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Health & Welfare Plans Newsletter

March 1, 2024

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[Guidance Overview]

New York State Proposes Network Adequacy Regs for Health Insurers

"If adopted, this regulation would establish network adequacy standards for behavioral health services ... The regulation specifies that an adequate network of health care providers includes residential facilities that provide sub-acute care, assertive community treatment providers, critical time intervention services providers, and mobile crisis intervention services providers."  MORE >>

ArentFox Schiff LLP

[Guidance Overview]

Summary of Draft CY 2025 Medicare Part D Redesign Program Instructions (PDF)

14 pages. "[CMS] released draft instructions on the CY2025 Part D Redesign. These draft instructions touch on many of the outstanding Part D benefit adjudication questions that the industry has been asking.... in addition to reinsurance, medical loss ratio, risk corridor, and Out-of-pocket cost (OOPC)/meaningful difference methodologies. Some guidance on Employer Group Waiver Plans (EGWPs) was also provided."  MORE >>

Wakely Consulting Group

J&J Lawsuit Shines Spotlight on Welfare Plan Fiduciary Duties

"[P]lan sponsors should take a proactive and critical look at their welfare plan governance and administration to ensure that fiduciary duties are being satisfied ... [1] Establish and maintain a health and welfare plan committee.... [2] Review and update committee documents and committee composition.... [3] Conduct regular fiduciary training ... [4] Monitor service providers; review and pay reasonable fees.... [5] Follow plan documents.... [6] Fiduciary liability insurance.... [7] Consider cybersecurity obligations.... [8] Highlight your wins."  MORE >>

Morris, Manning & Martin, LLP

IVF Uncertainty in Alabama: What Can Employers Do?

"Employers may want to identify employees and covered plan members residing in Alabama and consider the potential implications this ruling may have on their family building journey. Ask the health plan or fertility benefit vendor what IVF treatment and embryo transport access in Alabama looks like today -- whether in-network clinics are continuing to provide IVF treatment or have paused it -- and request regular updates.... This may also be a good time to review the plan's reproductive and medical travel benefits and the organization's leave policies."  MORE >>

Mercer

Ransomware Hack Hits Prescription Drug Market, Inconveniencing Millions

"Insurance giant UnitedHealthcare Group said the hackers struck its Change Health business unit, which routes prescription claims from pharmacies to companies that determine whether patients are covered by insurance and what they should pay. The hackers stole data about patients, encrypted company files and demanded money to unlock them, prompting the company to shut down most of its network as it worked to recover.... U.S. pharmacies reported a wide range of impacts, with independent stores experiencing some of the worst problems."  MORE >>

The Washington Post; subscription may be required

Cross-Plan Offsetting in Group Health Plans: The DOL Makes Its Position Clear

"In October of 2023, the DOL entered into a settlement agreement with EmblemHealth Inc. ... resolving claims that Emblem breached its fiduciary duties under ERISA by engaging in the practice of cross-plan offsetting.... Based on the potential ERISA violations and the practical problems that may result, employers that maintain health plans (particularly self-insured health plans) should determine whether their TPAs are engaging in cross-plan offsetting."  MORE >>

Verrill Dana LLP

What We Get Wrong About Predicting Mental Health Outcomes

"Health plans understand that mental health affects outcomes, but the theory often has not translated to improved delivery of health care to individual patients. The new role of incorporating mental health into predicting outcomes, in contrast, is one that focuses on well-executed intervention, not merely identification and awareness. It unifies predictive endeavors with the patient in a timely, relevant manner to address the influence that men- tal health has on all health care experiences."  MORE >>

Segal, via Benefits Quarterly

2023-2024 Voluntary Benefits Benchmarking Overview (PDF)

"[K]ey findings suggest many employers view offering or expanding their voluntary benefits programs as an effective strategy to address attraction and retention challenges in 2024."  MORE >>

Bolton

The CARES Act Paid Leave Door May Be Open, But the Path to Recovery Remains Narrow and Uncertain for Most Government Contractors

"[M]ost federal contractors know that it can be challenging to recover increased costs for paid leave stemming from the COVID-19 pandemic under Section 3610 of the [CARES] Act.... A recent Armed Services Board of Contract Appeals (ASBCA) decision provides claimants with some reason for hope by confirming that the ASBCA has Contract Disputes Act (CDA) jurisdiction over appeals from a contracting officer's denial of Section 3610 claims.... [E]stablishing jurisdiction is only the first step, and the path to recovering paid leave costs remains narrow and highly dependent on the facts of each case."  MORE >>

Miller & Chevalier

With Medical Debt Burdening Millions, a Financial Regulator Steps in to Help

"In the past two years, the [Consumer Financial Protection Bureau (CFPB)] has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans. In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports[.]"  MORE >>

KFF Health News

Practice of Prior Authorization Draws Increased Scrutiny

"At the federal level, [CMS] issued a final rule in January that requires electronic processing known as Application Programming Interface for prior authorizations ... Starting in 2026, required prior-authorization turnaround times are reduced to 72 hours for urgent claims and seven calendar days for non-urgent claims.... Elsewhere, states are looking at restrictions or outright bans on preauthorization for some services and procedures."  MORE >>

Mercer

Benefits in General

Employers Struggle to Meet Employee Demand for Higher Pay, Better Benefits

"{If] given the option for an enhanced benefit, employees expressed a clear preference for increased pay and increased 401(k) match, while employers assume employees would prefer improved health and dental insurance, health savings accounts and charitable contributions. Seven in 10 workers also reported experiencing challenges when it comes to understanding benefits offered by their employer."  MORE >>

PLANSPONSOR; free registration may be required

Breaking Down Health Care Expenses in Retirement

"Health insurance premiums account for between 73% and 81% of retirees' annual health care expenses and, for the most part, are predictable and can be paid from monthly income. However, out‑of‑pocket expenses can vary and should be paid from savings. Traditional financial planning principles and basic budgeting can help address many of the financial unknowns about health care costs in retirement."  MORE >>

T. Rowe Price

Employee Benefits Jobs

View job as Sr. Implementation Analyst - Retirement Plans for Ameritas

Sr. Implementation Analyst - Retirement Plans

Ameritas

Remote / Lincoln NE

View job as Sr. Implementation Analyst - Retirement Plans for Ameritas

Press Releases

DOL Recovers $438K for Two Workers Illegally Terminated by Alabama Car Manufacturer After They Took Protected Leave

Wage and Hour Division [WHD], U.S. Department of Labor [DOL]

Vanguard Announces CEO Retirement and Appointment of President

Vanguard

Kodak Company Statement on U.S. Pension Plan

Kodak

The ERISA Industry Committee Appoints Tom Christina as Executive Director of ERIC Legal Center

ERIC [ERISA Industry Committee]

Webcasts and Conferences
(Health & Welfare Plans)

Are You Ready For It? Health Plan Fee Litigation

March 7, 2024 WEBINAR

ERIC [ERISA Industry Committee]

Employment and Benefit Plan Issues in M&A: Due Diligence Checklist, Transaction Strategies, Risk Mitigation

March 20, 2024 WEBINAR

Strafford

Last Issue's Most Popular Items

When Are Disability Benefit Programs Exempt from ERISA?

Thomson Reuters / EBIA

District Court Finds Health Plan Not Required to Furnish Administrative Service Agreements in Response to ERISA Document Request

The Wagner Law Group

Hacking at UnitedHealth Unit Change Healthcare Cripples a Swath of the U.S. Health System

KFF Health News

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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