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Health & Welfare Plans Newsletter

December 23, 2021

9 New Job Opportunities 9 New Job Opportunities


[Official Guidance]

Text of CMS FAQs About Consolidated Appropriations Act, 2021 Implementation: Federal Independent Dispute Resolution System, Notice and Consent, Applicability (PDF)

"[1] Will the Model Standard Notice and Consent Document notice be changing?.... [2] Is a walk-through of the Federal Independent Dispute Resolution (IDR) system available? If so, when? ... [3] What happens if a patient decides to get elective, non-emergency care from an out-of-network provider at an in-network facility? Is that out-of-network provider required to present a Model Standard Notice and Consent Document if the provider wants to be able to bill the patient for any charges not covered by the patient's insurance? ... [4] Can you provide any information on how the various payers will be returning in-network and out-of-network indicators for the requesting providers in advance of the No Surprises Act? ... [5] Which physician types do the No Surprises Act rules apply to?"  MORE >>

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

[Guidance Overview]

HHS Releases Instructions for Prescription Drug and Health Care Spending Reports

"In addition to reviewing who must report and when, the instructions explain how the data is to be submitted through ... the Health Insurance Oversight System (HIOS). There are also detailed explanations of ... spending categories, data aggregation rules by state and market segment, and rebate and fee allocation methods ... CMS indicates that TPAs should combine, within each state and market segment, the data for all the self-insured plans for which [they are] reporting to reduce the number of submissions and the total amount of data uploaded into HIOS."  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

IRS Announces PCORI Fee Amounts for the 2022 Reporting Period

"[T]he original PCORI fee assessments under the [ACA] were scheduled to end after September 30, 2019, [but] Congress extended these fees ... for another ten years, until at least September 30, 2029. The updated PCORI fee is now $2.79 per covered life for all plan years ending on or after October 1, 2021, and before October 1, 2022, up from $2.66 for the prior period."  MORE >>

Jackson Lewis P.C.

[Guidance Overview]

IRS Releases 2021 Form 2441 and Instructions for Reporting Child and Dependent Care Expenses

"The 2021 form has been revised to include an attestation of eligibility for the refundable DCTC; the phaseout schedule for qualified expenses incurred and paid in 2021 that are considered in determining the 2021 credit; separate reporting of the credit for 2020 expenses paid in 2021; and separate lines for refundable and nonrefundable credit amounts. The DCAP portion of the 2021 form reflects the increased maximum DCAP reimbursement amounts and requires disclosure of DCAP amounts forfeited or carried over." [Also available: IRS Instructions for 2021 Form 2441]  MORE >>

Thomson Reuters / EBIA

[Guidance Overview]

New York City Poised to Require Employers to Provide Parents with Paid Child Vaccination Time Off

"On November 23, 2021, the New York City Council approved a bill that ... would amend New York City's Earned Safe and Sick Time Act ... [to] provide employees with paid time off in connection with vaccinating their children for COVID-19.... If signed by the Mayor or if no action is taken by the Mayor [by December 23], the amended ordinance will become effective immediately, with retroactive effect to November 2, 2021. The child vaccine paid time off would expire on December 31, 2022."  MORE >>

Seyfarth Shaw LLP

[Guidance Overview]

Washington State Delays Implementation of Long-Term Care Act

"Implementation was paused so the state legislature could improve the law during the 2022 legislative term. Until a future announcement is made, employers will not be required to collect the payroll deductions or remit them to the state. All penalties for non-compliance will also be waived during the pause. In addition to legislative action, Washington is expected to provide more regulatory guidance."  MORE >>


[Guidance Overview]

Agencies Issue Interim Final Regs on Prescription Drug and Health Care Spending Data Submission by Group Health Plans and Health Insurance Issuers

"While there will be no enforcement action for reports filed on or before December 27, 2022, group health plans will need to use this extra time to revise their service agreements with TPAs and PBMs so that they will be in a position to comply by the extended deadline. They will need to address liability for reporting amongst the parties, ways a plan can review a report prior to submission to confirm its accuracy, and the process for any editing, all to occur prior to extended reporting deadline (and in later years by June 1 of each year)."  MORE >>

The Wagner Law Group

[Guidance Overview]

Exceptional Usefulness and Quality icon Prepare for Shot-or-Test Mandate Inspections

"Important dates: January 10, 2022 -- OSHA will begin enforcing the ETS requirements, exclusive of the testing requirement. February 9, 2022 -- OSHA's deadline for workers to be fully vaccinated or tested on a weekly basis. Recommended Next Steps ... In an abundance of caution, small employers, even though they are not subject to ETS, might want to adopt ETS standards to limit potential risk. "  MORE >>

