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Health & Welfare Plans Newsletter
December 30, 2021
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13 New Job Opportunities
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[Official Guidance]
Text of Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities (PDF)
38 pages. "This document includes information on how the parties to a payment dispute may initiate the Federal IDR Process and describes the requirements of the Federal IDR Process, including the requirements that certified IDR entities must follow in making a payment
determination. This document also includes ... guidance on confidentiality standards, record keeping requirements, and the process for revocation of IDR certification, as well as how parties may request an extension of certain time periods for extenuating circumstances." MORE >>
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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[Official Guidance]
Text of CMS Guidance for States, Plans, and Issuers on State External Review Processes Regarding Requirements in the No Surprises Act (PDF)
6 pages. "HHS expects that states with an applicable state external review process will continue to administer their state process with respect to external review of adverse benefit determinations other than [No Surprises Act (NSA)] compliance matters. If an applicable state
external review process cannot accommodate review of NSA compliance matters, HHS is offering states, starting on January 1, 2022, the opportunity to refer adverse benefit determinations by issuers of insured coverage that involve NSA compliance matters to the Federal HHS-administered external review process.... Alternatively, plans and issuers subject to an applicable state external review process that cannot accommodate external review
of NSA compliance matters by January 1, 2022 may choose to use the accredited independent review organization (IRO) contracting Federal external review process established under 45 CFR 147.136(d)(1)-(3) for NSA compliance matters only.... Regardless of which Federal external review process is selected, such process may be used for external review of NSA compliance matters until such time that a state can make changes to its laws or
expand the scope of the state's IRO contracts to accommodate external reviews of NSA compliance matters." MORE >>
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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[Guidance Overview]
Proposed 2023 Payment Rule, Part 1: Essential Health Benefits And Other Market Reforms
"This article addresses proposed changes to the regulations implementing the market reforms enacted in the ACA. This includes EHB-related requirements, LGBTQ nondiscrimination protections, discriminatory benefit design, the repayment of past due premiums, and MLR changes. These
provisions generally apply to coverage offered both inside and outside of the exchanges and extend, in some instances, to coverage in the large group market." MORE >>
Health Affairs
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[Guidance Overview]
Should Employers Withhold WA Cares Fund Premiums Starting January 1?
"Given the high likelihood that the legislature will materially revise the collection and timing of the premium payments, and ESD's agreement to not impose penalties on employers, it is likely many employers will decide not to collect premiums starting January 1,
2022 ... If, however, the legislature does not follow through on lawmakers' published statements to amend WA Cares Fund, employers could be left owing premiums on behalf of employees who have left employment or who otherwise have insufficient wages from which to pay premiums by the April 1, 2022, deadline." MORE >>
Davis Wright Tremaine LLP
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[Guidance Overview]
CMS Toolkit on COVID-19 Vaccine, for Health Insurance Issuers and Medicare Advantage Plans (PDF)
29 pages; rev. Dec. 29, 2021. "This toolkit: [1] Provides a list of operational considerations for issuers ... as they design their approach to promoting COVID-19 vaccinations and information on how issuers ... can communicate with providers and enrollees on
vaccinations and coverage. [2] Outlines recent legislative and regulatory provisions applicable to issuers that ensure that enrollees can receive a COVID-19 vaccine in a convenient setting, with no out-of-pocket costs. [3] Encourages issuers ... to implement streamlined processes to quickly administer COVID-19 vaccine coverage. [4] Describes how issuers ... can maximize the number of their enrollees who get
vaccinated once a COVID-19 vaccine becomes available to them.... This toolkit is designed for Medicare Advantage health plans and issuers of group or individual health insurance coverage." MORE >>
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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[Guidance Overview]
Expiration of OSHA's Healthcare ETS and Update on CMS Mandate
"On December 27, 2021, OSHA formally withdrew the [Healthcare] ETS.... OSHA confirmed that healthcare providers with more than 100 employees, who were previously exempt from the OSHA vaccine or test ETS due to coverage by the expired Healthcare ETS, are now
required to comply with the vaccine or test ETS by the January 10, 2021 enforcement date.... [T]he removal leave benefit requirements, which mandated employers to pay employees who missed work as a result of COVID-19 isolation, appear to no longer be in force following the expiration of the Healthcare ETS." MORE >>
Vorys
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Employee Benefits Jobs |
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Actuarial Analyst
Nyhart, part of FuturePlan by Ascensus
Remote / San Diego CA / AZ / CO / ID / MT / NM / NV / OR / UT / WA / WY
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Last Issue's Most Popular Items |
Federal Agencies Release 2021 Annual Return/Report Series: Forms 5500, 5500-SF and 5500-EZ
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; Internal Revenue Service [IRS]; and Pension Benefit Guaranty Corporation [PBGC]
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Text of CMS Notice: Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2023 Benefit Year (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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Text of CMS Proposed Regs: ACA Benefit and Payment Parameters for 2023
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.
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