Health & Welfare Plans Newsletter

December 22, 2020

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Creative Pension Consultants, Inc.
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[Guidance Overview]

COVID-19 Vaccine Considerations for Group Health Plans

"Coronavirus relief enacted in March requires group health plans and issuers to cover COVID-19 vaccines and other preventive services without cost sharing. An interim final rule issued in November provides guidelines for the COVID-19 preventive-services coverage requirement. The rule took effect immediately and sunsets at the end of the COVID-19 public health emergency." Icon to read more

Mercer

[Guidance Overview]

CMS Issues Final Rule on Value-Based Drug Purchasing Methods for States, Manufacturers and Private Payers

"With the new flexibilities under this final rule, manufacturers will be more willing to negotiate with payers, ... with drug pricing being driven by the value of their drug to the individual patient. This is significant, especially in the era of new genetic-based treatments which may initially be expensive, yet in the long run offer significant value to the patient and payer. Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits, and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price." [Also available: Fact SheetIcon to read more

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

[Guidance Overview]

Proposed Changes to HIPAA Privacy Regs Would Affect Group Health Plans

"The [proposed rule] would clarify that a business associate is required to disclose PHI to the covered entity so the covered entity can meet its access obligations.... [and] would require changes to the notice of privacy practices.... [A] health plan would have to act on a request for access to inspect or obtain a copy of PHI in a shorter timeframe, namely 15 days after receipt of the request.... [The proposed rule] would require health plans to post fee schedules on their website for common types of requests for copies of PHI and, upon request, provide individualized estimates of fees for copies." Icon to read more

Seyfarth Shaw LLP

[Guidance Overview]

Departments Issue Final Rule on Transparency in Coverage

"[The Final Rule imposes] new requirements on group health plans and health insurers in the individual and group markets to disclose cost-sharing information, in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information.... The Final Rule does not apply to grandfathered health plans; account-based group health plans, such as HRAs, including individual-coverage HRAs; or health FSAs, healthcare-sharing ministries, or short-term limited duration insurance plans." Icon to read more

Winston & Strawn LLP

[Guidance Overview]

Proposed Privacy Rules Grant Health Plans New Flexibility, Add New Obligations

"[T]he proposed HIPAA Privacy Rule changes include grant new flexibility to health plans and health care providers to share protected health information ('PHI') for care integration and with family and other caregivers, while also imposing tighter requirements on Covered Entities for providing individuals access to PHI and other individual rights." Icon to read more

Solutions Law Press

[Guidance Overview]

Upcoming Deadline iconNew York State, Modified New York City Sick and Safe Leave Obligations Fully Effective January 1

"The regulations, unfortunately, do not clarify whether the employer headcount determination is based on a state or national employee complement, and whether employers can require a specific amount of notice for the use of protected time, among many other open issues. Further, the regulations do not address whether an employer that frontloads the required 40 or 56 hours must carry over time despite the statute's express limitation on annual usage of 40 or 56 hours." Icon to read more

Jackson Lewis P.C.

[Guidance Overview]

Upcoming Deadline iconMassachusetts Paid Family and Medical Leave: Latest Updates Ahead of January 1, 2021, Effective Date

"The DFML states on its website that 'EMPLOYERS MUST TAKE ACTION' (emphasis in original) by registering a 'leave administrator,' and thereby creating an Employer Account, in order to receive DFML notices showing when employees have started and submitted applications for leave under the PFML Act and when their applications have received determinations." Icon to read more

Ogletree Deakins

Second Circuit Sends PBM 'Clawback' Litigation Plaintiffs Back to the Drawing Board

"The Second Circuit's most recent decision adds to the growing body of case law addressing the question of whether PBMs owe a fiduciary duty to ERISA plan participants when entering into arrangements that may result in PBMs receiving clawback payments.... The Second Circuit agreed with the district court that Anthem was not acting as a fiduciary when it sold the NextRx Companies to Express Scripts.... In addition, the Second Circuit also determined that the district court correctly held that Express Scripts was not a fiduciary." [Doe v. Express Scripts, No. 18-346 (2d Cir. Dec. 7, 2020)] Icon to read more

Akerman

Exceptional Usefulness and Quality iconComprehensive Explanation of the Medicare Part D Prescription Drug Benefit

76 pages. "Medicare Part D has cost less than originally forecasted, due in part to lower-than-predicted enrollment and increased use of less expensive generic drugs. However, the Medicare Trustees project spending on Part D benefits will accelerate over the next 10 years due to the expectation of further increases in the number of enrollees, costs associated with the elimination of the out-of-pocket cost coverage gap in 2020, changes in the distribution of enrollees among coverage categories, a slowing of the trend toward greater generic drug utilization, and an increase in the usage and prices of specialty drugs." [R40611, updated Dec. 18, 2020] Icon to read more

Congressional Research Service [CRS]

Congress Declines to Extend FFCRA Leave, Offers Tax Credits to Those Voluntarily Providing Paid Leave

"[The bill passed by Congress but not yet signed into law by the President] results in the following: [1] Mandated FFCRA Leave ends on December 31, 2020; [2] As of January 1, 2021, covered employers may voluntarily provide emergency paid sick leave or emergency paid FMLA Leave under FFCRA (as adopted earlier this year) and take the tax credit associated with this leave; [3] The tax credit may only be taken for leave through March 31, 2021. In other words, FFCRA leave is no longer required, but if covered employers voluntarily provide these leave benefits through March 31, 2021, they are eligible to take the tax credit for the leave." Icon to read more

FMLA Insights

Benefits in General

[Official Guidance]

Hit the Road, Jack: IRS Issues Standard Mileage Rates for 2021

"Beginning on January 1, 2021, the standard mileage rates for the use of a car (also vans, pickups or panel trucks) will be: 56 cents per mile driven for business use, down 1.5 cents from the rate for 2020, 16 cents per mile driven for medical or moving purposes for qualified active duty members of the Armed Forces, down 1 cent from the rate for 2020, and 14 cents per mile driven in service of charitable organizations, the rate is set by statute and remains unchanged from 2020." Icon to read more

Internal Revenue Service [IRS]

Most Popular Items in the Previous Issue

Text of HR 133: Consolidated Appropriations Act of 2021 (PDF)
U.S. House of Representatives Committee on Rules

Pelosi, Schumer Joint Statement on Coronavirus Relief and Omnibus Agreement
House Speaker Nancy Pelosi and Senate Democratic Leader Chuck Schumer

View COVID-19 News and Resources

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