[Guidance Overview]

Proposed Regs Extend ACA Individual Statement Due Dates

"Five states ... and Washington, DC, have implemented or enacted individual health coverage mandates. Reporting entities with health plan participants living in these jurisdictions may need to provide Form 1095-B or an alternative form to responsible individuals, despite the federal relief."  MORE >>

Mercer

[Guidance Overview]

Good Faith Compliance Standard for ACA Reporting by Large Employers Is Ending

"Up until this reporting year, employers just had to 'try their best' when it came to filling out reporting forms.... Now ... employers ... not only need to file their Forms 1094/1095-C with the IRS, but they also need to get them right.... [E]mployers may be penalized for inaccurate/incomplete information returns, which comes with a fine of up to $280 per form for 2021."  MORE >>

MZQ Consulting, LLC

[Guidance Overview]

Illinois DOL Releases Guidance for Consumer Coverage Disclosure Act

"A new disclosure requirement ... requires employers sponsoring health plans in Illinois to disclose a written list of offered benefits compared to the list of essential health benefits offered by the State of Illinois. According to the rule, because the requirement is on employers, not insurance plans, the disclosure is not preempted by [ERISA]. The [Illinois DOL] provided a sample chart of essential health benefits employers can use to fulfill the disclosure requirement. There are penalties for failure to comply."  MORE >>

EPIC

Fifth Circuit: Employee's Retirement Constitutes 'Qualifying Event' and Triggers Employer's COBRA Notice Obligation

"The district court erred when it determined that there was no qualifying event because the retirement was not contemporaneous with the loss of coverage. 'A loss of coverage does not need to be contemporaneous to the qualifying event.' The loss of coverage need only occur within 18 months of a qualifying event." [Randolph v. E. Baton Rouge Parish School Sys., No. 21-30022 (5th Cir. Nov. 30, 2021)]  MORE >>

Roberts Disability Law

Understanding the Evolving Business Models and Revenue of Pharmacy Benefit Managers (PDF)

28 pages. "When considering future prescription drug policy options, it is vital to consider the implications of PBM incentive structures for patients and other stakeholders within the market: [1] PBMs benefit directly from prescription medicine list price growth, leading to misaligned incentives in the system.... [2] Excess complexity and information asymmetry in the market prevent payers and patients from properly evaluating PBM decisions or drug costs.... [3] Lack of meaningful PBM industry standards, limited transparency, and lack of regulatory oversight enable PBM revenue growth."  MORE >>

PBM Accountability Project

Hospitals' Infrequently Published Prices Suggest Substantial Variance in Radiology Service Charges to Commercial Payers

"Despite the threat of daily fines, hospitals have so far been slow to publish their prices online in accordance with a new federal regulation.... [New data suggest] roughly two-thirds of U.S. hospitals have not published commercial negotiated prices for at least one of the 13 radiology services designated as a common shoppable service by [CMS].... Further, the hospitals that did share their radiology service commercial negotiated prices appear to be all over the map, often setting price tags that varied by hundreds or thousands of dollars for certain imaging services."  MORE >>

FierceHealthcare

CMS Makes Templates Available to Help with Aspects of the New Surprise Billing Regs

"The resources ... include forms for: [1] Notifying self-pay and uninsured patients of their right to receive a good-faith estimate of expected charges; [2] Generating a good-faith estimate; [3] Tracking the data elements that are required in the good-faith estimate; [4] Tracking required documents for the provider-patient dispute resolution process, which can be used when charges exceed the good-faith estimate by at least $400."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Even Before COVID-19, Many Adults Delayed or Did Not Get Needed Prescription Drugs Because of Costs

"Nearly 13 million adults delayed or did not get needed prescription drugs in [2018 and 2019] because of the cost ... Nearly all Medicare beneficiaries and more than 8 in 10 privately insured adults with unmet needs have been diagnosed with a chronic condition ... More than one-quarter of adults with Medicare (25.4 percent) and 5.3 percent of privately insured adults spent more than 1 percent of their family incomes on their individual out-of-pocket prescription drug costs."  MORE >>

Urban Institute

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Bolton Announces Appointment of James E. Downing as Chief Executive Officer

Bolton

Transamerica Selected as Recordkeeper for Franklin Templeton Retirement Group Plan Solution

Transamerica

IRI Announces 2021 Federal Champion of Retirement Security Award Recipients

Insured Retirement Institute [IRI]

Qualified Plan Advisors Launches Pooled Employer Plan (PEP)

Qualified Plan Advisors [QPA]

Aon Launches Interactive Model to Quantify Impact of Social Determinants of Health for U.S. Employers

Aon Hewitt

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Surveying the Digital Experience of Health Plan Members

RECORDED

Corporate Insight

How Health System Employers Can Collaborate with TPAs to Optimize Benefits, Improve Outcomes, and Control Health Care Spend

December 15, 2021 WEBCAST

World Congress

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Employer Checklist for New Health Plan Price Transparency Rules and CAA

Foley & Lardner LLP

Illinois Imposes Group Health Coverage Disclosure Requirements

Haynes and Boone, LLP

HHS Adjusts 2021 HIPAA, ACA and MSP Monetary Penalties

Mercer