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[Official Guidance]

Text of CMS Extension of Non-Enforcement of ACA-Compliance with Respect to Certain Policies (PDF)

"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." Icon to read more

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

[Guidance Overview]

Legislation Repeals Federal Antitrust Immunity for the Health Insurance Business

"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." Icon to read more

Fox Rothschild LLP

[Guidance Overview]

Health and Dental Insurers Now Subject to Federal Antitrust Laws

"[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." Icon to read more

Katie Keith, in Health Affairs Blog

[Guidance Overview]

EEOC Issues New Proposed Wellness Guidance: Is It the Cure We Have Been Waiting For?

"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." Icon to read more

Winston & Strawn LLP

[Guidance Overview]

The No Surprises Act: Implications for Health Plans, Health Care Facilities, and Health Care Providers

"[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." Icon to read more

Epstein Becker Green

[Guidance Overview]

Exceptional Usefulness and Quality iconPending Proposed Rule Would Make Far-Reaching Changes to HIPAA Privacy Regime

"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." Icon to read more

Akin Gump

[Guidance Overview]

Some California Localities Continue to Maintain Local COVID-19 Sick Leave Requirements

"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." Icon to read more

Hunton Andrews Kurth LLP

Average Employee Premium Contribution and Deductibles, by State, 2019

Interactive map shows average premium contributions and deductible amounts for each state as a percent of median household income. Icon to read more

The Commonwealth Fund

Supreme Court's PBM Ruling Will Impact ERISA Plans for Years to Come

"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)] Icon to read more

MZQ Consulting, LLC

The Unsubsidized Uninsured: The Impact of Premium Affordability on Insurance Coverage (PDF)

"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." Icon
to read more

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

Benefits in General

[Guidance Overview]

IRS Proposed Rules Address Automatic Postponement of Tax Deadlines During Federally Declared Disasters

"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)." Icon to read more

Thomson Reuters Practical Law

Press Releases

DCIIA Announces Launch of Plan Sponsor Institute
Defined Contribution Institutional Investment Association [DCIIA]

Most Popular Items in the Previous Issue

Top Considerations for Adopting FSA Funding Relief
Society for Human Resource Management [SHRM]; membership may be required to view article

View COVID-19 News and Resources, Inc.
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(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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