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April 17, 2020 logo logo
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[Official Guidance]

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

Updated Apr. 15, 2020. "The 2019 benefit year risk adjustment model was recalibrated using blended coefficients from the 2016 enrollee-level External Data Gathering Environment (EDGE) data and 2014 and 2015 MarketScan data. Additionally, [HHS] removed two severity-only drug classes from the 2019 benefit year risk adjustment models that no longer meaningfully predict incremental risk. 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-Developed Risk Adjustment Model Algorithm Software (ZIP)

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

[Guidance Overview]

Valuing Health Plan Cost for Coronavirus (COVID-19) Related Employment Tax Credits

"[E]xpenses related to medical, dental, and vision plans would be included in the credit. However, expenses related to employee assistance programs, wellness programs, and onsite medical clinics are included only if the benefits available cause these programs to be group health plans.... Qualified health plan expenses include contributions by the employer as well as pre-tax salary reduction contributions made by employees."

Nixon Peabody LLP

[Guidance Overview]

Managing the Notice and Documentation Requirements Under the New Paid Sick and FMLA Leave Law

"What is the time frame for requesting EPSL and FMLA+? ... What information is required when an employee requests leave? ... What documentation must the employee provide to support the need for EPSL and FMLA+? ... When must this documentation be provided? ... [If] an employee fails in some regard with respect to providing notice or supporting information or documentation, the employer should give the employee notice of the failure and an opportunity to correct the deficiency prior to denying the leave."

FMLA Insights

[Guidance Overview]

New San Francisco Bay Area COVID-19 Related Paid Sick Leave Ordinances

"The San Jose ordinance covers employees who are required to leave their homes to perform essential work and services, whereas San Francisco's Public Health Emergency Leave Ordinance (PHELO) covers all employees, including those teleworking or furloughed. Paid PHELO leave is in addition to currently required and/or provided paid employer leave and San Francisco employers are prohibited from changing any paid time off policies on or after the ordinance's effective date, except to provide additional paid leave. The new sick leave under San Jose's ordinance is not addition to other leave, provided the employer already provides at least 80 hours of paid sick or personal leave."

Akin Gump

[Guidance Overview]

Los Angeles Issues Order Exempting Certain Businesses from Providing Supplemental Paid Sick Leave to Employees Affected by COVID-19

"The Order significantly narrows which employers are required to provide supplemental sick leave pay. The ordinance's scope encompassed all employers with over 500 employees nationwide. The Order, by contrast, applies only to employers who have either [1] 500 or more employees in the City or [2] 2,000 or more employees throughout the United States. The Order also exempts [certain] categories of employer who meet either (or both) of the '500 employees in the city' or '2,000 employees nationwide' thresholds from their obligations to provide supplemental sick leave pay[.]"

K&L Gates

New York Challenges FFCRA Leave Rules

"[T]he State of New York argues that the DOL improperly restricted the availability of leave to millions of employees by excluding employees whose workplaces are closed under state shelter in place and stay at home orders, and by adopting an excessively broad definition of 'health care provider.' The lawsuit also challenges the temporary rule's provisions concerning intermittent leave and the documentation employees must provide with their leave request before a request may be granted." [New York v. Scalia, No. 20-3020 (S.D.N.Y. complaint filed Apr. 14, 2020)]

Franczek P.C.

Shifting Employee Benefits Priorities Due to COVID-19

"Now is the time to reinvigorate efforts to raise employee awareness of programs ranging from telemedicine, to condition management programs to pharmaceutical subscription services.... [E]mployers may also benefit disproportionately by adding new vendors and programs to support employees' needs and to make targeted efforts in controlling healthcare spending under these new circumstances."

Tango Health

Helping Employees Through COVID-19 Pandemic with PTO Donation

"A medical emergency leave-sharing plan is for employees who have exhausted all of their PTO and who need more because of a 'medical emergency.' A plan can allow a donor-employee to donate accrued PTO either to a 'leave bank' to be held available for any other employee as needed, or to a specific co-worker."

Seyfarth Shaw LLP

Illinois Paid Sick Leave Must Be Taken Immediately After Birth

"The Illinois Supreme Court [ruled] ... that a teacher’s use of paid sick leave for the birth of a child must be taken during the six-week period immediately following the birth under Section 24-6 of the Illinois School Code. Once that six-week period has elapsed, a teacher may not use paid sick days for birth unless he or she provides a physician’s certificate as set forth in the statute." [Dynak v. Board of Education of Wood Dale School District 7, No. 125062 (Ill. Apr. 16, 2020)]

Franczek P.C.


How Will COVID-19 Change Employee Benefits?

"Virtually overnight, the insurance and healthcare world made a giant pivot to be able to offer medical care in a virtual environment.... [E]mployers are going to need a formal leave management program.... Not being able to have in-person meetings is forcing us all to experiment with -- and become proficient in -- other modes of communication."

OneDigital Health and Benefits

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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