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[Official Guidance]

Text of CMS Final Regs: ACA Benefit and Payment Parameters for 2022

131 pages. "This final rule sets forth provisions related to user fees for federally-facilitated Exchanges and State-based Exchanges on the Federal Platform. It includes changes related to acceptance of payments by issuers of individual market Qualified Health Plans and clarifies the regulation imposing network adequacy standards with regard to Qualified Health Plans that do not use provider networks. It also adds a new direct enrollment option for federally-facilitated Exchanges and State Exchanges and implements changes related to section 1332 State Innovation Waivers.... These regulations are effective on March 15, 2021." Icon to read more

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

[Guidance Overview]

Text of CMS Fact Sheet: Notice of Benefit and Payment Parameters for 2022 Final Rule (PDF)

"For the 2022 benefit year, HHS is finalizing a user fee rate of 2.25 percent of premiums for issuers offering plans through a Federally-facilitated Exchange (FFE), and a user fee rate of 1.75 percent of premiums for issuers offering plans through State-based Exchanges on the Federal Platform (SBE-FP)....

"HHS is finalizing the proposal to establish in regulation a new option by which a State Exchange, SBE-FP or FFE state may facilitate enrollment of qualified individuals into individual market qualified health plans (QHPs) primarily through approved private-sector, direct enrollment (DE) entities (such as QHP issuers and web brokers)....

"HHS is finalizing a proposal that will require individual market QHP issuers to accept payments made on behalf of an enrollee from an individual coverage health reimbursement arrangement (individual coverage HRA) or qualified small employer health reimbursement arrangement (QSEHRA) when such payments are made using any of the payment methods that QHP issuers are required to accept under existing rules ...

"HHS is finalizing a revision to the QHP network adequacy regulation clarifying that a QHP that does not vary benefits based on whether a covered service is furnished by a provider with whom the QHP has a network participation agreement is not required to comply with the network adequacy standards to be certified as a QHP." Icon to read more

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

[Guidance Overview]

CMS Continues Building Better, More Affordable Insurance Marketplace with Payment Notice for 2022 Coverage Year

"The policies and parameters announced today give consumers, insurers, and other stakeholders across the health care industry ample time to prepare for implementing top priorities in 2022. Those priorities include: [1] Lower premiums.... [2] Flexibility to help states develop their own health care programs that meet unique local needs.... [3] New options for states to develop next generation Exchanges that leverage web-brokers and insurance issuers for the direct purchase of QHPs.... [4] Protective provisions for consumers covered through certain health reimbursement arrangements (HRAs).... [5] Greater clarity on building plans that lack a traditional provider network." Icon to read more

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

[Guidance Overview]

EEOC Issues Long-Awaited Proposed Wellness Program Rules

"The ADA proposed rules would create an entirely new compliance framework for employers that sponsor wellness programs.... If the proposed rules are finalized in their present form, existing wellness programs may need to be reconfigured to fit within the new parameters.... The GINA proposed rules represent a major shift in policy. Previously, employers could offer significant rewards in exchange for a spouse (or other family member) who completes an HRA. The GINA proposed rules would pare this down to a de minimis reward." Icon to read more

Ogletree Deakins

[Guidance Overview]

EEOC Proposes Wellness Program Changes

"The most significant of the proposed ADA rule changes include a de minimis incentive limit for participatory wellness programs and the elimination of the employer notice requirement ... The proposed GINA rule also limits incentives to a de minimis standard, but allows them in exchange for information about a family member's manifestation of disease or disorder." Icon to read more


[Guidance Overview]

EEOC's New ADA Regs Could Complicate Employer Plans' Efforts to Offer Incentives for Getting the COVID Vaccine as Part of a Wellness Program

"[T]he ADA can be avoided altogether if the employee gets vaccinated by a third party provider who is not under a contract with the employer to administer the vaccine because the medical pre-screening questions are not attributed to the employer under this scenario. Thus, an employer could structure its wellness program to provide a financial incentive to participants to receive a vaccine from a third-party vendor, not under contract with the employer (e.g., a local pharmacy chain), without running afoul of the ADA." Icon to read more


[Guidance Overview]

What's in Those Proposed Wellness Regs?

"According to interpretive guidance issued along with the proposed ADA regulations, to qualify for the 'safe harbor,' the wellness program must actually use the medical information gathered 'and require[] employees to satisfy a standard related to [a] health factor, such as achieving a certain blood pressure or cholesterol level, to receive an award or avoid a penalty.' If the program merely gathers information and doesn't use it, then it will not qualify for the safe harbor." Icon to read more

Constangy, Brooks, Smith & Prophete LLP

[Guidance Overview]

The Wait Is Over! EEOC Issues New Proposed Wellness Regs

"Under the proposed rule, employers (not just the group health plan like HIPAA) will be limited to receiving aggregated/de-identified medical information from the wellness program, except as needed to administer the program and other limited purposes. Additionally, employers cannot require employees to agree to the sale, exchange, sharing, transfer, or other disclosure of medical information, or waive confidentiality protections as a condition of participating in the program." Icon to read more

OneDigital Health and Benefits

[Guidance Overview]

New Law Requires Transparency and Prohibits Surprise Billing

"The No Surprises Act sets up a process that health plans and providers must follow when a bill for emergency services is sent to the plan by a non-participating provider.... Health plans must send an initial payment or a notice of denial of payment to the provider or facility within 30 calendar days of the non-participating provider sending the bill. The provider and the plan may initiate negotiations to determine a payment amount agreed on by the provider or facility and the plan for the service[.]" Icon to read more


[Guidance Overview]

New Law Strengthens Parity for Mental Health and Substance Use Disorder Benefits

"Plan sponsors will need to perform and document NQTL comparative analyses. For plans with one or more third-party administrators, this will require coordination to confirm and collect the analyses.... The new requirements may create an increase in complaints by plan participants regarding parity NQTL noncompliance.... Any complaint that reaches a federal department will increase the likelihood that an NQTL comparative analyses will be requested." Icon to read more


Press Releases

Most Popular Items in the Previous Issue

Best Practices for ERISA Plan Fiduciary Governance (PDF)
Winston & Strawn LLP, via Defined Contribution Insights

View COVID-19 News and Resources, Inc.
56 Creeksong Road
Whittier, North Carolina 28789
(407) 644-4146

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

BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2021, 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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