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Health & Welfare Plans Newsletter

June 17, 2024

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[Official Guidance]

Text of Instructions to IRS Form 720: Payment of Patient-Centered Outcomes Research Fee (PDF)

22 pages; Jun. 6, 2024. "What's New: Sections 4375 and 4376 patient-centered outcomes research fee increase. The fee for policy and plan years ending on or after October 1, 2023, but before October 1, 2024, is increased to the applicable rate of $3.22 multiplied by the average number of lives covered under the policy or plan. The fee for policy and plan years ending on or after October 1, 2022, but before October 1, 2023, remains at the applicable rate of $3.00, multiplied by the average number of lives covered under the policy or plan." [Also available: 2024 IRS Form 720, Quarterly Federal Excise Tax Return]  MORE >>

Internal Revenue Service [IRS]

[Guidance Overview]

New HIPAA Privacy Protections for Reproductive Healthcare: What You Need to Know and Steps You Can Take Now

"While the rule may not significantly change the scope of health information that is protected under HIPAA, you will need to implement certain changes to comply, including revising your HIPAA Notice of Privacy Practices.... You'll need to explain when an attestation is required and add descriptions and examples of prohibited uses and disclosures of PHI under the new rule. The compliance deadline for updating your NPP is February 16, 2026."  MORE >>

Fisher Phillips

[Guidance Overview]

Exceptional Usefulness and Quality icon The Inflation Reduction Act impact on Group Medicare Part D plans

"While Part D is becoming more attractive to Medicare-eligible seniors, IRA changes may be financially adverse for [Employer Group Waiver Plan (EGWP)] sponsors.... [R]icher benefits will increase plan cost.... [T]otal funding received by EGWP sponsors ... is likely to decline starting in 2025.... [T]he decrease in reinsurance payments may far exceed the increase in direct subsidies, thus driving an increase in net plan cost of, possibly, $1,000 or more per member in 2025."  MORE >>

Willis Towers Watson

What Health Plan Sponsors Should Know About Covering Gene Therapies

"Gene therapies for muscular dystrophy and hemophilia can each cost more than $3 million per treatment. Other recently approved therapies have surpassed $4 million per treatment, and it is possible that future approved products could be priced even higher.... Fully insured carve-out policies provide a large degree of financial protection to employers, as the insurer entirely absorbs the cost of gene therapy."  MORE >>


The Impact of Price Transparency in Outpatient Provider Markets

"[The authors conducted] a randomized-controlled trial to examine the impact of a state-wide medical charge transparency tool in outpatient provider markets in New York State.... [R]esults are consistent with price transparency having a minimal effect on consumer shopping while slightly improving provider information about competitors' charges."  MORE >>

National Bureau of Economic Research [NBER]; purchase may be required for full document

Market Design in Regulated Health Insurance Markets: Risk Adjustment vs. Subsidies

"[S]ubsidies offer two advantages over risk adjustment in markets with adverse selection. They provide greater flexibility in tailoring premiums to heterogeneous buyers, and they produce equilibria with lower markups and greater enrollment.... Holding government spending fixed, [the authors] estimate that subsidies can increase enrollment by 16 percentage points (76%) over risk adjustment, while all consumers are weakly better off."  MORE >>

National Bureau of Economic Research [NBER]; purchase may be required for full document

What Employers Should Know About Summer Intern Programs

"In most states, there are no laws requiring that an employer provide employees or interns with paid time off or any other benefit, with the exclusion of health care.... [The ACA[ requires that large employers (those with 50 or more full-time employees) provide paid interns who work more than 30 hours per week, the opportunity to enroll in health insurance no later than their 90th day of employment."  MORE >>

Parker Poe

Taking a Vacation from Work May Soon Become Mandatory

"Less than 10% of workers nationally are required by factors including law or regulation to take a minimum amount of vacation.... 78% of Americans do not use the maximum amount of paid time off allowed by their employer. With employee stress and burnout running high, more companies are considering mandatory vacation, even to the point of a full office shutdown to make it happen."  MORE >>



Pharmacy Coalition Petitions SCOTUS to Reverse Lower Court on Oklahoma’s PBM Regulations

"A coalition of pharmacy groups [asked] the U.S. Supreme Court to once again decide whether states can regulate pharmacy benefit managers after the Tenth Circuit Court of Appeals struck down a lower court that upheld a law passed by Oklahoma in 2019." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. filed May 10, 2024, No. 23-1213)]  MORE >>

National Community Pharmacists Association [NCPA]


PACT Joins 70 Organizations to Urge Congress to Keep Employer-Provided Coverage Tax-Free

"In a letter to Congressional leaders, PACT and the other organizations, including a diverse group of employers, unions, patient advocacy groups, and health care stakeholders, demonstrated the widespread support for maintaining employer-provided coverage as well as the economic and health care benefits in keeping the system tax-free."  MORE >>

U.S. Chamber of Commerce

Employee Benefits Jobs

View job as Retirement Plan Administrator for The Finway Group

Retirement Plan Administrator

The Finway Group

Remote / West Des Moines IA

View job as Retirement Plan Administrator for The Finway Group

Press Releases

Maynard Nexsen Earns High Distinctions in Chambers 2024

Maynard Nexsen

Last Issue's Most Popular Items

District Court Allows ADA Challenge to Wellness Incentives to Stay Alive

Constangy, Brooks, Smith & Prophete LLP

AI in the Workplace: Crafting Policies for Employees' Use of Generative AI

HR Daily Advisor

Contracting with PBMs: Critical High-Value Issues to Consider

Wiley Rein LLP

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

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