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Health & Welfare Plans Newsletter

July 20, 2021

5 New Job Opportunities


[Official Guidance]

Text of CMS Updated 2022 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF)

17 pages. "[T]his document announces some minor revisions to the 2022 benefit year final risk adjustment adult model coefficients. The reason for these revisions is to apply a constraint to the enrollment duration factors (EDFs) that was missing in the 2022 Payment Notice's risk adjustment model coefficients."  MORE >>

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

[Guidance Overview]

FAQs Address Coverage of PrEP, Related STI Screening and Hepatitis Testing, and More

"In issuing the FAQs, the Departments acknowledged that plans and insurers may not have understood that the USPSTF's June 2019 recommendation on PrEP also applies to coverage of PrEP-related support services.... Assuming calendar days, the Departments' limited nonenforcement period will end on September 17, 2021."  MORE >>

Thomson Reuters Practical Law

[Guidance Overview]

Feds Call on Insurers to Fully Cover HIV Prevention Drug Prep Without Cost-Sharing

"[DOL and HHS issued FAQs on July 19] directing most insurers to offer pre-exposure prophylaxis (PrEP) to beneficiaries at no cost. The guidance ... comes after HIV patient advocacy groups have found that insurance plans have been slow to offer preventative drugs without cost-sharing obligations.... [Insurers] have 60 days to come in compliance with the no cost-sharing requirement."  MORE >>


[Guidance Overview]

No Surprises Act: HHS Issues Interim Final Rule

"When does this rule apply? ... What plans are covered by the interim final rule? ... Major provisions of the interim final rule ... How is billing determined? ... What about cost sharing? ... What notices must providers and group or individual health plans give to patients?"  MORE >>


[Guidance Overview]

Mental Health Parity Compliance: FAQs and Conducting Comparative Analyses

"One snag in the Departments' guidance is the apparent assumption that NQTLs have already been identified.... For employers to gain a better understanding of how plans are self-checking parity compliance, they may want to ask for the following information ... [W]here these requests relate to a plan's decision-making process, a plan's responses may help employers anticipate their employees' complaints related to MH/SUD benefits decisions."  MORE >>


[Guidance Overview]

Military Personnel in a Civilian Workforce: Frequently Asked USERRA Questions

"[1] Is an employer required to accommodate leave for military duty when an employee does not have orders? ... [2] Does an employee continue to accrue vacation leave while on military leave? ... [3] Is an employer required to accommodate leave for voluntary deployments? ... [4] May an employer permit an employee to continue working in a full- or part-time status while on military orders? ... [5] Does USERRA cover temporary employees?"  MORE >>

Ogletree Deakins

[Guidance Overview]

CMS Proposes Rule to Increase Hospital Price Transparency

"CMS proposes to increase the penalty for some hospitals that do not comply with Hospital Price Transparency final rule.  Specifically, CMS is proposing to set a minimum civil monetary penalty of $300/day that would apply to smaller hospitals with a bed count of 30 or fewer and apply a penalty of $10/bed/day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500." [See also: text of proposed regulations and a Fact Sheet.]  MORE >>

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

CMS Prepares to Make Noncompliance with Price Transparency Requirements Much More Expensive

"The $300 rate would remain for hospitals with 30 or fewer beds. The penalty would rise by $10 per day for each additional bed, with a maximum allowable penalty of $5,500 per day. In other words, hospitals would not be subject to an incrementally higher penalty for bed counts beyond 550. Thus, for hospitals that remain noncompliant for an entire year, the penalty would range from $109,500 to slightly more than $2 million."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Large Self-Insured Employers Lack Power to Effectively Negotiate Hospital Prices

"In most areas of the United States, self-insured employers lack market power to negotiate hospital prices. There is no evidence that greater employer market power is associated with lower hospital prices in the employer-sponsored insurance markets. Employer coalitions would need to enroll a considerable number of employers to have a sufficient market power to negotiate with hospitals. Self-insured employers may consider building purchase alliances with state and local government employee groups to enhance their market power and lower negotiated prices for hospital services."  MORE >>

American Journal of Managed Care

Insurer Filings Suggest COVID-19 Pandemic Will Not Drive Health Spending in 2022

"This brief reviews initial 2022 premium rate filings for Marketplace-participating individual market insurers in 13 states and the District of Columbia.... [M]ost of these insurers expect health utilization patterns to return to pre-pandemic levels and therefore most are factoring in no additional costs or savings related to COVID-19 into their 2022 premiums. These insurers also tended to make similar assumptions about how COVID-19 would affect their group market costs."  MORE >>

Henry J. Kaiser Family Foundation

Benefits in General

[Official Guidance]

ERISA Advisory Council to Meet August 26 and 27

"[T]he 207th open meeting of [the ERISA Advisory Council] will be held via a teleconference on Thursday, August 26 and Friday, August 27, 2021.... The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The Advisory Council will study the following topics: [1] Gaps in Retirement Savings Based on Race, Ethnicity and Gender, and [2] Understanding Brokerage Window Prevalence, Usage, and Implementation."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Employee Benefits Jobs

View job as Distribution Specialist II
for Nova 401(k) Associates Distribution Specialist II

Nova 401(k) Associates

Telecommute / Houston TX

View job as Sr. Retirement Analyst
for Baldwin Risk Partners Sr. Retirement Analyst

Baldwin Risk Partners

Telecommute / FL

View job as Employee Benefits Investigator
for Employee Benefits Security Administration [EBSA] Employee Benefits Investigator

Employee Benefits Security Administration [EBSA]

Telecommute / Pasadena CA

View job as Compliance Analyst
for Smart Retire USA Compliance Analyst

Smart Retire USA

Nashville TN

View job as Retirement Plan Administration Supervisor
for Harding Shymanski & Co. Retirement Plan Administration Supervisor

Harding Shymanski & Co.

Telecommute / Evansville IN

Selected New Discussions

Nondiscrimination Rules Apply to Health Benefits Through Cafeteria Plan for Certain Retirees?

"Employer wants to encourage longevity, is looking at offering benefits to certain retired employees that meet certain requirements. Example: A Cafeteria Plan is amended to allow only active group health insurance plan participants who are at least 60 years of age but younger than 65 (i.e. Medicare eligibility) AND have a minimum of 10 years of GSB service to participate in the Plan after retirement. Would that be allowed?"

BenefitsLink Message Boards

Press Releases

HealthPartners UnityPoint Health Now Offering Health Insurance to Small Businesses in Iowa

HealthPartners UnityPoint Health

Integrated Pension Services Combines Forces with Friedman LLP's Benefits 21

Integrated Pension Services

Webcasts and Conferences
(Health & Welfare Plans)

The ACA and the Supreme Court: What Actuaries Need to Know

July 23, 2021 WEBCAST

Society of Actuaries

Last Issue's Most Popular Items

Text of Agency FAQs About ACA Implementation, Part 47 (PDF)

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

Don't Overlook This Tax Planning Opportunity: One-Time IRA-to-HSA Rollover


COBRA Premium Assistance Requirements for Exempt Employers

Bloomberg Law

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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.

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