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Health & Welfare Plans Newsletter

November 1, 2022

2 New Job Opportunities 2 New Job Opportunities


[Official Guidance]

Text of CMS Memo: Patient-Provider Dispute Resolution Administrative Fee as Established in Interim Final Rule for Surprise Billing, Part II (PDF)

"The [No Surprises Act] established a new patient-provider dispute resolution (PPDR) process which allows uninsured (or self-pay) individuals a path to challenge medical bills that are at least $400 more than the initial good faith estimate. This document details the administrative fee that uninsured (or self-pay) individuals must submit to participate in the process. For 2023, the cost to initiate a PPDR case is $25."  MORE >>

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

[Official Guidance]

Text of CMS Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities (PDF)

44 pages. "The purpose of this document is to provide guidance to certified IDR entities on various aspects of the Federal IDR Process. 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 information related to other aspects of the Federal IDR Process that certified IDR entities must follow, including 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]

[Official Guidance]

Text of CMS Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties (PDF)

41 pages. "This document provides guidance to disputing parties (also referred to as 'the parties') who are seeking to resolve a claim for payment for OON health care items or services through the Federal IDR Process.... This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process. Additional guidance may be developed in the future to address specific questions or scenarios submitted by the public."  MORE >>

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

[Guidance Overview]

Surprise Billing Final Regs Are Now in Effect

"The final regulations are applicable with respect to items or services provided or furnished on or after October 25, 2022, for plan years beginning on or after January 1, 2022.... Plans and issuers may use reasonable methods to provide the additional disclosure with an initial payment or notice of denial of payment while the automated systems and procedures are updated."  MORE >>

Husch Blackwell

[Guidance Overview]

IRS Expands Mid-Year Cafeteria Plan Change Opportunities to Address 'Family Glitch'

"Starting January 1, 2023, a non-calendar year cafeteria plan may permit an employee to revoke prospectively an election for family coverage so that the employee's family members can enroll in ACA marketplace coverage if: [1] One or more of the employee's family members are eligible to enroll in Marketplace coverage during a special enrollment period or during Marketplace annual open enrollment, and [2] The revocation of the employee's family coverage election corresponds with the intended enrollment of the family member in the Marketplace plan.... Employers are not required to adopt these new permitted election changes."  MORE >>


Top Compliance Issues for Health and Leave Benefits in 2023

"In 2023, employers will continue to focus on complying with transparency requirements ... Other issues in the spotlight include health plan coverage of gender, family planning (including abortion) and behavioral health.... Employers may want -- or have -- to expand behavioral health coverage in response to the nation's mental health crisis and tougher enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA)."  MORE >>


Managing FMLA Leave and PTO in the Post-COVID-19 Landscape

"While best practices for handling the intersection of FMLA and PTO pre-pandemic are still largely the same as they were before, a complex patchwork of state and local laws and the rise of post-COVID-19 conditions under the umbrella of long COVID-19 merit their own set of considerations[.]"  MORE >>

HR Dive

Benefits in General

[Guidance Overview]

The Annual Form 5500 Audit: DOL Broadens Criteria for Independent Qualified Public Accountants

"This matters to employers because it will open the market to new accounting firms that can issue the accountant's report for the Form 5500 annual filing. IQPAs are the auditors who issue the annual accountant's report. While not all Form 5500-filers are subject to the accountant's report requirement, ERISA-covered retirement plans (except for certain small retirement plans) and funded welfare plans must provide the accountant's report annually."  MORE >>

Faegre Drinker

Employee Benefits Jobs

View job as Client Service Manager
            for Maxus Plan Solutions

Client Service Manager

Maxus Plan Solutions

Remote / Charlotte NC

View job as Client Service Manager for Maxus Plan Solutions

View job as Retirement Plan Data Analyst (Seasonal)
            for ERISA Services, Inc.

Retirement Plan Data Analyst (Seasonal)

ERISA Services, Inc.


View job as Retirement Plan Data Analyst (Seasonal) for ERISA Services, Inc.

Webcasts and Conferences
(Health & Welfare Plans)

Recognized Security Practices


Office of Civil Rights [OCR], U.S. Department of Health & Human Services [HHS}

2023 DMEC FMLA/ADA Employer Compliance Conference

March 27, 2023 in FL

Disability Management Employer Coalition [DMEC]

2023 DMEC Virtual Compliance Conference

May 3, 2023 WEBCAST

Disability Management Employer Coalition [DMEC]

Last Issue's Most Popular Items

IRS Releases Final Rule Addressing 'Family Glitch' (PDF)

Groom Law Group, via American Health Law Association

What Are Your Employee Benefits Really Worth?


What Plan Sponsors Are Doing to Manage the Rising Cost of Cancer Care and Improve Outcomes


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

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