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[Official Guidance]

Text of HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' Software Instructions for the 2020 Benefit Year (PDF)

24 pages; Aug. 3, 2020 update. "The methodology that HHS will use when operating a risk adjustment program on behalf of a State for the 2020 benefit year will calculate a plan average risk score for each covered plan based upon the relative risk of the plan's enrollees, and apply a state payment transfer formula in order to determine risk adjustment payments and charges for plans within a State market risk pool." [Also available:  Instructions (PDF); Technical Details (PDF); and 2019 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]

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

[Guidance Overview]

New Massachusetts Paid Family and Medical Leave Regs: Here Are Big Picture Issues for Employers

"Final regulations are out, and the DFML is expected to be issuing additional guidance and forms prior to January 1, 2021. Pending that further guidance, it may be a bit early for employers to formally adopt a policy that specifically addresses the PFMLL, beyond the information already provided in the poster and legally required notices. In the meantime, however, there is plenty that employers can do now to get ready."

Hirsch Roberts Weinstein LLP

Federal District Court Nixes Several Aspects of FFCRA Regs, Creating Compliance Headaches for Employers

"[T]he Court determined that DOL could not require that employees actually be working in order to take FFCRA leave.... This. Is. A. Big. Deal.... This decision just crashed a semi-trailer through some key FFCRA regulatory provisions that employers have been relying on since April 1, and the DOL would be wise to give some thought to (at a minimum) the manner in which employers should address availability of work and the definition of health care provider.... In the unlikely event this ruling applies retroactively, let's face it: we're all together in a world of hurt." [New York v. U.S. Dept. of Labor, No. 20-3020 (S.D.N.Y. Aug. 3, 2020)]

FMLA Insights

Back to Square One: District Court Ruling Upends Rules for COVID-19 Leave

"As a result of the decision, employers covered by this ruling must now do the following: [1] Determine whether any employees you have been excluding from FFCRA coverage because they fell under the 'health care provider' exemption can still be exempted now that the court narrowed the definition; [2] Avoid using work availability as a consideration when determining whether leave should be provided; [3] Cease requiring your consent prior to allowing otherwise-permitted intermittent leave; and [4] Refrain from requiring documentation as a precondition prior to permitting employees to take available FFCRA leave." [New York v. U.S. Dept. of Labor, No. 20-3020 (S.D.N.Y. Aug. 3, 2020)]

Fisher Phillips

Federal District Court Strikes Down Key Provisions of DOL Regs on FFCRA Paid Sick and Expanded FMLA Leave

"[T]he district court's decision does not make clear whether its decision to vacate portions of the final rule applies only to the state of New York or on a broader, nationwide basis....[The] decision to strike down the work availability requirements opens the door for leave requests by employees who are furloughed or temporarily laid off or whose employers have had to temporarily cease operations under state or local orders, or due to economic circumstances during the pandemic." [New York v. U.S. Dept. of Labor, No. 20-3020 (S.D.N.Y. Aug. 3, 2020)]


Caution Advised iconIn $1 Million HIPAA Settlement, HHS Emphasizes Business Associate and Encryption Compliance

"The [covered entity] will pay $1,040,000 to settle the potential violations resulting from a stolen laptop and must take corrective measures that include encryption compliance, revising its affiliated covered entity status, and designating a business associate (BA) manager to identify its BAs."

Thomson Reuters Practical Law

HHS Issues Report to Address Surprise Medical Billing

"Two proposed solutions to surprise billing mentioned in the Report are rate-setting and independent dispute resolution (IDR).... While opposition to surprise-bill-control legislation has been loud, it should not go without notice that the two largest physician staffing firms happen to be owned by private equity firms who together have spent approximately $58 million on television and radio commercials and nearly $1 million on Facebook ads since last summer in order to influence the surprise billing debate."


Covered California Announces Record-Low Rate Hike for 2021

"Premiums for health plans sold through Covered California, the state's [ACA] insurance exchange, will rise an average of 0.6% next year -- the smallest hike since it started providing coverage in 2014 ... The rate changes will vary across regions, ranging from an average increase of 5.6% in Santa Clara County to reductions of 2.1% in southwestern Los Angeles County and 2.6% in Mono, Inyo and Imperial counties."

Kaiser Health News


COVID-19 Proves Need for Universal Medical Coverage

"Our U.S. healthcare financing is a clumsy mixture of public, private, and employer-based insurance. As the COVID-19 calamity has shown, our current 'hodgepodge' financing denies high-quality care to people who are economically and socially underprivileged. We also allow increasing numbers of Americans to fall into these deprived categories as massive job losses lead to terminations of health insurance."

Erica Heiman, Jack Bernard and Henry Kahn, via Atlanta Journal-Constitution

Press Releases

Most Popular Items in the Previous Issue

Text of CMS Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

View COVID-19 News and Resources, Inc.
1298 Minnesota Avenue, Suite H
Winter Park, Florida 32789
(407) 644-4146

Lois Baker, J.D., President
David Rhett Baker, J.D., Editor and Publisher
Holly Horton, Business Manager

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