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[Official Guidance]

Text of Agency Final Regs: Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage

82 pages. "This document includes final rules regarding grandfathered group health plans and grandfathered group health insurance coverage that amend current rules to provide greater flexibility for certain grandfathered health plans to make changes to certain types of fixed- amount cost-sharing requirements without causing a loss of grandfather status under the [ACA]." Icon to read more

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Department of the Treasury

[Official Guidance]

Text of HHS Proposed Modifications to the HIPAA Privacy Rule (PDF)

357 pages. "[HHS] is issuing this Notice of Proposed Rulemaking (NPRM) to modify the Standards for the Privacy of Individually Identifiable Health Information (Privacy Rule) under [HIPAA and the HITECH Act]. These modifications address standards that may impede the transition to value-based health care by limiting or discouraging care coordination and case management communications among individuals and covered entities (including hospitals, physicians, and other health care providers, payors, and insurers) or posing other unnecessary burdens. The proposals in this NPRM address these burdens while continuing to protect the privacy and security of individuals' protected health information." Icon to read more

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

[Official Guidance]

Text of Draft IRS Publication 15-B: Employer's Tax Guide to Fringe Benefits, for Use in 2021 (PDF)

35 pages, Dec. 3, 2020. "What's New: Cents-per-mile rule.... Qualified parking exclusion and commuter transportation benefit.... Contribution limit on a health flexible spending arrangement (FSA).... New Form 1099-NEC. " Icon to read more

Internal Revenue Service [IRS]

[Guidance Overview]

DOL, HHS and Treasury Issue Final Rule to Provide Greater Flexibility for Grandfathered Group Health Plans

"[T]he rule clarifies that grandfathered group health coverage that is a high deductible health plan (HDHP) may increase fixed-amount cost-sharing requirements, such as deductibles, to the extent necessary to maintain its status as an HDHP without losing grandfather status. This change ensures that participants and beneficiaries enrolled in that coverage remain eligible to contribute to a health savings account. Second, the final rule provides an alternative method of measuring permitted increases in fixed-amount cost sharing that allows plans and issuers to better account for changes in the costs of health coverage over time." Icon to read more

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Department of the Treasury

[Guidance Overview]

HHS Proposes Modifications to the HIPAA Privacy Rule

"The proposed changes ... include strengthening individuals' rights to access their own health information, including electronic information; improving information sharing for care coordination and case management for individuals; facilitating greater family and caregiver involvement in the care of individuals experiencing emergencies or health crises; enhancing flexibilities for disclosures in emergency or threatening circumstances, such as the Opioid and COVID-19 public health emergencies; and reducing administrative burdens on HIPAA covered health care providers and health plans, while continuing to protect individuals' health information privacy interests." Icon to read more

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

[Guidance Overview]

Pittsburgh Ordinance Requires Employers to Provide Paid Sick Leave for COVID-19-Related Reasons, Effective Immediately

"COVID-19 Sick Time is to be made available immediately to eligible employees without any waiting period or accrual. COVID-19 Sick Time may be used intermittently and in the smallest increment that the employer's payroll system uses to account for absences or use of other time. Under the Ordinance, employees need only give employers notice of the need for COVID-19 Sick Time as soon as practicable. Employers are expressly prohibited from requiring employees to find someone to replace them if they take COVID-19 Sick Time." Icon to read more


Supreme Court: ERISA Does Not Preempt Arkansas Regulation of PBMs

"The Court held that 'Act 900 is merely a form of cost regulation' that applies equally to all PBMs and pharmacies in Arkansas, and therefore is not impermissibly connected with an ERISA plan. A statute refers to ERISA when it 'acts immediately and exclusively upon ERISA plans or where the existence of ERISA plans is essential to the law's operation.' The Court concluded that Act 900 does not refer to ERISA because it applies to all PBMs without regard to whether the PBM manages an ERISA plan." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Faegre Drinker

How Health Benefit Analytics Support Organizational Financial Health and Employee Wellness

"While many take the easy route to managing rising health benefit costs by cutting benefits or increasing employees' cost burden, it's not a sustainable fix. The smarter approach is to learn what's driving those costs and then act. Health benefits analytics are a major part of the solution: They provide employers with real-time insights into utilization patterns and healthcare costs. These insights can lead to improved cost containment and smarter multi-year benefits strategies -- and a better negotiating position at renewal." Icon to read more

HUB International

Can an Employer Lawfully Deny a Bonus to an Employee Who Takes FMLA or FFCRA Leave?

"[W]hen qualifying employees for, and/or calculating bonus payments under the FMLA regulations, employers must treat employees who take FMLA leave the same as those who are on 'an equivalent leave status for a reason that does not qualify as FMLA leave.' " Icon to read more

FMLA Insights

How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems

"CBO describes the methods it has developed to analyze the federal budgetary costs of proposals for single-payer health care systems that are based on the Medicare fee-for-service program. Five illustrative options show how differences in payment rates, cost sharing, and coverage of long-term services and supports under a single-payer system would affect the federal budget in 2030 and other outcomes. CBO's projections of national health expenditures under current law are a key basis for the estimates." [Working Paper 2020-08, Dec. 10, 2020] Icon to read more

Congressional Budget Office [CBO]


Supreme Court Rules That States Can Regulate PBMs

"The unanimous (8-0) decision ruled in favor of the interests of community pharmacies' favor, who have been fighting for several years to regulate pharmacy benefit managers (PBMs) ... The ruling is a win for 45 states, led by Arkansas, who now have more authority to protect local businesses and their patients from PBM overreach." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Pharmaceutical Commerce

Benefits in General

[Official Guidance]

Text of Draft IRS Publication 15-A: Employer's Supplemental Tax Guide, for Use in 2021 (PDF)

28 pages, Dec. 10, 2020. Topics include: [1] Who are employees? [2] Employee or independent contractor? [3] Employees of exempt organizations. [4] Religious exemptions and special rules for ministers. [5] Wages and other compensation. [6] Sick pay reporting. [7] Pensions and annuities. Icon to read more

Internal Revenue Service [IRS]

Congressional Pushback to Recent IRS Guidance on Deductibility of Expenses Related to PPP Loans

"Given existing Internal Revenue Code provisions and regulations, as well as federal case law, regarding the tax deductibility of reimbursable expenses, it might be challenging for the Treasury Department and IRS to now stake out a rationale that directly opposes the position it has taken in Notice 2020-32, Revenue Ruling 2020-27, and Revenue Procedure 2020-51. However, the joint statement by Senators Grassley and Wyden indicates that there is bipartisan support for a potential legislative solution[.]" Icon to read more

Groom Law Group

Press Releases

Most Popular Items in the Previous Issue

Legal Considerations When an Employee Dies
Pillsbury Winthrop Shaw Pittman LLP

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