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Deadline Coming Up for Calendar Year Plans to Submit Medicare Part D Notice to CMS

"The filing deadline is 60 days following the first day of the plan year.... The Disclosure to CMS Form requires employers to provide detailed information to CMS including but not limited to, the name of the entity offering coverage, whether the entity has any subsidiaries, the number of benefit options offered, the creditable coverage status of the options offered, the period covered by the Disclosure to CMS Form, the number of Part D eligible individuals, the date of the notice of creditable coverage, and any change in creditable coverage status."

PCORI Fees Due by July 31, 2024

"Notice 2023-70 sets the adjusted applicable dollar amount used to calculate the fee at $3.22.... [T]his fee is imposed per average number of covered lives for plan years that end on or after October 1, 2023, and before October 1, 2024. For self-funded plans, the average number of covered lives is calculated by one of three methods: [1] the actual count method; [2] the snapshot method; or [3] the Form 5500 method."

October 14 Is Deadline for Medicare Part D Notice of Creditable (Or Non-Creditable) Coverage

"[T]here are five instances in which such notice must be provided: [1] Prior to an individual's initial enrollment period for Part D; [2] Prior to the effective date of enrollment in your company's prescription drug coverage; [3] Upon any change in your plan's creditable status; [4] Prior to the annual election period for Part D (which begins each October 15); and [5]Upon the individual's request."

PCORI Fees Due by July 31, 2023!

"[T]here are specific calculation methods used to configure the number of covered lives and special rules may apply depending on the type of plan being reported.... HRAs and health FSAs that are not excepted from reporting only must count the covered participants and not the spouses and dependents. The Form 720 instructions do not outline all of these rules."

October 14 Deadline: Medicare Part D Notice of Creditable (or Non-Creditable) Coverage

"With respect to group health plans including prescription coverage offered by an employer to any Medicare Part D eligible employees (whether or not retired) or to Medicare Part D Medicare-eligible spouses or dependents, the employer must provide those individuals with a Notice of Creditable or Non-Creditable Coverage to advise them whether the drug plan's total gross value is at least as valuable as the standard Part D coverage (i.e., creditable). Medicare Part D notices must be provided to Medicare-eligible individuals prior to October 15th of each year (i.e., by October 14th)."

Updated PCORI Fees Payable in 2022

"Due to the fact that the [HHS] did not publish updated National Health Expenditures tables for 2021, this year's fees are based on the projections set out in the 2020 tables.... [P]lans should pay close attention to next year's fee changes as the accuracy of 2020's projections may be affected by current inflationary trends."

Broker and Consultant Fee Transparency to Group Health Plans

"Covered service providers must disclose to covered plans specified information regarding the services to be provided and the compensation the covered service provide reasonably expects to receive ... for any new contracts or arrangements as of [December 27, 2021].... While the disclosures contemplated by the statutory provision are intended to come from the covered service provider, the fiduciary responsibility rest with the covered plan sponsor."

Be Ready for Enforcement of Transparency Rules

"The transparency rules do set forth protections for insured arrangements when the group health plan requires the insurer to provide such information via a written agreement. If insurer fails to comply, then the insurer violates transparency disclosure requirements, not the group health plan.... [A self-funded] group health plan ... can enter into a written agreement requiring the TPA to provide the information. However, the plan is still responsible if the TPA fails to comply. Therefore, it is imperative to have an indemnification agreement with the TPA."

Deadline Approaches for Disclosure to CMS of Medicare Part D Creditable Coverage

"The regulations also require group health plan sponsors with Part D eligible individuals to submit a similar notice to [CMS] ... The filing deadline is 60 days following the first day of the plan year. If you operate a calendar year plan, the deadline is the end of February."

Fifth Circuit Lifts Stay of CMS Vaccine Mandate for Healthcare Workers in Most States

"The court decided to limit the injunction to the 14 states that filed the initial action ... This decision did not impact the preliminary injunction over the 10 states that filed suit in Missouri v Biden ... Meaning, that only [24 states] are currently protected by court order and are not required to comply with the CMS mandate." [State of Louisiana v. Becerra, No. 21-30734 (5th Cir. Dec. 15, 2021)]