Health & Welfare Plans Newsletter

April 28, 2020

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COBRA Compliance
April 29, 2020 WEBCAST
Employee Benefits Law Group PC

Going Viral: Vaccinate Your Employee Benefits Plans Against the Impacts of COVID-19
April 30, 2020 WEBCAST
Hall Benefits Law

COBRA Compliance
May 7, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Employer Forum on Pharmacy Benefits & Specialty Drugs - Flatten the Curve on Specialty Drug
June 17, 2020 WEBCAST
Midwest Business Group on Health

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View Coronavirus (COVID-19) News and Resources

[Official Guidance]

Text of CMS Risk Adjustment FAQ on COVID-19: Telehealth Services (PDF)

"[Q:] In light of the COVID-19 pandemic, can CMS clarify which telehealth services are valid for data submissions for the HHS-operated risk adjustment program? [A:] Any service provided through telehealth that is reimbursable under applicable state law and otherwise meets applicable risk adjustment data submission standards may be submitted to issuers' [EDGE] servers for purposes of the HHS-operated risk adjustment program."

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

[Guidance Overview]

California Cities Require Employers to Provide COVID-19 Sick Leave

"Three California cities -- Los Angeles, San Francisco and San Jose -- have recently enacted paid sick leave laws in response to the COVID-19 pandemic.... Each law has [1] different employee eligibility requirements ... [2] varying caps ... [3] different standards for eligibility.... [4] different exemptions.... [5] different requirements governing the type of information that an employer may or may not require prior to or as a condition of granting leave.... [6] different notice or posting requirements.... [7] different penalties for potential violations or retaliation."

Pepper Hamilton LLP

[Guidance Overview]

As the FFCRA Goes Live, the DOL Continues to Publish Revised and New Guidance for Employers

"With the DOL's temporary period of non-enforcement ending on April 17th, even those employers who make a good faith effort to comply with the law (and the DOL's ever-changing guidance) may now be subject to enforcement for violations.... What's more, as highlighted in the Q&A, not only will the DOL enforce the FFCRA going forward, but it is also prepared to enforce the law retroactively."

Bryan Cave Leighton Paisner LLP

[Guidance Overview]

IRS Addresses Post-TCJA Calculations of UBTI for VEBAs and SUBs

"The [IRS] has issued proposed regulations addressing how certain tax-exempt entities, including voluntary employees' beneficiary associations (VEBAs) and supplemental unemployment benefit (SUB) trusts, determine if they have more than one unrelated trade or business and, if so, how these entities calculate their unrelated business taxable income (UBTI). The regulations reflect statutory changes under the Tax Cuts and Jobs Act (TCJA), which was enacted in December 2017."

Thomson Reuters Practical Law

Supreme Court Hands Decisive Win to Health Insurers Seeking Compensation for ACA Losses

"[T]he government was required to reimburse the insurers for their losses according to the formula outlined in the ACA. And it was obligated to do so ... even if Congress had not specifically appropriated funds to make those payments. Second, the court continued, Congress did not repeal or suspend the government's obligation to reimburse the insurers when it passed appropriations bills with riders that prohibited the use of funds for risk-corridor payments." [Maine Community Health Options v. U.S., No. 18-1023 (S. Ct. Apr. 27, 2020)]

SCOTUSblog

Insurers Are Entitled to Risk Corridors Payments: What the Supreme Court Said and What Happens Next

"The Court's ruling upholds what Justice Sonia Sotomayor refers to as 'a principle as old as the nation itself: the government should honor its obligations.' Insurers will receive billions in unpaid risk corridors payments, but it could take time for these funds to flow to insurers. And the impact of this decision will vary significantly by state and insurer." [Maine Community Health Options v. U.S., No. 18-1023 (S. Ct. Apr. 27, 2020)]

Katie Keith, in Health Affairs

Health Insurers Prosper as COVID-19 Deflates Demand For Elective Treatments

"As doctors and consumers are forced to put most nonemergency procedures on hold, many health insurers foresee strong profits. So why is the industry looking to Congress for help? Insurers say that while that falloff in claims for non-COVID care is offsetting for now many insurers' costs associated with the pandemic, the future is far more fraught. Costs could remain modest or quickly outstrip savings. A recession could drive revenue down. Or the coronavirus could resurge next winter and spike treatment expenses."

Kaiser Health News

California Requires Extra Two Weeks of Paid Sick Leave for Critical Food-Service Workers

"California Gov. Gavin Newsom has mandated emergency paid sick leave for 'the unsung heroes' who risk their health to stock supermarket shelves, harvest produce, deliver grocery orders and staff warehouses. Full-time workers are eligible for up to two weeks of sick pay, and part-time employees will receive an amount of leave proportionate to the hours they typically work in a two-week period."

Society for Human Resource Management [SHRM]; membership may be required to view article

[Opinion]

Health Plans Need to Go Farther To Get Us Through the COVID-19 Crisis

"To keep health care services readily available through this crisis and beyond, we need health plans to provide bridge financing, advancing operating funding for 120 days and paying for telemedicine at the same rate as in-person visits.... Payers wouldn't exist without providers. Most important, members need access to these providers to get health services in their homes. Stable revenue flow is clearly an all-around win, in the interests of patients, providers, payers and employers."

Validation Institute

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Late Forms 5500 Have Been Filed But DOL's Delinquent Filer Voluntary Compliance Program Was Not Used

"New client had not been filing Forms 5500 for many years. Previous service provider prepared and filed 5 years' worth of Forms 5500 but not through the DOL's Delinquent Filer Voluntary Compliance Program. Client has now received notices from IRS wanting lots of money. Has anyone been successful going through that program after the IRS has become involved?"

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Press Releases

DOL Obtains Consent Order and Judgment to Remove Fiduciaries from Cleveland, Ohio, Retirement Plan
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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