The Wagner Law Group

Report of House Committee on Oversight and Reform: Drug Pricing Investigation (PDF)

269 pages. "Although the markets for these products differ, the Committee uncovered common practices that cut across the industry. First, drug companies have raised prices with abandon, especially when they succeed in delaying or blocking competition.... Second, companies have manipulated the patent system and marketing exclusivities granted by the [FDA] to extend their monopolies far longer than lawmakers envisioned when they created these systems.... Third, all the companies the Committee investigated have employed anticompetitive strategies to suppress generic competition.... These practices persist because the highly complex U.S. pharmaceutical market creates perverse incentives to raise prices, and unlike in other countries, drug companies can do so without limitation."  MORE >>

Committee on Oversight and Government Reform, U.S. House of Representatives

Justices Will Hear Arguments on January 7 in Challenges to Biden Vaccine Policies

"[T]he justices announced on [December 22] that they will hear oral arguments on Jan. 7 on two federal policies: a vaccine-or-test mandate for workers at large employers, and a vaccine mandate for health care workers at facilities that receive federal funding.... [T]he formal question in both disputes is whether the government should be allowed to enforce the policies while litigation challenging them continues. But the justices' views on whether to grant emergency relief will likely be influenced by their views on the merits of the underlying challenges themselves."  MORE >>


Insurer Need Not Defer to Participant's Physician or Government Agency Decisions

"On appeal, the Court ruled that the insurer did not 'arbitrarily refuse to credit' the participant's doctor's opinion.... The insurer reached its final decision only after determining that his physician's opinions were inconsistent both with her own treatment notes and the findings of the other doctors.... Similarly, the insurer was not obligated to defer to the government agencies' rulings, which, the Court noted had, in any event, not been properly submitted for review." [Feeney v. Unum Life Ins. Co., No. 20-1685 (7th Cir. Nov. 3, 2021; unpub.)]  MORE >>

The Wagner Law Group

Benefits in General

Interpreting Pandemic-Related Decreases in Life Expectancy (PDF)

"The [CDC] has published provisional ... estimates ... that the average life expectancy of Americans decreased by a year and a half during 2020, primarily due to the impact of COVID-19. This development ... creates an impression that the average American will live a year and a half less than they otherwise would have due to COVID-19. But what is 'life expectancy' -- and does the CDC's statement really mean what many people think it means?"  MORE >>

American Academy of Actuaries

Employee Benefits Jobs

View job as Participant Directed Retirement Plan Specialist
for T Bank, NA, a Tectonic Financial Company Participant Directed Retirement Plan Specialist

T Bank, NA, a Tectonic Financial Company

Remote / Dallas TX

View job as Participant Directed Retirement Plan Specialist
for T Bank, NA, a Tectonic Financial Company

View job as Implementation Specialist
for One of the Best TPA Firms in the US Implementation Specialist

One of the Best TPA Firms in the US

Remote / Oklahoma City OK

View job as Implementation Specialist
for One of the Best TPA Firms in the US

View job as Plan Administrator
for Stones River Consulting Plan Administrator

Stones River Consulting


View job as Plan Administrator
for Stones River Consulting

View job as Client Relations Manager/Compliance Analyst
for Alliance Benefit Group of Houston, Inc. Client Relations Manager/Compliance Analyst

Alliance Benefit Group of Houston, Inc.

Remote / Houston TX

View job as Client Relations Manager/Compliance Analyst
for Alliance Benefit Group of Houston, Inc.

View job as Cash Balance Retirement Account Administrator
for Alerus Cash Balance Retirement Account Administrator


Remote / MI / MN / ND / NH

View job as Retirement Account Administrator, Senior
for Alerus Retirement Account Administrator, Senior



View job as H&W Claims Administrator
for Alerus H&W Claims Administrator



View job as 401(k) Plan Administrator Trainee/Assistant
for Southern Pension Services 401(k) Plan Administrator Trainee/Assistant

Southern Pension Services

Tampa FL

View job as Compliance Administrator II
for Associated Pension Consultants Compliance Administrator II

Associated Pension Consultants


Webcasts and Conferences
(Health & Welfare Plans)

The Nutcracker: The Compliance Nightmare After Christmas

January 25, 2022 WEBCAST

Worldwide Employee Benefits Network [WEB] - Dallas Chapter

Last Issue's Most Popular Items

Text of CMS Guidance on Good Faith Estimates and the Patient-Provider Dispute Resolution Process for Providers and Facilities (PDF)

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

2021 Year End Benefit Plan Reminders


Finally, Final Instructions: Due Date for Furnishing Form 1095-C Extended


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

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