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July 29, 2020

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View COVID-19 News and Resources

[Guidance Overview]

D.C. Requires Employers to Provide Paid and Unpaid COVID-19 Leave

"D.C. employers now must navigate an additional set of paid and unpaid leave requirements.... The CSEA requires employers (except for health care providers) with between 50 and 499 employees to provide employees with up to two weeks (for a maximum of 80 hours) of paid 'public health emergency leave' for any of the reasons paid leave is available under the [FFCRA]."

Proskauer

Tenth Circuit Addresses Standard of Review for Benefit Claim Denials

"[T]he US Court of Appeals for the Tenth Circuit held that a de novo standard of review (rather than the more deferential arbitrary and capricious standard) applied to the denial because the claims administrator failed to notify the participants of its discretionary authority. Even if the deferential standard of review applied, however, the Tenth Circuit concluded that the claims administrator failed to properly apply its medical necessity criteria, and therefore acted arbitrarily and capriciously." [Lyn M. v. Premera Blue Cross, No. 18-4098 (10th Cir. Jul. 24, 2020)]

Thomson Reuters Practical Law

Cross-Plan Offsetting Practice Is Challenged in Class Action Lawsuit

"[E]mployers/plan sponsors should consider the following actions: [1] Review TPA service agreements and any benefit booklets issued by the TPA ... to determine whether the TPA uses cross-plan offsetting; [2] If cross-plan offsetting is used by the TPA, determine whether the employer can opt out of that practice; and [3] Ensure that any service agreements with a TPA that uses cross-plan offsetting contain adequate indemnification against any losses or damages that the employer may incur in the event that cross-plan offsetting is determined to be in violation of ERISA[.]" [Scott v. UnitedHealth Group, Inc., No. 20-1570 (D. Minn. complaint filed Jul. 14, 2020)]

Haynes and Boone, LLP

Employers Rate the Quality of Health Plans

"At 71%, Cigna rated the highest for responsiveness to employer priorities.... Cigna and Aetna also led the pack at putting employer needs above the contracted provider needs, but only at 38% each.... 56% of employers said their plans made it easy to get usable data, while 43% said their plans provided employees with information on quality.... Only a little over half of the employers surveyed were satisfied with their health plans helping to reduce unnecessary costs.... Asked to grade their health plans overall from A to F, employers graded BCBS the highest at 2.56, with Cigna not far behind."

BenefitsPro; free registration required

HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization Amid COVID-19

"[T]elehealth adoption increased by nearly 50 percent in primary care at the peak ... While the report did not analyze specialist visits, other studies mentioned in the report have also shown dramatic increases in telehealth use during the pandemic among specialists such as psychiatry, gastroenterology and neurology[.]"

U.S. Department of Health and Human Services [HHS]

Medicare Beneficiary Use of Telehealth Visits: Early Data from the Start of the COVID-19 Pandemic

"This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the [public health emergency (PHE)].... The analysis found Medicare primary care visits dropped precipitously from mid-March at the start of the pandemic, at the same telehealth visits increased for primary care. Nearly half of Medicare primary care visits were provided via telehealth in April, compared with less than one percent before the PHE in February."

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

IRS Addresses Reconciliation and Recapture Rules for Tax Credits Under FFCRA and CARES Act

"In issuing its temporary regulations, the IRS indicated that a refund, credit, or advance of any part of the credits to an employer that is more than the amount to which the employer is entitled is an erroneous refund for which the IRS will seek repayment through a recapture process."

Thomson Reuters Practical Law

Who Pays for Health Care Costs? The Effects of Health Care Prices on Wages

"[The authors] find that hospital mergers lead to a $521 increase in hospital prices, a $579 increase in hospital spending among the privately insured population and a similar, $638 reduction in wages. Both the hospital price and spending increases and the reduction in wages are driven by mergers that occur within hospital markets, rather than cross-market hospital mergers. [These] results imply that consumers bear the price effects of hospital mergers in the form of reduced wages. [The authors] also find evidence of changes in benefit design structure and adoption of high-deductible health plans."

RAND Corporation

[Opinion]

Executive Orders Take Aim at Prescription Drug Costs

"Not only are the orders not designed to save money for employer plans, the orders themselves do not have the force of law. Instead, they merely direct various regulatory agencies to issue rules consistent with the principles expressed in the orders."

Lockton

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