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Health & Welfare Plans Newsletter

June 22, 2022

3 New Job Opportunities 3 New Job Opportunities

 

[Guidance Overview]

Upcoming Deadline icon July 1 Deadline for ACA Transparency in Coverage: Is Your Company (and Your Health Plan Provider) Ready?

"[G]roup health plans subject to the TiC Final Rules must disclose through three separate [machine-readable files (MRFs)] the following pricing information for each coverage option: [1] In-network provider negotiated rates for all items and covered services, [2] Historical out-of-network allowed amounts for providers, and [3] In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy-location level The MRFs must be updated on a monthly basis and must clearly state the date the files were last updated.... [O]nly the in-network and out-of-network MRFs must be made publicly available by July 1, 2022."  MORE >>

Jones Walker

[Guidance Overview]

Philadelphia Employers Soon Must Provide Commuter Benefits

"The 'Employee Commuter Transit Benefit Programs,' would apply to employers with 50 or more 'covered employees.' Covered employees must be offered a pre-tax payroll deduction for mass transit expenses, qualified bicycle expenses, or an employer-paid benefit for a fare instrument.... Once implemented into law, this ordinance would take effect on December 31, 2022."  MORE >>

Ballard Spahr LLP

[Guidance Overview]

Bloomington, Minnesota, Passes Paid Sick and Safe Leave Ordinance

"The Bloomington Earned Sick and Safe Leave Ordinance takes effect on July 1, 2023, and will require employers with six or more employees to provide their Bloomington employees with one hour of paid sick and safe leave for every thirty hours worked, up to a maximum of forty-eight hours per year. Employees will be allowed to carry over unused sick and safe leave from one calendar year to the next, up to a maximum of eighty hours."  MORE >>

Ogletree Deakins

Texas-Based Study Raises Questions About IDR Criteria in No Surprises Act Arbitrations

"Arbiters in Texas have tended to issue judgments that mirror the median in-network rate even with guidance instructing them to consider other factors.... Initially, [HHS] issued regulations requiring arbiters to primarily consider the median in-network payment amount for a given service in a given market ... HHS has been working on new regulations that purportedly will incorporate [additional] criteria.... [T]he new study calls into question whether such changes will have a substantial effect on outcomes."  MORE >>

Healthcare Financial Management Association [HFMA]; free registration required

Health Plans Mapping Out Technology Strategy for Home Care

"Health plans are expanding their platform to include home-based healthcare services, and sometimes acting as the primary care provider of record. These new services are part of the evolution to risk-based care. New technologies, including telehealth, allow for more services in the home and connections to providers in other locations."  MORE >>

HealthLeaders Media

Drivers of 2023 Health Insurance Premium Changes (PDF)

12 pages. "The expiration of the ARPA enhanced premium subsidies will likely cause a decline in enrollment and a worsening of the risk pool, leading to higher premiums.... Inflation may have some effect on provider costs, but because provider payments lag inflation, real effects might not occur until later plan years."  MORE >>

American Academy of Actuaries

Supreme Court Sides with Health Plan Over Dialysis Payments

"In a 7-2 decision, the U.S. Supreme Court made it harder to prove that a health plan violates the Medicare secondary payer rules when the plan requires patients to pay high out-of-pocket costs to treat kidney failure with dialysis, when patients who switch exclusively to Medicare coverage, regardless of age, could have dialysis covered at less cost to themselves." [Marietta Memorial Hospital Employee Health Benefit Plan v. Da Vita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

Supreme Court Overturns Cutbacks in Medicare Prescription Drug Reimbursements

"Most in the healthcare industry are viewing the Court's Opinion as a victory for 340B hospitals and clinics who saw roughly $1.6 billion in annual cuts to reimbursement rates for prescription drugs after the 2018 rule went into effect. Notably, the Court recognized that 340B hospitals can make profits on the differential between their acquisition cost and the reimbursement rate for Medicare. Though the Court declined to dictate remedies, 340B hospitals may be able to recoup some of the payments that were withheld under the rule." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]   MORE >>

Morris, Manning & Martin, LLP

Supreme Court: Health Plan's Dialysis Coverage Did Not Violate Medicare Secondary Payer Rules

"The Court rejected a Sixth Circuit ruling that the MSP statute authorized liability under a disparate-impact theory." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]  MORE >>

Thomson Reuters Practical Law

Benefits in General

[Official Guidance]

DOL Regulatory Agenda, Spring 2022, Including Employee Benefit Items

Benefits-related items from EBSA and from the Wage and Hour Division (WHD) (changes from the Fall 2021 DOL Regulatory Agenda are noted):

Prerule Stage

  • Improved Fee Disclosure for Welfare Plans
  • Improving Participant Engagement and Effectiveness of ERISA Retirement Plan Disclosures
  • Pooled Employer Plans

Proposed Rules

  • Improvement of the Form 5500 Series and Implementing Related Regulations Under ERISA
  • Definition of the Term 'Fiduciary'
  • Prohibited Transaction Exemption Procedures
  • Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
  • Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021
  • Short-Term Limited Duration Insurance; Update
  • Coverage of Certain Preventive Services Under the [ACA] (New)
  • Requirements Related to Advanced Explanation of Benefits and Other Provisions Under the Consolidated Appropriations Act, 2021 (New)

