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Health & Welfare Plans Newsletter

November 3, 2023

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[Official Guidance]

Text of CMS Final Regs: Medicare Hospital Payment System and Price Transparency Requirements

1672 pages. "In addition [to other changes], this final rule updates and refines requirements for hospitals to make public their standard charge information and enforcement of hospital price transparency."  MORE >>

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

[Official Guidance]

Text of CMS FAQs: Medicare Secondary Payer and Certain Civil Money Penalties (PDF)

"To help RREs prepare for potential CMPs, CMS is addressing some frequently asked questions. CMS will also be hosting webinars in January 2024 ... How does this rule affect my Section 111 reporting obligations? ... What are the key dates associated with this rule? ... When will CMS issue the first penalties under this rule? ... What is subject to a penalty? ... How will CMS identify instances of non-compliance? ... Will there be any limits on how many records could be audited for a particular RRE? ... What if the individual became entitled to Medicare after ORM was assumed or GHP coverage became effective? ... What if settlement occurs, but the specific TPOC amount is determined later? ... What if RREs have additional questions about their Section 111 Mandatory Insurer Reporting?"  MORE >>

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

[Guidance Overview]

CMS Fact Sheet: Hospital Price Transparency

"Standardization of Files and data elements for enhanced consumer access and readability ... Improved accessibility for oversight ... Required affirmation statement ... Strengthened and streamlined enforcement capabilities."  MORE >>

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

[Guidance Overview]

CMS Makes Hospital Prices More Transparent and Expands Access to Behavioral Health Care

"CMS [is] strengthening hospital price transparency regulations to require hospitals to make standard charges publicly available in a more standardized manner. This will make it easier for the public to learn what a hospital charges for a particular service, for third parties to develop consumer-friendly materials, for hospitals to comply, and for CMS to enforce the regulations. CMS is also streamlining hospital price transparency enforcement capabilities[.]"  MORE >>

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

[Guidance Overview]

What Employers Need to Know About California's New Reproductive Loss Leave Law

"The law requires confidentiality.... [E]mployers may not interfere with an employee's right to take Reproductive Loss Leave, or retaliate against employees for requesting or taking this leave. Employees should create written policies providing Reproductive Loss Leave to employees."  MORE >>

Liebert Cassidy Whitmore

[Guidance Overview]

Managing the Challenges of Intermittent FMLA

"With respect to intermittent FMLA leave for remote employees, employers need to take extra care to ensure that timekeeping is properly recorded. If digital timekeeping isn't an option, it would be helpful to create a spreadsheet and require the employee to record intermittent FMLA time each day. The employee would need to turn that spreadsheet in at the end of each week to human resources to allow for proper tracking and recordkeeping of FMLA leave."  MORE >>

HR Daily Advisor

Senate Finance Committee Releases Discussion Draft of Medicare Mental Health, PBM Reforms

"[The] discussion draft [includes] policies aimed at expanding mental health care under Medicaid and Medicare and reducing prescription drug costs for seniors at the pharmacy counter.... [These proposals are] in addition to pharmacy benefit manager (PBM) reforms previously passed out of Committee in July[.]"  MORE >>

Committee on Finance, U.S. Senate

Do Insurers Provide Fair Access to Prescription Drugs?

"[M]ost coverage policies were structured to provide fair access for this set of 18 drugs. Insurers' cost-sharing policies fell short of ICER's criteria somewhat frequently, and several aspects of insurance policies were insufficiently transparent to consumers.... The transparency of policies to consumers was lackluster. Ideally, insurers would communicate in plain language to individuals whether their drugs will be covered and at what cost. Health plans should consider revising their materials to meet these goals."  MORE >>

The Commonwealth Fund

Benefits in General

Foxx, Good Demand Transcribed Interviews After Acting Labor Secretary Fails to Respond to Request for Information

"The letter, which follows a September 19 request for materials, highlights EBSA's expensive and overreaching investigations of retirement plan sponsors -- often described as endless and aimless -- that are ultimately punishing employers and discouraging them from sponsoring retirement benefit plans."  MORE >>

Committee on Education and the Workforce, U.S. House of Representatives

Employee Benefits Jobs

View job as Regional Director
            for Employee Benefits Security Administration [EBSA]

Regional Director

Employee Benefits Security Administration [EBSA]

Remote / Atlanta GA

View job as Regional Director for Employee Benefits Security Administration [EBSA]

Webcasts and Conferences
(Health & Welfare Plans)

ERISA Group Health Plan Fees and Expenses: New Challenges

December 14, 2023 WEBINAR


Family-Forming Benefit Plans - ERISA and Tax Considerations

December 20, 2023 WEBINAR

American Bar Association Joint Committee on Employee Benefits [JCEB]

Last Issue's Most Popular Items

DOL Announces Settlement Relating to TPA's Cross-Plan Offsetting Practice (PDF)

Thomson Reuters / EBIA

What Is the Gag Clause Prohibition Compliance Attestation? (PDF)

Thomson Reuters / EBIA

Agencies Propose Extensive Modifications to Regs Implementing Surprise Billing IDR (PDF)

Thomson Reuters / EBIA

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

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