Health & Welfare Plans Newsletter

December 21, 2020

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[Official Guidance]

Text of HHS FAQs: HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (PDF)

"This guidance addresses how the [HIPAA] Privacy Rule permits a covered entity or its business associate to use health information exchanges (HIEs) to disclose protected health information (PHI) for the public health activities of a public health authority (PHA).... [1] What is a Health Information Exchange (HIE)? ... [2] When does the HIPAA Privacy Rule permit a covered entity or its business associate to disclose PHI to an HIE for purposes of reporting the PHI to a PHA, without an individual's authorization? ... [3] Can a covered entity rely on a PHA's request to disclose a summary record to a PHA or HIE as being the minimum necessary PHI needed by the PHA to accomplish the public health purpose of the disclosure? ... [4] May a covered entity disclose PHI to a PHA through an HIE without receiving a direct request from the PHA? ... [5] May an HIE provide PHI it has received as a business associate of a covered entity to a PHA for public health purposes without first obtaining permission from the covered entity? ... [6] Is a covered entity required to provide notice to individuals about its disclosures of PHI to a PHA for public health purposes? Is an HIE that is a business associate required to provide such notice?" Icon to read more

Office of Civil Rights [OCR], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

HHS Proposes Changes to the HIPAA Privacy Rule

"[A]mong other provisions, the Proposed Rule proposes modifications to the Privacy Rule that improve an individual's access to PHI and clarify the scope of care coordination and case management.... [M]any of the key provisions of the Proposed Rule ... also reflect a U.S. District Court for the District of Columbia decision from earlier this year that vacated in part certain HHS regulations regarding the delivery of an individual's PHI to third parties." Icon to read more

Ropes & Gray LLP

[Guidance Overview]

Exceptional Usefulness and Quality iconACA Reporting Penalties

"The general ACA reporting penalties are $280 for the late/incorrect Forms 1095-C furnished to employees, and $280 for the late/incorrect Forms 1094-C and 1095-C filed with the IRS. That comes to a total potential general penalty of $560 per employee, but exceptions may apply." Icon to read more

ABD Insurance & Financial Services

[Guidance Overview]

Upcoming Deadline iconMassachusetts Releases New Forms and Updates Ahead of Tiered Benefits Rollout

"In anticipation of the availability of most benefits on January 1, 2021, the [Massachusetts Department of Family and Medical Leave (DFML)] has released helpful materials ... to guide employers and workers. The DFML has also issued a new workplace poster that must be displayed in the workplace.... [This] summary contains details about the new updates and links to forms prepared by the DFML." Icon to read more

Epstein Becker Green

[Guidance Overview]

Paid Family and Medical Leave Benefits Available to Massachusetts Employees on Jan. 1, 2021

"Starting Jan. 1, 2021, employees in Massachusetts may begin to apply for and receive paid leave under the state's new Paid Family and Medical Leave (PFML) law. Most Massachusetts workers will be eligible to take up to 26 weeks of paid leave per benefit year under the new law. Massachusetts employers should be taking the final steps necessary to ensure they comply with their obligations under PFML." Icon to read more

Holland & Knight

Pelosi, Schumer Joint Statement on Coronavirus Relief and Omnibus Agreement

"The package includes bipartisan, bicameral legislation that will end surprise billing for emergency and scheduled care.... The agreement provides a tax credit to support employers offering paid sick leave, based on the Families First framework.... The agreement extends and improves the Employee Retention Tax Credit to help keep workers in the jobs during coronavirus closures or reduced revenue." Icon to read more

House Speaker Nancy Pelosi and Senate Democratic Leader Chuck Schumer

Supreme Court Holds Arkansas Statute Regulating PBMs Not Preempted by ERISA

"The Court's opinion reinforces that ERISA preemption does not have as broad of a sweep as the statute's language might suggest. State laws that may indirectly impact a plan's costs or a participant's benefits, that 'establish[] a floor for the cost of the benefits that plans choose to provide,' ... do not impact 'central matters of plan administration' and so are not preempted. The Court's ruling will no doubt embolden states seeking to regulate pharmacy and PBM conduct, and will be relied upon by parties seeking to protect state law-based rights in court, with respect to prescription drug reimbursement or otherwise." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon to read more

Arent Fox

The Implications of Rutledge v. PCMA for State Health Care Cost Regulation

"The decision opens up further avenues beyond PBMs to broader state health reforms aimed at reigning in the costs of health services and prescription drugs, protecting consumers, and expanding affordable access to more people.... Most immediately, Rutledge puts PBM regulations passed by more than 45 states on much firmer footing. These laws do different things, but they are all aimed at reigning in prescription drug costs." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] Icon
to read more

Erin C. Fuse Brown and Elizabeth Y. McCuskey, via Health Affairs Blog

Recent Successful Benefit Claim Against Employer Highlights Importance of Prudent Service Provider Selection and Document Review

"Even though Sullivan alerted her employer's TPA several times that she believed her life insurance benefits were incorrectly calculated, the matter was never fully investigated. Employers that outsource plan administration need to put processes in place for accurate reporting and monitor vendors to assure compliance." [Sullivan-Mestecky v. Verizon Communications Inc., No. 18-1591 (2d Cir. Jun. 1, 2020)] Icon to read more

Hall Benefits Law

Self-Insured Health Plans: Checking the Health of Your Third-Party Administrator

"TPA audits are a powerful tool employers can use to meet their fiduciary duty, and they offer an unbiased view of the TPA's accuracy of processing claims. A typical claims audit includes ... [1] Review the Administrative Services Agreement (ASA) ... [2] Analyze the data ... [3] Test a sample of claims." Icon to read more

Withum Smith+Brown, PC

Marketplace Pulse: Prescription Drug Benefits

"There are major differences between ACA plans and large group employer coverage when it comes to drug benefits. Individual and small group plans both have more formulary tiers than large group plans. Nearly all (95%) of individual market and 93 percent of small group plans have four or more tiers compared with 54 percent of traditional employer plans and 36 percent of high deductible employer plans. More tiers translates into higher out of pocket costs, since patient cost-sharing is higher for brand and specialty drugs." Icon to read more

Robert Wood Johnson Foundation

[Opinion]

Forget the 'Progressive' Promise of Free Care for All When It Comes to Government-Controlled Health Care

"Government-imposed lower payment rates and the provision of care 'free' at the point of service induces increased demand. These Medicare payment reductions and caps can also reduce the supply and the availability of services. Waiting times for care in 'model single-payer' Canada are the worst among economically advanced nations." Icon to read more

The Heritage Foundation

Press Releases

DOL Files Complaint to Protect Participants and Beneficiaries of Failing Medova MEWA Operating in 38 States
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Most Popular Items in the Previous Issue

IRS Regulatory Agenda, Fall 2020 (Employee Benefit Items)
Internal Revenue Service [IRS], U.S. Department of the Treasury

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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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