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Health & Welfare Plans Newsletter

January 31, 2022

9 New Job Opportunities 9 New Job Opportunities


[Guidance Overview]

Governor Signs Bills to Delay and Modify Washington State Long-Term Care Act

"[E]mployers who have withheld the payroll tax from employees and who have not sent the amounts to the State will need to issue refunds within 120 days of the collection date. To the extent amounts have been sent to the State, the State will also make refunds within this 120 day period. Employers who delayed withholding the payroll tax will not ... need to start implementing the tax until 2023."  MORE >>


[Guidance Overview]

Proposed Regs Would Lower Medicare Part D Costs at the Pharmacy Counter in 2023

"Some pharmacy contracts may have terms that include contingent prices based on performance or other metrics. In such cases, the net price must reflect the best possible reductions, meaning it is possible the pharmacy price concessions at point of sale could create a negative [direct and indirect remuneration (DIR)] once reconciled at year-end."  MORE >>


District Court Finds Provider Can Bring Suit to Enforce COVID Test Coverage Requirement (PDF)

"The terms of the FFCRA and CARES Act support finding an implied private right of action to enforce the right to reimbursement for COVID-19 testing against [group health plans] and administrators ... A private right of action to recover the mandated reimbursement is fully consistent with the legislative scheme ... Diagnostic Affiliates has pled sufficient factual allegations to support its standing to assert ERISA claims on behalf of the patients it served by pleading that it has obtained many assignments from patient members of the plans." [Diagnostic Affiliates of Northeast Houston, LLC v. United Healthcare Services, Inc., No. 21-0131 (N.D. Tex. Jan. 18, 2022)]  MORE >>

U.S. District Court for the Northern District of Texas

Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

"[The Independent Dispute Resolution (IDR)] entity is required to begin with the presumption that the qualifying payment amount (QPA) is the appropriate amount. In general, the QPA is the Plan's median contracted rate for the same or similar service in the specific geographic area. This presumption is the basis of the controversy as the Out-Of-Network Providers deem a Plan's median contracted rate to be an inappropriate starting point."  MORE >>


2022 MHPAEA Report to Congress Details Enforcement Efforts

"The results described in the 2022 Report confirm that many plan sponsors cannot prove their insurers and TPAs are operating plans in compliance with MHPAEA's parity requirements and there are common areas of non-compliance."  MORE >>


Incorporating Preventative Care Into Your Post-COVID Benefits Experience

"[D]ata captured in consumer-directed health plans such as FSAs, HSAs and HRAs can provide a 360-degree view of the individual's health. Complemented with information available to them as payers, this makes it possible to guide the individual to more effective care.... To take this approach, however, self-funded employers will need to reevaluate the systems through which their CDH plans are provided."  MORE >>

Brian Strom, via Employee Benefit News

Drug Pricing Issues to Watch in 2022

"Among the drug pricing developments to watch in 2022, those at the top include legislation that would allow Medicare price negotiation and alter antitrust rules for the pharmaceutical industry, Federal Trade Commission rulemaking on unfair methods of competition, and court rulings on the federal 340B drug pricing program and so-called 'patent thickets.' Continuing state legislative activity on a wide range of issues, such as price transparency and drug importation, merits a close eye as well."  MORE >>

White & Case LLP

Benefit Plan Design: Focusing on the Social Determinants of Health

"Health plan sponsors can influence SDoH by providing health and financial security through fair and equitable hiring practices, compensation and career development, an inclusive work culture and affordable benefits that include advocacy and navigation support. When employers do not act to address these factors, they may lose the ability to enhance worker health and ultimately risk unfavorable impacts to employee productivity and business results."  MORE >>

Willis Towers Watson

Oregon Public Option Implementation Report (PDF)

38 pages. "[Oregon Health Authority (OHA) and the Department of Consumer and Business Services (DCBS)] seek to develop an affordable, comprehensive, on-Marketplace public option that has low cost-sharing and robust benefits, and that advances many of the State’s broader health equity and cost containment goals. ... The State is pursuing a multifaceted strategy to eliminate health inequities in Oregon, and the public option can be a key component of achieving that goal by implementing an affordable and equitable coverage option that can effectively close the remaining coverage gap."  MORE >>

Manatt, Phelps & Phillips, LLP


Brookings Institution Comments to CMS on the 2023 Notice of Benefit and Payment Parameters

"[The] letter urges CMS not to implement network adequacy standards related to emergency physicians because doing so would increase patient out-of-pocket costs and premiums without improving patient access."  MORE >>

The Brookings Institution

Benefits in General

Employers Are Enhancing Employee Benefits This Year

"If you're seeking out or evaluating a job offer, here are some benefits that could be of great value to you.... [1] Paid time off ... [2] Subsidized or free health insurance ... [3] Matching dollars for your retirement plan ... [4] Gym or fitness equipment subsidies."  MORE >>


Employee Benefits Jobs

View job as Retirement Plan Administrator
for Prime Benefits Retirement Plan Administrator

Prime Benefits

Remote / Baltimore MD

View job as Retirement Plan Administrator
for Prime Benefits

View job as Defined Contribution Administrator
for Primark Benefits Defined Contribution Administrator

Primark Benefits

Remote / San Mateo CA

View job as Defined Contribution Administrator
for Primark Benefits

View job as Account Representative
for Nolan Financial Account Representative

Nolan Financial

Remote / Bethesda MD

View job as Account Analyst / Sr. Account Analyst
for Nolan Financial Account Analyst / Sr. Account Analyst

Nolan Financial

Remote / Bethesda MD

View job as Director, Plan Services
for Nolan Financial Director, Plan Services

Nolan Financial

Remote / Bethesda MD

View job as Senior Sales Executive
for HANYS Benefit Services Senior Sales Executive

HANYS Benefit Services

Rensselaer NY

View job as ESOP Manager
for Newport ESOP Manager


Remote / AZ / CA / CO / FL / GA / IA / IL / KS / MA / MD / MI / MO / NJ / NY / OH / SC / TX / VA / WI

View job as Employee Benefits Attorney
for Lathrop GPM Employee Benefits Attorney

Lathrop GPM

CA / CO / DC / IL / KS / MA / MN / MO / TX

View job as Administrative Manager
for Teamsters Local 436 Welfare and Pension Funds Administrative Manager

Teamsters Local 436 Welfare and Pension Funds

Cleveland OH

Webcasts and Conferences
(Health & Welfare Plans)

Surpassing Mere Compliance: Including Reference Based Pricing



Healthcare COVID Update: What We Know Now that We Didn’t Know Then

March 9, 2022 WEBCAST

Conference of Consulting Actuaries

Quantify This: A Guide to Benchmarking Best Practices

April 20, 2022 WEBCAST

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

Data Privacy and Security: Key Concerns for Employee Benefit Plans

Groom Law Group

Washington State Long-Term Care Premium Tax Formally on Ice

Lane Powell

Agencies Report MHPAEA Compliance Lacking, But Don't Name and Shame Plans and Issuers... Yet

Sheppard Mullin

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

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