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Health & Welfare Plans Newsletter January 20, 2021 |
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Newly Posted |
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Discussions |
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This Newsletter:
BenefitsLink Retirement Plans Newsletter:
Message Boards Digest:
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[Official Guidance]
"This bulletin extends the [CMS] policy under which CMS will not take enforcement action against certain non-grandfathered health insurance coverage in the individual and small group market that is out of compliance with certain specified market reforms. The extended non-enforcement policy in this bulletin applies for policy years beginning on or before October 1, 2022, provided that all such coverage comes into compliance with the specified requirements by January 1, 2023." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] |
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[Guidance Overview]
"The goal of federal antitrust laws is to promote and protect competition in the marketplace for the benefit of the public. However, the insurance industry has been immunized from antitrust scrutiny for more than three-quarters of a century pursuant to a World War II-era statute. Signed into law by President Trump on January 13, 2021, the Competitive Health Insurance Reform Act of 2020 constitutes a major change by removing that immunity for the health insurance business." Fox Rothschild LLP |
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[Guidance Overview]
"[T]he new law amends 15 U.S.C. Section 1013 to state that nothing in the McCarran-Ferguson Act prevents federal antitrust laws from applying to the business of health insurance, which includes the business of dental insurance and limited-scope dental benefits.... With this exemption now gone, the Department of Justice and the Federal Trade Commission can more easily investigate antitrust concerns and enforce federal laws, even though antitrust regulation had previously been left to the states. The legislation makes clear that parts of the Federal Trade Commission Act apply to all health insurers, including those that are not for-profit companies." Katie Keith, in Health Affairs Blog |
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[Guidance Overview]
"The Proposed Rules attempt to address the incentive issue, while loosening the rules on certain types of wellness programs. Spoiler alert, the 30%/50% incentive remains intact for health-contingent wellness programs, but participatory wellness program incentives have been reduced to a de minimis amount. In addition, the Proposed Rules limit incentives for wellness programs that request information about a family member's manifestation of disease or disorder to de minimis amounts." Winston & Strawn LLP |
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[Guidance Overview]
"[This] Alert summarizes the Act's [1] surprise billing and balance billing prohibitions, [2] the negotiation and independent dispute resolution (IDR) process for rate disputes between health plans and out-of-network health care facilities and providers, and [3] health care industry notice and disclosure requirements." Epstein Becker Green |
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[Guidance Overview]
"The [HHS] Proposed Rule would affect how individuals may exercise their rights to access and share their protected health information (PHI), limit and adjust the fees covered entities may charge for access, introduce new concepts such as 'electronic health record' (EHR) and 'personal health application' (PHA) into a health information ecosystem already awash in acronyms, broaden data sharing by modifying the 'minimum necessary' standard and adjusting the definition of 'health care operations,' and reduce administrative burdens relating to the ubiquitous HIPAA notice of privacy practices, among other changes." Akin Gump |
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[Guidance Overview]
"In California, the requirement to provide statewide supplemental paid sick leave for COVID-19 related reasons also expired on December 31, 2020. However, many localities continue to maintain COVID-19 sick leave requirements. These local laws were enacted to cover employers with 500 or more employees that were not required to provide paid sick leave benefits under the FFCRA and to provide up to 80 hours of sick leave for covered employees." Hunton Andrews Kurth LLP |
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Interactive map shows average premium contributions and deductible amounts for each state as a percent of median household income. The Commonwealth Fund |
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"SCOTUS seems to have opened the door to direct state-level regulation of PBMs and other vendors that provide services to self-funded plans, like third-party claims administrators.... The earlier standard allowed provider regulation that has an indirect impact on an employer plan costs. Now, SCOTUS is saying that state laws that regulate the amount PBMs pay for prescriptions directly but do not reference ERISA plans specifically are not preempted. The Rutledge opinion also weakens the longstanding holding that regulatory uniformity is a core ERISA principle." [Rutledge v. Pharmaceutical Care Mgmt. Assoc., No. 18-540 (S. Ct. Dec. 10, 2020)] MZQ Consulting, LLC |
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"The ACA's expansion of Medicaid eligibility to non-disabled adults, along with the introduction of premium tax credit subsidies to low- and middle-income Americans purchasing an individual market plan through an Exchange, increased access to coverage for many people. However, other ACA requirements increased the cost of health insurance coverage and, in turn, reduced the affordability of health coverage for many other people -- in particular people without access to employer-sponsored coverage and who earn too much money to qualify for the ACA's premium subsidies. This report takes a closer look at the unsubsidized population and the impact of increasing premiums on health coverage." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] |
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Benefits in General |
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[Guidance Overview]
"Despite the mandatory 60-day postponement provision, Treasury makes clear in its proposed regulations that it would continue to exercise a good deal of discretion in the disaster context -- particularly as to defining the scope of time-sensitive acts to be postponed for individuals (and in some cases, the government itself)." Thomson Reuters Practical Law |
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Press Releases |
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DCIIA Announces Launch of Plan Sponsor Institute
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Most Popular Items in the Previous Issue |
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Top Considerations for Adopting FSA Funding Relief
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Top Employee Benefits Trends for 2021 (PDF)
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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 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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