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January 20, 2020 logo logo
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[Official Guidance]

Text of HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' Software Instructions for the 2019 Benefit Year (PDF)

25 pages; updated Jan. 17, 2020. "The 2019 benefit year risk adjustment model was recalibrated ... Additionally, [CMS] removed two severity-only drug classes from the 2019 benefit year risk adjustment models ... The high-cost risk pool calculation incorporated into the HHS risk adjustment methodology beginning for the 2018 benefit year continued for the 2019 benefit year." [Also available: Technical Details (XLSX) and 2019 Benefit Year Risk Adjustment SAS Version of HHS-Development Risk Adjustment Model Algorithm Software (ZIP)]

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

[Guidance Overview]

IRS Provides Relief for Furnishing Forms 1095-B and 1095-C to Individuals

"Notice 2019-63 does not extend the due dates for filing Forms 1094-B, 1095-B, 1094-C, and/or 1095-C with the IRS.... The Notice extends the deadline for employers and insurers to issue statements to employees on Form 1095-B or Form 1095-C from January 31, 2020 to March 2, 2020.... Treasury and the IRS request comments as to whether an extension of the due date for furnishing statements to individuals, and an extension of good-faith reporting relief, will be necessary for future years ... The notice does not specify a deadline for comments."


[Guidance Overview]

New Colorado Surprise Medical Billing Law Arbitration Provisions, Explained

"Colorado joined the handful of other states that have begun to put in place consumer protections addressing surprise bills when its new out-of-network [OON] law ... took effect on Jan. 1, 2020.... The OON Law will not apply to ... self-funded plans ... Additionally, the protections in the OON Law do not apply to a patient who voluntarily chooses to use an out-of-network provider or facility instead of an in-network provider or facility."

Venable, via Lexology; free registration required

Supreme Court to Hear Trump Appeal in ACA Contraception Fight

"At issue is a challenge by the states of Pennsylvania and New Jersey to the administration's 2018 rule that permits broad religious and moral exemptions to the [ACA's] contraception mandate and expands accommodations already allowed ... The administration has asked the Supreme Court to reverse a nationwide injunction issued by a lower court blocking the rule from taking effect. " [Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, Nos. 17-3752, 18-1253, 19-1129, 19-1189 (3d Cir. Jul. 12, 2019; cert. pet. granted Jan. 17, 2020)]


Diverse Stakeholders Ask Supreme Court to Promptly Hear ACA Case

"Multiple amici asked the Court not to leave the ACA in 'limbo' for many more years. Allowing the Fifth Circuit's decision to stand, they argued, would sow unnecessary confusion across the health care system.... If the Court grants the request for expedited consideration ... Texas could be heard and decided before the end of the court's term in June 2020." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. and motion to expedite consideration filed Jan. 3, 2020)]

Katie Keith, in Health Affairs


Now is the time to become a member of ECFC

Sponsored by ECFC [Employers Council on Flexible Compensation]

ECFC is dedicated to maintaining and expanding employee benefit programs on a tax-advantaged basis. Members include employers, TPAs, health plan providers, brokers, payers, providers, payment networks, processors, and financial institutions. Learn more

Health Plan Sponsors Welcome Repeal of Cadillac Tax

"Plan sponsors should note, however, that the reporting of the value of employer-provided coverage on the Form W-2 in Box 12, using Code DD, did not change. As a result, employers should continue to report the value on Form W-2.... Sponsors of self-insured health plans should continue to add payment of the PCORI fee to their compliance calendars, monitor applicable rates, and budget for the payments for the next 10 years. Insurers of fully-insured health plans are responsible for reporting and paying the PCORI fee."

Epstein Becker Green

IRS Publication 5187: Affordable Care Act -- What You and Your Family Need to Know (PDF)

22 pages, for 2019 tax year. "This publication ... provides information about the individual shared responsibility and the premium tax credit. A glossary is included to help taxpayers understand some terms related to the health care law."

Internal Revenue Service [IRS]

Press Releases

Most Popular Items in the Previous Issue, Inc.
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020, 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, 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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