Health & Welfare Plans Newsletter

November 30, 2020

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[Official Guidance]

Text of HHS Proposed Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates to State Innovation Waiver (Section 1332 Waiver) Implementing Regs (PDF)

395 pages. "This proposed rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It includes proposed changes related to special enrollment periods; Navigator program standards; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; acceptance of payments by issuers of individual market Qualified Health Plans; and other related topics. It proposes clarifications to the regulation imposing network adequacy standards with regard to Qualified Health Plans that do not use provider networks. It proposes changes to the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. It also proposes a new direct enrollment option for Federally-facilitated Exchanges and State Exchanges. This proposed rule also proposes changes related to section 1332 State Innovation Waivers." [Also see: Fact Sheet and Press ReleaseIcon to read more

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

[Official Guidance]

Text of HHS Final Regs: HHS-Operated Risk Adjustment Data Validation Under the ACA's HHS-Operated Risk Adjustment Program

83 pages. "This final rule adopts certain changes to the risk adjustment data validation error estimation methodology beginning with the 2019 benefit year for states where [HHS] operates the risk adjustment program. This rule is finalizing changes to the HHS-RADV error estimation methodology, which is used to calculate adjusted risk scores and risk adjustment transfers, beginning with the 2019 benefit year of HHS-RADV. This rule also finalizes a change to the benefit year to which HHS-RADV adjustments to risk scores and risk adjustment transfers would be applied beginning with the 2020 benefit year of HHS-RADV." Icon to read more

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

[Official Guidance]

Text of IRS Final Regs Clarifying Premium Tax Credit Unaffected by Suspension of Personal Exemption Deduction

14 pages. "This document includes final regulations under sections 36B and 6011 of the Internal Revenue Code that clarify that the reduction of the personal exemption deduction to zero for taxable years beginning after December 31, 2017, and before January 1, 2026, does not affect an individual taxpayer's ability to claim the premium tax credit. These final regulations affect individuals who claim the premium tax credit." Icon to read more

Internal Revenue Service [IRS]

[Guidance Overview]

The 2022 Proposed Payment Notice: Exchange Provisions

"In the proposed rule's most dramatic change, CMS would allow states to opt into an Exchange Direct Enrollment (Exchange DE) option where states could transition away from a single, centralized exchange (HealthCare.gov) to enrollment via private sector entities (insurers, web-brokers, and agents and brokers)." Icon to read more

Katie Keith, via Health Affairs Blog

[Guidance Overview]

The 2022 Proposed Payment Notice: Medical Loss Ratios, Special Enrollment Periods, and More

"CMS proposes to amend the definition of prescription drug rebates and other price concessions in its MLR formula.... The 2022 proposed payment notice includes no changes regarding the coverage of essential health benefits (EHB) and instead merely lays out timelines for state reporting.... CMS proposes a series of changes to special enrollment periods (SEPs) for exchange enrollees who become newly eligible for APTC and for those who are eligible for a SEP but did not receive timely notice of the triggering event. CMS also addresses the cessation of employer contributions to COBRA." Icon to read more

Katie Keith, via Health Affairs Blog

[Guidance Overview]

The 2022 Proposed Payment Notice: Risk Adjustment

"This post considers the proposed changes to the risk adjustment program related to user fees, recalibration of the risk adjustment models, the model itself, enrollment duration factors, and changes to risk adjustment data validation (RADV) requirements[.]" Icon to read more

Katie Keith, via Health Affairs Blog

Private Industry Employer Health Benefits Costs Rise for Year Ending September 2020

"Health benefits costs for private industry employers increased 1.8 percent for the 12 months ending in September 2020. Employer health benefits costs have increased by 2.3 percent or less in every 12-month period since March 2017. These data begin in 1982." Icon to read more

U.S. Bureau of Labor Statistics [BLS]

[Opinion]

UnitedHealth ERISA Ruling Exposes Faults in Behavioral Health Coverage

"The court's judgment goes directly to the heart of America's health care system, which does not always render coverage decisions that are consistent with medical necessity and in accordance with treatment recommended by patients' medical providers but instead has ... put insurers' profits ahead of patients' health. The Wit rulings are also a major step toward bringing an end to the stigmatization of those with mental illness and fulfilling the promise of the Mental Health Parity and Addiction Equity Act." [Wit v. United Behavioral Health, Nos. 14-2346, 14-5337 (N.D. Cal. Nov. 3, 2020)] Icon to read more

DeBofsky Sherman Casciari Reynolds P.C.

Benefits in General

The Best Employee Perks That Actually Help Retention

"[K]eeping employees happy is a function of not only having meaningful work to do, but also compensating them appropriately for that work. In recent years, this has led to an ever-growing number of 'perks' that firms offer employees to keep them happy, from retirement benefits to health insurance, to education reimbursement to student loan support, and gym memberships, and employer-provided meals. But in the end, employers can't just pile on a never-ending stream of employee benefits and perks in the hopes that it will help employees to retain; at some point, the question becomes: what are the best 'perks' and employee benefits that really, actually help to retain employees?" Icon to read more

Nerd's Eye View

Press Releases

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
Holly Horton, Business Manager  hollyhorton@benefitslink.com

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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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