Health & Welfare Plans Newsletter

July 16, 2020

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View COVID-19 News and Resources

[Official Guidance]

Text of DOL Request for Information: State- and Employer-Provided Paid Leave Programs

"The Department is publishing this Request for Information (RFI) to gather information concerning the effectiveness of current state- and employer-provided paid leave programs, and how access or lack of access to paid leave programs impacts America's workers and their families. The information provided will help the Department identify promising practices related to eligibility requirements, related costs, and administrative models of existing paid leave programs."

Women's Bureau, U.S. Department of Labor [DOL]

[Official Guidance]

Text of DOL Request for Information: Family and Medical Leave Act of 1993

14 pages. "The [DOL] is seeking information from the public regarding the regulations implementing the Family and Medical Leave Act of 1993 (FMLA). The Department is publishing this Request for Information (RFI) to gather information concerning the effectiveness of the current regulations and to aid the Department in its administration of the FMLA. The information provided will help the Department identify topics for which additional compliance assistance could be helpful, including opportunities for outreach to ensure employers are aware of their obligations under the law and employees are informed about their rights and responsibilities in using FMLA leave."

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

[Guidance Overview]

Editor's Pick DC Employees Now Eligible to Collect Benefits Under the Universal Paid Leave Amendment Act of 2016: List of Action Steps

"As of July 1, 2020, ... employees are now eligible to collect benefits.... [1] [M]ake sure to post and distribute the required notice.... [2] Identify employees covered by the Act in light of updated guidance, especially when so many employees are working remotely outside of DC during the COVID-19 pandemic.... [3] Consider how (or whether) current paid leave policies should change in light of the new UPL benefit.... [4] Check whether current policies distinguish between extended medical leave and brief sick leave to better coordinate across the expanding leave landscape."

Epstein Becker Green

[Guidance Overview]

DOL Issues FFCRA Guidance on Camp Closures

"As [FAB 2020-4] acknowledges, there is no one-size-fits-all rule establishing employee eligibility for FFCRA leave in light of summer camp and program closures this summer. Rather, employers will be left to determine in each case whether the camp or program would have been the child's place of care but for COVID-19 related reasons."

Buck

[Guidance Overview]

Editor's Pick DOL Announces Enhancements to Assist Employees, Employers and Other Stakeholders in Use of Family and Medical Leave

"WHD’s new forms are simpler and easier for employees, employers, leave administrators and healthcare providers to understand and use. Revised with substantial public input, the forms include more questions that users can answer by checking a response box and electronic signature features to reduce contact. WHD believes the changes will reduce the time users spend providing information, improve communications between leave applicants and administrators and reduce the likelihood of violations."

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

[Guidance Overview]

HHS Final Regs Address Disclosures of Substance Use Disorder Records to Align More Closely with HIPAA

"[T]he final regulations reiterate that, if a patient consents to disclosure of information for payment or health care operations, the recipient of the patient information may further disclose the information to its contractors, subcontractors, and legal representatives for payment and health care operations without additional consent.... [T]he regulations now contain a non-exhaustive list of activities (previously mentioned only in a regulatory preamble) that will be considered payment and health care operations. Listed activities include claims management, obtaining payment under a contract for reinsurance, underwriting, enrollment, determinations of eligibility or coverage, medical necessity reviews, care coordination, and case management."

Thomson Reuters / EBIA

[Guidance Overview]

Proposed Regs Would Increase Flexibility for Grandfathered Health Plans

"The proposal includes updated statistics on grandfathered plans: In 2019, approximately 22% of employers that offered health benefits offered at least one grandfathered group health plan (down from 72% in 2011), and 13% of workers with employer-sponsored coverage were enrolled in a grandfathered group health plan in 2019 (down from 56% in 2011). Although the number of grandfathered plans has decreased each year since the ACA was enacted, the agencies believe that some employers, insurers, and participants continue to find value in grandfathered plans."

Thomson Reuters / EBIA

ACA Reporting Compliance: Inspector General's Report May Foreshadow a More Intolerant IRS

"The Treasury Inspector General for Tax Administration (TIGTA) recently reported that, due to the IRS's leniency related to ACA employer mandate compliance and reporting, penalty collections under the ACA for violations of the mandate have been a fraction of what was expected at the time of the ACA passage.... Unfortunately for employers, rather than ascribing that deficit to poor prognostication skills on the part of the CBO, TIGTA ascribed that disparity to deficiencies -- too soft gloved an approach -- in the IRS assessment and collection process."

Lockton

Amazon Teams with Crossover Health to Pilot Employee Health Centers

"The first pilot of the 'Neighborhood Health Centers' -- which will made available exclusively to the tech giant's employees and their families -- will be located in the Dallas-Fort Worth area ... Crossover will fully operate and staff the centers ... Amazon ultimately expects to establish 20 health centers in five cities across the U.S."

FierceHealthcare

Ohio Attorney General Sues Express Scripts to Recoup Alleged Prescription Overcharges

"The suit, filed on behalf of the Ohio Highway Patrol Retirement System, seeks to recover unspecified damages from Express Scripts, which had been the PBM for HPRS' health plans since 2010. 'This particular PBM egregiously charged for services it didn't deliver," [Ohio Attorney General Dave Yost] said. 'Its repeated breaches cost Ohioans millions, and we want our money back.' " [Ohio Highway Patrol Retirement System v. Express Scripts, Inc., No. AM-20CV004504 (Franklin Cty. Ohio, complaint filed Jul. 13, 2020)]

National Center for Policy Analysis [NCPA]

2021 Health Benefits: Get Smart About Controlling Costs Without Leaving Employees Exposed

"If you've only tried one route, such as traditional group options, now may be the time to get a quote from other partners who can design different plans around your needs.... Consider what's most important to your team from a flexibility standpoint -- being able to adjust your contributions from year to year, allow employees to seamlessly switch between coverage options, the ability for employees to take benefits with them when they go, and so on.... Does your partner offer regular check-ins, easy-to-understand reporting, digital portals for employers and employees to access account information, or ongoing consulting and support to make the best decisions for your team and your budget?"

Financial Executives International Daily

Ripple Effects: Assessing Impacts of the Supreme Court's Risk Corridors Decision

"[Q]uestions of the government's full liability for Risk Corridor payments could potentially linger for several years. Separately, the Court's decision may affect insurer claims for payment under the ACA's cost-sharing reduction (CSR) program, which compensates insurers to help cover the cost of required reductions in an insured's cost sharing. Finally, HHS and insurers may need to consider how Risk Corridor settlements or judgments should be treated under the ACA's medical loss ratio calculation rules. This Sidebar examines each of these potential ripple effects in turn and notes considerations for Congress." [Maine Community Health Options v. U.S., No. 18-1023 (S. Ct. Apr. 27, 2020)] [LSB10519 Jul. 16, 2020]

Congressional Research Service [CRS]

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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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