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February 13, 2020 logo logo
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[Official Guidance]

Text of CMS Proposed Regs: Medicare Program -- Medicare Secondary Payer and Certain Civil Money Penalties

44 pages. "This proposed rule would specify how and when CMS must calculate and impose civil money penalties (CMPs) when group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) fail to meet their Medicare Secondary Payer (MSP) reporting obligations in any one or more of the following ways: [1] when RREs fail to register and report as required by MSP reporting requirements; [2] when RREs report as required, but report in a manner that exceeds error tolerances established by [HHS]; [3] when RREs contradict the information the RREs have reported when CMS attempts to recover its payments from these RREs. This proposed rule would also establish CMP amounts and circumstances under which CMPs would and would not be imposed."

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


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[Guidance Overview]

ACA Guidance Round-Up: Draft Letter to Issuers, HRAs, and More

"The annual 'letter to issuers' provides operational and technical guidance for issuers that offer QHPs or stand-alone dental plans through the federally facilitated marketplaces. Many of the standards outlined in the letter apply equally to QHPs sold inside and outside of the marketplaces in the individual and small group markets.... CMS issued guidance to states on how to request that new excepted benefit HRAs not be allowed to reimburse premiums for short-term plans in the small group market."

Katie Keith, in Health Affairs

Tapping Into Telehealth to Expand Care

"As state leaders seek to capitalize on the potential for telehealth to support the health care workforce and improve access to care, a number of policy issues arise. Prescribing practices, reimbursement and licensure are among key topics being addressed in state legislatures and Congress."

National Conference of State Legislatures [NCSL]

State Policy Options to Reduce Prescription Drug Spending

"States that wish to lower their prescription drug expenditures face a number of challenges. Federal law preempts the most sweeping, comprehensive state reforms that could lower prescription drug prices. Moreover, the complexity of the prescription drug supply chain and the myriad interactions that different state agencies have with different parts of the supply chain require a multifaceted approach.... This report discusses policy options available to states and Washington, D.C. to lower their drug spending."

Center for American Progress

Status of the State Individual Health Insurance Coverage Mandates

"Here is a summary from each state that has passed individual mandates and their reporting requirements: [1] California ... [2] District of Columbia ... [3] Massachusetts   ... [4] New Jersey ... [5] Rhode Island ... [6] Vermont ... There are five additional states considering individual mandates: Connecticut, Hawaii, Maryland, Minnesota and Washington."

International Foundation of Employee Benefit Plans [IFEBP]

Another Association Health Plan Success Story

"Rates for ACA plans require merely a list of employees, their ages, sex and marital status, and the nature and location of the business. No medical info is necessary. So groups with 3 employees on chemo and 4 on dialysis pay the exact same rate as those with relatively healthy employees.... AHP plans require medical histories, current meds and the like, and thus the process requires more effort ... But healthier groups can benefit greatly[.]"



Prescription Drug Woes on Both Sides of the US-Canada Border

"Canada's drug spending is increasing dramatically and becoming a larger share of health care costs.... [If] a national pharmacare proposal is similar to the Quebec model, it could provide valuable insights on how a public option operates among private plans.... If and when Canada moves forward with pharmacare, it is likely that Canadian policy makers will put in place measures to make it more difficult for the US to adopt a drug importation scheme focused mainly on Canada."

Oliver Kim, in Health Affairs

Benefits in General

Preemption Case Highlights Different Definitions of 'Employee' Under the Code and ERISA

"Since none of the field representatives participating in the plan were common-law employees, and it was undisputed that participation in the plan was limited to field representatives, the court concluded the plan was not an ERISA plan. Given these 'unambiguous' limitations on ERISA's scope, the court was unpersuaded by the [DOL's] argument that the program should still be treated as an ERISA plan 'because the IRS has long treated independent contractors as employees for tax purposes and Congress' objective was to harmonize ERISA with longstanding tax provisions.' " [Kilfoyle v. Hill, No. 19-1831 (N.D. Ohio Jan. 10, 2020)]

Thomson Reuters / EBIA

Benefits Tech: Top Trends for Employers to Watch in 2020

"Tech is [1] helping the right people get into the right plans ... [2] proactively reminding employees when they may be eligible for a claim ... [3] helping organizations manage change ... [4] starting to simplify leave management ... [5] becoming more efficient and consistent."


Press Releases

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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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