Health & Welfare Plans Newsletter

August 3, 2020

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COBRA Compliance
August 20, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Voluntary Fiduciary Correction Program
August 20, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Benefit Flexibility: Who, What, Why, and Other Great Questions - Answered
August 26, 2020 WEBCAST
ArmadaCare

COBRA Compliance
September 17, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

COBRA Compliance
October 15, 2020 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

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[Guidance Overview]

California Releases Details on Employer Reporting for Its Individual Health Insurance Mandate

"To date the most detailed document California has released regarding employer reporting for the State's individual mandate is the draft copy of publication 3895C. The State wisely decided to allow employers to use the same Forms the employer submits to the federal government to satisfy the California employer reporting requirement.... What some employers may find worrisome is the draft publication states the California due date to furnish the Form 1095-C to California residents will remain January 31, 2021 regardless of any federal extension."

Accord

[Guidance Overview]

A Primer on the Filing of an ACA Protective Refund Claim

"Sometime this year or next, the U.S. Supreme Court may once again decide on the constitutionality of the [ACA]. A ruling by the Court against the ACA may give rise to refunds of certain taxes ... paid by individuals and certain trusts ... In the case of an extended 2016 tax return (Form 1040 or Form 1041 for certain trusts) filed after July 15, 2017, and through October 16, 2017, the extended filing date is generally three years from the 2017 filing date; there are additional extended filing opportunities where 2016 tax filings were filed after October 16, 2017. By filing a PRC, the statute of limitation generally remains open until the constitutional issues are resolved."

EisnerAmper

Editor's PickHow the Pharmacy Benefit Industry Is Reacting to a Pandemic: Policy Changes, Actions, and Potential Impacts

"PBMs are a major influencer in the supply chain of outpatient pharmaceutical products ... These entities have moved quickly to develop new policies that provide guidance and assurance to their plan sponsor clients and members amid the coronavirus outbreak.... This discussion highlights actions PBMs are taking across these segments and the potential effects on plan sponsors and members."

Milliman

Million Dollar Laptop: The Perils of HIPAA, Encryption, and Mobile Devices

"[HHS] has closed an investigation into a Rhode Island health system stemming from a 2017 breach.... The incident is a reminder to all HIPAA-regulated organizations, whether covered entities or business associates, of the necessity of encrypting all mobile data devices.... [A]ccess to encrypted data does not constitute a breach."

Poyner Spruill LLP

D.C. Court of Appeals Opinion Upholding HHS Cuts to Medicare Drug Reimbursement Rates (PDF)

42 pages. "[HHS] reduced the reimbursement rate for covered drugs by 28.5% ... for 340B hospitals because they can obtain drugs far more cheaply than other hospitals.... Several hospitals and hospital associations challenge HHS's decision, claiming that it rests on an impermissible construction of the governing statute.... We hold that HHS's decision to lower drug reimbursement rates for 340B hospitals rests on a reasonable interpretation of the Medicare statute." [American Hospital Ass'n v. Azar, No. 19-5048 (D.C. Cir. Jul. 31, 2020)]

U.S. Court of Appeals for the District of Columbia Circuit

Variation in Health Care Prices Across Public and Large Private Payers

"[P]rivate insurers pay 37 percent more than [traditional Medicare (TM)], and [Medicare Advantage] pays 10 percent more than TM for the five most common inpatient diagnoses....Among the five largest US insurers, the most expensive insurer negotiates prices that are 5-26 percent higher than the mean price for the 20 most common inpatient diagnoses. Additionally, we find a 10 percent increase in insurer market share corresponds to a 7 percent decrease in inpatient negotiated prices and a 10 percent decrease in the standard deviation of prices. This finding suggests that increased insurer market power allows payers to negotiate prospective payment contracts -- rather than the more common fee-for-service payments -- thereby offloading financial risk to providers."

National Bureau of Economic Research [NBER]; purchase required for full document

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When Does a Program of Medical Stipends for Terminees Become Subject to ERISA?

"Terminated employees who meet certain requirements are given a stipend to be used to purchase their own medical coverage from one of several designated insurance providers. (If one provider is more expensive, the employee covers the difference.) Then they're treated as being within the same group by the provider. At what point is this considered a group plan subject to ERISA?"

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