Health & Welfare Plans Newsletter

June 3, 2020

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View COVID-19 News and Resources

[Official Guidance]

Text of DOD Final Regs: TRICARE Pharmacy Benefits Program Reforms

"Section 702 of the National Defense Authorization Act for Fiscal Year 2018 ... made significant changes to the TRICARE Pharmacy Benefits Program; specifically it: [1] Updated co-payment requirements; [2] authorized a new process for encouraging use of pharmaceutical agents that provide the best clinical effectiveness ... and [3] authorized special reimbursement methods, amounts, and procedures to encourage use of high-value products and discourage use of low-value products with respect to pharmaceutical agents provided as part of medical services from authorized providers. This rule finalizes the changes made to the TRICARE Pharmacy Benefit Program[.]"

U.S. Department of Defense

[Guidance Overview]

The Zombie PCORI Fee Is Back and Due July 31

"If you are feeling a sense that the rules around benefits haven't changed enough in the last three months, this is a reminder of a change made during the long ago time of December 2019. In those ancient times, the PCORI fee rose from the dead. We all thought the annual PCORI (Patient-Centered Outcomes Research Institute) was set to expire back in 2019 but the SECURE Act extended the PCORI fee for another 10 years, meaning the fee will be in effect until 2029 for most plans (2030 for others, depending on the plan's year-end).... The fee and the related IRS Form 720 are due no later than July 31st."

Graydon

[Guidance Overview]

Kids Are Home for the Summer, So Can Parents Take FFCRA Leave?

"My employees have been teleworking successfully since we all got sent home in March. Now that it's summer, they want FFCRA leave to cultivate their sun tans -- I mean, take care of their kids. But their kids have been out of school since March, and the employees were able to work! Can I ask what's changed, and maybe deny the leave?"

Constangy, Brooks, Smith & Prophete LLP

COVID-19 and the Impact on Telehealth Services

"Recent [Medicare] policy changes have temporarily relaxed restrictions on where and by whom telehealth services can be provided, making them much more accessible during the current public health emergency.... Waiver of originating site requirement ... New or existing patients ... Expanded list of services and providers ... Audio vs. video."

ORBA

Telehealth Claim Lines Increase 4,347% Nationwide in a Year

"Telehealth claim lines increased 4,347% nationally from 0.17% of medical claim lines in March 2019 to 7.52% in March 2020 ... The data represent the privately insured population, excluding Medicare and Medicaid.... Telehealth claim lines grew 15,503% in the Northeast, from 0.07% of medical claim lines in March 2019 to 11.07% in March 2020[.]"

American Journal of Managed Care

California Legislators Propose New Employee Leave Laws

"[T]here are four bills pending that will expand or create a new leave of absence on employers with at least a single employee: [1] AB 3216: 12 weeks of leave under CFRA a year, 4 months of pregnancy disability leave, 80 hours of emergency leave/year, and at least 3 days of paid sick leave/year. [2] AB 2999: 10 days of bereavement leave per year. [3] SB 1383: unlimited time off from work for a school closure or day care closure. [4] AB 2992: protected time off for an employee who is a victim of a crime or a family member who is a victim of a crime ... These proposed leaves of absence are in addition to the existing leaves of absence California already has in place."

Benefit Revolution

Employers Face Decisions Over Keeping Telework Options

"While some employees are happy to stop working from home and to return to the worksite, others would like their organizations to continue allowing remote-work opportunities. Employers, however, view things differently."

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

[Opinion]

Health Care Reform Design Issues and Trade-Offs Facing Us Today

"This paper describes the central issues at the heart of current health care reform proposals, with a focus on understanding that each proposal requires society to make difficult choices and appreciating the trade-offs of each choice."

Urban Institute

Benefits in General

[Guidance Overview]

COVID-19: IRA and HSA Providers Have Until August 31 to File Form 5498 for 2019

"The IRS recently issued new guidance in Notice 2020-35 that further extends the July 15, 2020 deadline until August 31, 2020 for IRA trustees, custodians, and issuers to file Form 5498 (IRA Contribution Information) for 2019 with the IRS and provide a copy to IRA owners and beneficiaries. This extension also applies to Form 5498-ESA (Coverdell Contribution Information) and Form 5498-SA (HSA, Archer MSA, or Medicare Advantage MSA Information). The Notice further explains that the penalty for failure to file Form 5498 will not begin to accrue until September 1, 2020."

Morgan Lewis

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 BenefitsLink.com, 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 BenefitsLink.com, 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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