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Health & Welfare Plans Newsletter January 29, 2020 |
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Webcasts, Conferences Cost Differences for Oncology Medicines Based on Site of Treatment
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Discussions |
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[Guidance Overview] Illinois Paid Sick Leave Updates "Effective July 1, 2020, [the Chicago Paid Sick Leave Ordinance] will apply to all employers with at least one covered employee, regardless of whether the employer has a Chicago worksite or is subject to business license requirements.... By the time Cook County's Earned Sick Leave Ordinance took effect on July 1, 2017, over 80% of suburban municipalities voted to 'opt out' of the law.... Since then, five municipalities reversed course and withdrew their opt-outs:[.]" Littler |
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District Court Vacates Part of OCR HIPAA Rules on PHI Record Access by Third Parties "Utilizing the flexibility resulting from the Ciox rder could help reduce health plan costs of compliance with the HIPAA right of access rule by allowing the health plan and its records providers more freedom to determine the charges and format for delivering PHI in response to records requests received from other insurers, lawyers and other third parties." [Ciox Health, LLC v. Azar, No 18-040 (D.D.C. Jan. 23, 2020)] Solutions Law Press |
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District Court Finds Contraceptive Care Exemption, Notre Dame Settlement Agreement, Violated APA "[T]he court found it 'especially disturbing' that HHS purported to bind future administrations, as well as future faculty, staff, and students at Notre Dame, by entering into such a broad Settlement Agreement that exempted Notre Dame from the regulations or any materially similar regulation or agency policy, and provided that no penalties would be assessed for noncompliance with 'any law or regulation' requiring contraceptive coverage." [Irish 4 Reproductive Health v. HHS, No. 18-491 (N.D. Ind. Jan. 16, 2020)] Wolters Kluwer; free registration required |
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"This issue brief answers key questions about the litigation as we await a decision from the Supreme Court about whether it will review the case." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. filed Jan. 3, 2020; motion to expedite consideration denied Jan. 21, 2020)] Henry J. Kaiser Family Foundation |
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What if Price Transparency Reduced Commercial Price Variation? "Based on a sample of nearly 420 million medical claims across 963 markets, [the authors] found that in 2017: [1] If price variation were reduced by applying the median price to the highest-priced half of claims -- for every service within each market -- national spending among the [employer-sponsored insurance (ESI)] population would decrease by nearly 20%; [2] If price variation were reduced by applying the median price to the lowest-priced half of claims -- for every service in each market -- then ESI spending would rise by 10.1%; and [3] If both happened simultaneously -- the median price was assigned to all claims for all services within all markets -- spending would decline by 9.0% nationwide." Health Care Cost Institute |
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Accounting for the Burden and Redistribution of Health Care Costs: Who Uses Care and Who Pays for It "Health care financing arrangements are designed to redistribute funds for health care expenditures.... Higher-income households pay the most to finance health care in dollar amounts, but the burden of payments as a share of income is greater among lower-income households. [The authors] also find significant redistribution across age group and income groups." Health Services Research |
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New Health and Fringe Benefit Rules Under the Consolidated Appropriations Acts (PDF) "Plan sponsors should pay particular attention to the repeal of the excise tax on high-cost plans, as well as the application of the Health Insurance Provider Fee in 2020 and extension of the PCORI fee. These changes may have an impact on future health plan design strategies, as they can affect future cost increases by several percentage points, and also allow plan sponsors to continue some of their more comprehensive plan designs without fear of an excise tax." Segal |
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New York Announces 2020 HCRA Covered-Lives Assessment Rates "[The New York Health Care Reform Act (HCRA)] imposes on 'electing' health claim payers -- including self-funded plans -- an annual [covered lives assessment (CLA)] ... Nonelecting payers are not subject to the annual CLA but may incur significantly higher surcharges on certain in-state hospital expenses.... New York City has the highest annual CLA for electing payers: $173.53 per individual with self-only coverage and $572.66 per individual with family coverage. However, in Long Island, the CLA per covered individual shrinks to $60.60 (self) and $199.97 (family). The CLA drops as low as $8.85 (self) and $29.19 (family) in the Utica region." Mercer |
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HHS Threatens Funds to California Over Abortion Coverage "According to HHS, [California's Department of Managed Health Care (DMHC)] essentially forced plans and insurers doing business in California to either: [1] Violate the federal Weldon Amendment. [or] [2] Operate without state-approved plans and face potential DMHC enforcement action under California law.... [T]he health insurers removed abortion-related coverage exclusions and limitations from their policies. According to HHS, these changes 'forced over 28,000 people out of plans that up until that time had chosen to not cover elective abortions.' " Thomson Reuters Practical Law |
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Press Releases |
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Most Popular Items in the Previous Issue |
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Fertility and Surrogacy Benefits: Tax and Legal Implications (PDF)
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Recent Decisions Address Mental Health Coverage in the ERISA Context
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Class Action Enforcement and Implementation of the 2008 Parity Act
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