Members of Congress could call for more transparency about how hospitals use their federal drug discount program savings. According to this Bloomberg Law article, a study found that the Health Resources and Services Administration’s oversight of the 340B program could be improved. McDermott Partner Emily Jane Cook said there is interest in Congress overseeing aspects of hospitals, including the 340B program.
“I wouldn’t be surprised to see a bill being introduced that imposes more explicit oversight requirements,” Cook said.
Medicare Advantage (MA) plans are facing both regulatory and business risks following the conclusion of the COVID-19 Public Health Emergency (PHE). What are the major MA flexibilities and requirements related to the pandemic, and have they ended along with the PHE?
The Internal Revenue Service (IRS) recently issued a Chief Counsel Advice memorandum to remind sponsors of health and dependent care flexible spending arrangements (FSAs) about their responsibility to adequately substantiate claims in order to receive favorable tax treatment under Section 125 of the Internal Revenue Code (the Code). The IRS emphasizes that the standards for substantiation are stringent, and employers who fail to comply will face significant and undesirable consequences. The memorandum also provides a helpful overview of the relevant laws, illustrated through six examples of claims practices.
For decades, promoters have marketed programs to employers seeking to leverage the favorable tax treatment accorded employer-provided medical benefits. These programs are variously described as “wellness” or “preventive services” arrangements, and they are usually wrapped in or offered with hospital indemnity policies. While varying in their design features and terminology, these programs all hold out the promise of outsized income and/or payroll tax savings. But can these programs deliver on that promise?
In a new article published by the American Staffing Association, McDermott’s Alden J. Bianchi and American Staffing Association Senior Counsel Edward Lenz express their view that any such health program that claims to achieve material payroll tax savings exposes adopting employers to a significant risk of violating federal tax and other laws.
On May 3, 2023, the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The aim of the proposed rule is to enhance transparency in payment rates, establish uniformity in data and monitoring and provide states with fresh avenues to encourage the active involvement of beneficiaries in their Medicaid programs. These efforts are aimed at enhancing access to care. The rule places a special emphasis on home and community-based services (HCBS), encompassing mandates for direct care worker compensation, the development of grievance processes, defining critical incident reporting and implementing HCBS quality reporting measures.
As lawmakers race to put together a debt ceiling deal, Republicans and Democrats are working on healthcare legislation that they believe could have bipartisan support. According to this InsideHealthPolicy article, the potential legislation could include limited site-neutral pay expansions and duals reform.
The Centers for Medicare & Medicaid Services recently unveiled plans to toughen its hospital price transparency enforcement. According to this InsideHealthPolicy article, these proposals include earlier and automatic civil penalties, eliminating warning notices for hospitals that have not attempted to comply with price transparency requirements and giving hospitals no more than 45 days to implement a corrective action plan.
Numerous states—including Illinois, Hawaii, Tennessee, Montana, New Hampshire and Indiana—have been busy finalizing rulemaking and legislation impacting interstate compacts, professional practice standards and COVID-19 licensure flexibilities. What have these states been up to over the last month?
On April 12, 2023, Germany’s Federal Ministry of Finance and the Federal Ministry of Justice published the draft bill for a law on the financing of future-proof investments (Zukunftsfinanzierungsgesetz – ZuFinG-E).
This proposed legislation seeks to enhance the performance of the German capital market and bolster the appeal of Germany as a financial hub within the European financial center. It aims to achieve these goals by introducing numerous amendments to company, financial market and tax laws.
One significant aspect of the draft bill is the establishment of improved tax framework conditions to facilitate employee equity participation. This measure intends to make it easier for young companies to attract talented employees and maintain their competitiveness in the global talent market.
The Biden administration previously announced its intent to end the COVID-19 National Emergency (NE) and the COVID-19 Public Health Emergency (PHE) on May 11, 2023 (read our series introduction for more information). On April 10, 2023, President Biden signed a resolution moving up the end of the NE to April 10, 2023 (the PHE ended on May 11). The US Departments of Labor (DOL), Health and Human Services, and the Treasury (the Departments) issued a set of FAQs (available here) on March 29, 2023 (FAQs), which anticipated that the NE would end on May 11, 2023 (see our prior article explaining the FAQs). Plan sponsors should continue to treat May 11 as the end of the NE consistent with the FAQs until the Departments say otherwise.
During the COVID-19 pandemic, the Departments provided relief from certain benefit plan deadlines, including:
The minimum 60-day election period for the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage.
The date for making COBRA premium payments (45 days for the initial, then minimum 30-day grace periods).
The date for individuals to notify the plan of certain qualifying events (divorce, dependent child aging out of plan coverage) or determination of disability as it relates to COBRA coverage.
The date for providing a COBRA election notice (typically within 14 days after the plan receives notice of a qualifying event).
The 30-day period (or 60-day period, if applicable) to request Health Insurance Portability and Accountability Act (HIPAA) special enrollment.
The date within which individuals may file a benefit claim or an appeal of an adverse benefit determination under a plan’s claims procedures.
The date within which claimants may file a request for an external review after receipt of an adverse benefit determination or final internal adverse benefit determination.
This article discusses how the affected tolled deadlines will be phased out and what actions employers may need to take.
BACKGROUND
EBSA Disaster Relief Notice 2020-01, later extended by EBSA Disaster Relief Notice 2021-01, provided that the deadline by which action needs to be taken for the events described above was tolled until the earlier of: (i) one year from the date the deadline would have first started running for that individual or (ii) sixty (60) days from the end of the NE (the Outbreak Period). This guidance created a tolling deadline specific to each affected individual. Where the individual has not reached the one-year anniversary of the date of the initial deadline, timeframes will begin to run again sixty (60) days after the end of the NE (i.e., July 10, 2023).
The FAQs released by the Departments at the end of March provided much-needed clarification and various helpful examples for employers of how the outbreak period should be taken into consideration when calculating the tolled deadlines. For example, if an employee experiences a qualifying event under COBRA and loses coverage on April 1, 2023, the deadline for the individual to make a COBRA election is tolled until the earlier [...]
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