through payments for 2020, for states with reinsurance program waivers."

Office of Tax Analysis, U.S. Department of Treasury

[Official Guidance]

Method for Estimation of Impact of Maryland Easy Enrollment Policy on Section 1332 Reinsurance Waiver 2020 Premium Tax Credit Pass-through Amount (PDF)

"Maryland's auto-enrollment policy is expected to increase MHBE enrollment in the individual market. As a result, the per-enrollee PTC savings that result from the reinsurance program would apply to a larger number of enrollees, and Maryland's pass-through funding with the auto-enrollment policy is expected to be greater than it would have been absent the new policy."

Office of Tax Analysis, U.S. Department of the Treasury

[Official Guidance]

DOL Releases Search Tool for Apprenticeship and Training Plan Notices

EBSA has made available a new online tool which allows users to search and view Apprenticeship and Training Plan Notices filed with the Department of Labor (under 29 CFR 25230.104-22). Results can be printed or downloaded to Excel.

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

2019 ACA Information Reporting: IRS Extends Deadline and Good Faith Relief

"[Notice 2019-63] extended the deadline to March 2, 2020, for employers and health insurance providers to provide individuals with 2019 Forms 1095-B and 1095-C (previous date was January 31, 2020). Nonetheless, the IRS encourages employers and other coverage providers to furnish 2019 statements as soon as possible."

Drinker Biddle

Administration, State Plaintiffs Urge Against Expedited Review in ACA Case

"The DOJ explicitly asked the Court not to review Texas until after the case has been remanded to the district court for further analysis.... California and the House want the case to be heard by the Court in 2020 with a decision issued before the end of this year's term.... We will likely learn next week whether the Court is interested in considering Texas during its current term." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. and motion to expedite consideration filed Jan. 3, 2020; responses of federal respondents and state respondents, each filed on Jan. 10, 2020)]

Katie Keith, in Health Affairs

Administration Says ACA Lawsuit Can Wait Until After the Election

"The case, which seeks to invalidate the entire health care law, can wait for the lower courts to consider certain questions more carefully, [the U.S. Solicitor General, on behalf of the federal government and various federal agencies,] said in a filing to the Supreme Court on [Jan. 10]. There is no 'present, real-world emergency,' the brief says, that would require the court to rush the case's progress." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. and motion to expedite consideration filed Jan. 3, 2020; responses of federal respondents and state respondents each filed on Jan. 10, 2020)].

The New York Times; subscription may be required

New York State May Be First to Pass a New Paid Leave Law in 2020

"Governor Andrew Cuomo proposed legislation that would require private employers to provide sick leave to their workers.... [E]mployers with five to 99 employees would be required to provide at least five days of job-protected paid sick leave per year and employers with 100 or more employees would be required to provide at least 7 days of paid sick leave per year. Small businesses with 4 or fewer employees would be required to provide 5 days of unpaid sick leave."

Jackson Lewis P.C.

2019 Year in Review: Notable Changes in Law, Policy, and Enforcement of HIPAA

"[N]early 39 million health care data breaches had been reported to the [HHS] Office of Civil Rights (OCR) by the end of November 2019.... This article explores some of the trends that can be attributed to the growing number of breaches and how the OCR has responded to the difficulties experienced by healthcare entities covered by the security and confidentiality requirements applicable to protected health information (PHI) under [HIPAA]."

Sheppard Mullin

Why Do Health Insurers Deny Claims?

"Examples of types of claims that are frequently denied include: [1] Cancer care involving treatment such as stem cell transplantation, proton beam therapy, or newly developed high-cost medications; [2] Air ambulance transportation; [3] Residential treatment for behavioral health conditions; and [4] Emergency out-of-network treatment."

DeBofsky Sherman Casciari Reynolds P.C.

Editor's Pick Supreme Court to Rule on States' Right to Regulate Pharmacy Benefit Managers

"The US Supreme Court has announced it will hear a case in the coming months that could determine whether states have the right to regulate pharmacy benefit managers (PBMs).... The Eighth Circuit decision favored the Pharmaceutical Care Management Association (PCMA), ruling that [ERISA], a federal law that sets minimum standards for voluntarily established retirement and health plans in private industry, superseded an Arkansas law that sought to regulate PBMs." [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. granted Jan. 13, 2020)]

Pharmacy Times

Press Releases

Paris International is Certified for Fiduciary Excellence
Centre for Fiduciary Excellence [CEFEX]

OneDigital Acquires Kistler Tiffany Benefits
OneDigital Health and Benefits

Most Popular Items in the Previous Issue

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 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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