Final Rules

  • Pension Benefit Statements -- Lifetime Income Illustrations
  • Adoption of Amended and Restated Voluntary Fiduciary Correction Program
  • Implement SECURE Act and Related Revisions to Employee Benefit Plan Annual Reporting on the Form 5500 (moved from Proposed to Final)
  • Requirements Related to Surprise Billing, Part 1
  • Requirements Related to Surprise Billing, Part 2
  • Prudence and Loyalty in Selecting Plan Investments and Exercising Shareholder Rights (moved from Proposed to Final)
  • Amendment of Abandoned Plan Program
  • Updating the Davis-Bacon and Related Acts Regulations (moved from Proposed to Final)

MORE >>

U.S. Department of Labor [DOL]

[Official Guidance]

IRS Regulatory Agenda, Spring 2022, Including Employee Benefit Items

Partial list of benefit-related provisions (changes from the Fall 2021 IRS Regulatory Agenda are noted):

Proposed Rules

  • Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057
  • Nondiscrimination Relief for Closed Defined Benefit Plans (moved from Final to Proposed)
  • SECURE Act Modifications to Certain Rules Governing 401(k) Plans
  • Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
  • Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021
  • Requirements in Connection With Coverage of Certain Preventive Services (New)
  • Requirements Related to Advanced Explanation of Benefits and Other Provisions Under the Consolidated Appropriations Act, 2021 (New)

Final Rules

  • Update to Minimum Present Value Requirements for Defined Benefit Plan Distributions
  • Application of Normal Retirement Age Regulations to Governmental Plans
  • Additional Rules Regarding Information Reporting of Minimum Essential Coverage (New)
  • Withholding on Certain Retirement Plan Distributions Under Section 3405(a) and (b)
  • MEPs and the Unified Plan Rule (moved from Proposed to Final)
  • Application of the Employer Shared Responsibility & Certain Nondiscrimination Rules to HRAs and Other Account-Based Group Health Plans Integrated With Individual Health Insurance Coverage or Medicare (New)
  • Guidance on 401(a)(9) Required Minimum Distributions (moved from Proposed to Final)
  • Requirements Related to Surprise Billing, Part 1
  • Requirements Related to Surprise Billing, Part 2 (moved from Proposed to Final)
  • Requirements Related to Surprise Billing, Part 3 (Temporary Regulations)
  • Requirements Related to Surprise Billing, Part 4 (Temporary Regulations)
  • Information Reporting of Health Insurance Coverage and Other Issues Under Sections 6055 and 6056 (moved from Proposed to Final)

   MORE >>

Internal Revenue Service [IRS], U.S. Department of the Treasury

[Guidance Overview]

Big Changes Possible for the Davis-Bacon Act

"[T]he DOL has issued proposed regulations that represent the most comprehensive changes to the DBA since 1982.... The proposed regulations would require contractors to annualize ... all fringe benefit contributions, including for 'defined contribution pension plans (DCPPs)' to determine the hourly equivalent for which they can take a credit against the fringe benefit obligation.... For both funded and unfunded [fringe benefit] plans, the proposed regulations would also require an employer to pay any amount that an employee has been underpaid (including earnings) to an employee. In addition, employers would need to notify employees of the fringe benefits being paid and would need to ensure that the plans are properly funded."  MORE >>

Ascensus

Employee Benefits Jobs

View job as Junior Implementation Specialist - 401(k) Administration
          for Ubiquity Retirement + Savings Junior Implementation Specialist - 401(k) Administration

Ubiquity Retirement + Savings

Remote / San Francisco CA

View job as Junior Implementation Specialist - 401(k) Administration
          for Ubiquity Retirement + Savings

View job as Retirement Plan Relationship Manager
          for ERISA Services, Inc. Retirement Plan Relationship Manager

ERISA Services, Inc.

Remote / Loganville GA / Sterrett AL

View job as Retirement Plan Relationship Manager
          for ERISA Services, Inc.

View job as Retirement Plan Services Manager
          for Alerus Financial Retirement Plan Services Manager

Alerus Financial

Remote

View job as Retirement Plan Services Manager
          for Alerus Financial

Press Releases

Hue Health and Banner Health Launch '39North,' a Direct Primary Care Plan in Northern Colorado, Powered by Flume Health

Hue Health

OneAmerica® Brings Aboard Veteran to Head Retirement Business Development

OneAmerica

Tim Hunt Joins Newfront's Growing Employee Benefits Team

Newfront

Morgan Stanley at Work to Acquire Leading Nonqualified Deferred Compensation Plan Provider American Financial Systems

Morgan Stanley

Webcasts and Conferences
(Health & Welfare Plans)

Post Roe v. Wade: Potential Civil and Criminal Liability for Employers

RECORDED

Choate

Navigating the Interplay Between Leave Laws: A Focus on the FMLA and ADA

July 19, 2022 WEBCAST

The Wagner Law Group P.C.

Last Issue's Most Popular Items

Text of Supreme Court Opinion: Group Health Plan's Limits on Coverage for Outpatient Dialysis Does Not Violate the Medicare Secondary Payer Statute (PDF)

Supreme Court of the United States

Is EEOC Wellness Guidance Coming Out of the Deep Freeze?

E is for ERISA

HSAs No Longer Promote Consumer Cost-Consciousness

Health Affairs

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

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