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[Official Guidance]

Text of CMS Final 2021 Actuarial Value Calculator Methodology (PDF)

26 pages. "The AV Calculator represents an empirical estimate of the [actuarial value (AV)] calculated in a manner that provides a close approximation to the actual average spending by a wide range of consumers in a standard population. This document is meant to detail the specific methodologies used in the AV calculation.... The final 2021 AV Calculator is [available online].... [T]he 2021 AV Calculator does not affect any 2020 plans, and will only be applicable for 2021 plans."

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

[Official Guidance]

HHS OIG Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2019

"When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs [HHS] to substitute the ASP-based payment amount with a lower calculated rate.... In the third quarter of 2019, 11 drug codes met CMS's price substitution criteria by exceeding the 5 percent threshold for 2 consecutive quarters or 3 of the previous 4 quarters."

Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of CMS Interoperability and Patient Access Final Rule

"This rule finalizes new policies that give patients access to their health information and moves the healthcare system toward greater interoperability." [Also available: CMS Fact Sheet]

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

[Official Guidance]

Text of HHS Final Regs: 21st Century Cures Act -- Interoperability, Information Blocking, and the ONC Health IT Certification Program

"The rule is designed to give patients and their healthcare providers secure access to health information. It also aims to increase innovation and competition by fostering an ecosystem of new applications to provide patients with more choices in their healthcare. It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured electronic health information using smartphone applications. The rule includes a provision requiring that patients can electronically access all of their electronic health information (EHI), structured and/or unstructured, at no cost. Finally, to further support access and exchange of EHI, the rule implements the information blocking provisions of the Cures Act. The rule outlines eight exceptions to the definition of information blocking."

Office of the National Coordinator for Health Information Technology [ONC], U.S. Department of Health and Human Services [hhs]

[Guidance Overview]

HHS Finalizes Historic Rules to Provide Patients More Control of Their Health Data

"The ONC Final Rule identifies and finalizes the reasonable and necessary activities that do not constitute information blocking while establishing new rules to prevent 'information blocking' practices (e.g., anti-competitive behaviors) by healthcare providers, developers of certified health IT, health information exchanges, and health information networks as required by the Cures Act.... ONC's final rule establishes secure, standards-based application programming interface (API) requirements to support a patient's access and control of their electronic health information.... As a result of this rule, patients will be able to securely and easily obtain and use their electronic health information from their provider's medical record for free, using the smartphone app of their choice."

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

[Guidance Overview]

IRS Creates Open-Ended Potential Liability Exposure for Employer 4980H Penalties

"Although it remains to be seen if or how aggressively the IRS will attempt to pursue ESRPs for returns filed more than three years ago, ALEs should not assume that they are, at any time, 'in the clear' for such years but should instead be prepared to pay or challenge an ESRP with respect to any calendar year beginning with 2015."

Troutman Sanders

Several States Order Insurers to Waive Cost-Sharing for COVID-19 Testing

"At least three states have now directed insurance carriers to waive all health plan cost-sharing associated with COVID-19 testing: California, New York [and] Washington.... More states are likely to follow in the coming weeks. Even for those states without a directive to waive COVID-19 testing cost-sharing, insurance carriers may move voluntarily to make such services available at no cost to employees and family members."

ABD Insurance & Financial Services


Californians Must Buy Health Insurance or Face a Penalty Unless ... They Don't Want To

"In California folks can qualify for other people's money to help them buy health insurance so long as they make less than 600% of the federal poverty level (FPL) ... [which is] $154,500 for a family of four.... This is nothing more than charade to make it look as if we have an individual mandate without really having one. And the only folks who will actually end up paying this tax/penalty are those who are totally caught off guard or just not even trying a little bit."

Benefit Revolution

Benefits in General

[Official Guidance]

Text of IRS Disaster Relief Announcement TN-2020-01, for Tennessee Victims of Severe Storms, Tornadoes and Flooding

"The President has declared that a major disaster occurred in the State of Tennessee.... Individuals and households who reside or have a business in Davidson, Putnam and Wilson counties may qualify for tax relief.... [C]ertain deadlines falling on or after March 3, 2020, and before July 15, 2020, are granted additional time to file through July 15, 2020."

Internal Revenue Service [IRS]

2020 Benefits Update (PDF)

44 presentation slides. Topics: [1] Retirement plan changes under the SECURE Act; [2] New rules for e-delivery of ERISA documents and notices; and [3] Update on ACA repeal and CalSavers.

E is for ERISA

Coronavirus and Benefit Plan Offerings

"Overall, while action at a [retirement] plan level (as opposed to an investor level) may be unwarranted, taking action to review investment options offered in the plan (with experts, as appropriate) -- and documenting that review -- is of paramount importance from an ERISA fiduciary perspective.... For those [health] plans with self-insured coverage, it may be important to vet what, if any changes, could be warranted and accommodated by carriers/TPAs to get employees access to a test and when available, a vaccine."

Michael Best

Press Releases

Upcoming Events About Health & Welfare Plans

Mar. 10
District of Columbia
How to Lower Health Care Costs: Competition, Regulation, and Administrative Expenses
Brookings Institution
Mar. 10
District of Columbia
Affordable Care Act Turns 10
Health Affairs
Mar. 10
Taken By Surprise: State Approaches to Surprise Medical Billing
National Conference of State Legislatures [NCSL]
Mar. 10
Litigation Lessons and Minimizing Risks
Trucker Huss
Mar. 11
Getting It Right - Know Your Fiduciary Responsibilities: Retirement and Health Plan Sponsors - Day 1
Employee Benefits Security Administration [EBSA], U.S. Department of Labor
Mar. 12
It's Not You, It's Healthcare: What's Next for Access & Employee Education
Employee Benefit Adviser
Mar. 12
Getting It Right - Know Your Fiduciary Responsibilities: Retirement and Health Plan Sponsors - Day 2
Employee Benefits Security Administration [EBSA], U.S. Department of Labor
Mar. 12
Annual Legal & Regulatory Update
Worldwide Employee Benefits Network [WEB] - Northeast Ohio Chapter
Mar. 15
Mid-Sized Retirement & Healthcare Plan Management Conference
University Conference Services
Mar. 16
Use of Individual Medicare Marketplaces for Public Sector Retiree Health Care: A Guide For Elected Officials
Center for State and Local Government Excellence

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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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