Health and Welfare Plans Archives - Page 17 of 129

CMS Releases Proposed Rule: Medicaid Program; Ensuring Access to Medicaid Services

by Katie Waldo, Kayla Holgash, Rodney Whitlock and Debra Curtis | May 30, 2023 | Employee Benefits, Health and Welfare Plans

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.

Download the full analysis.

Bipartisan Health Bills Pick Up Steam, but Contentious Debt Ceiling Negotiations Continue

by McDermott Will & Emery | May 26, 2023 | Employee Benefits, Health and Welfare Plans

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.

Read more here.

CMS Ups Hospital Price Transparency Enforcement, Seeks More Authority from Congress

by Steven J. Schnelle | May 25, 2023 | Employee Benefits, Health and Welfare Plans

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.

Read more here.

May Trending in Telehealth

by Patrick Zanayed and Jayda Greco | May 24, 2023 | Digital Health, Employee Benefits, Health and Welfare Plans

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?

Learn more here.

Preparing for the End of the COVID-19 Emergency: Deadline Tolling

by Jacob Mattinson, Sarah Raaii, Alden Bianchi and Teal Trujillo | May 18, 2023 | Employee Benefits, Health and Welfare Plans

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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IRS Announces 2024 Limits for Health Savings Accounts, High-Deductible Health Plans and Excepted Benefit HRAs

by Jacob Mattinson and Sarah Raaii | May 17, 2023 | Employee Benefits, Health and Welfare Plans

Recently, the Internal Revenue Service (IRS) announced (See Revenue Procedure 2023-23) cost-of-living adjustments to the applicable dollar limits for health savings accounts (HSAs), high-deductible health plans (HDHPs) and excepted benefit health reimbursement arrangements (HRAs) for 2024. All of the dollar limits currently in effect for 2023 will change for 2024, with the exception of one limit. The HSA catch-up contribution for individuals ages 55 and older will not change as it is not subject to cost-of-living adjustments.

See the adjustments here.

Ending Free COVID Tests Risks Worsening the Pandemic

by Amy Kelbick and Eric Zimmerman | May 16, 2023 | Employee Benefits, Health and Welfare Plans

The end of the COVID-19 public health emergency also means the end of coverage of self-administered, over-the-counter COVID tests. In this MedTech Dive opinion article, McDermott+Consulting’s Amy Kelbick and Eric Zimmerman argue that insurers, including Medicare, should continue to cover COVID tests at no cost and without requiring a prescription even after the public health emergency ends.

Read more here.

April Trending in Telehealth

by Marshall E. Jackson, Jr. and Jayda Greco | May 11, 2023 | Digital Health, Employee Benefits, Health and Welfare Plans

Numerous states—including North Dakota, Hawaii, Indiana, Texas and New Hampshire—have been busy finalizing rulemaking and legislation impacting healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate virtual care. What have these states been up to over the last month?

Learn more here.

From Clinic to Courtroom: Legislation and Litigation Limiting Prescription Practices

by Alden Bianchi | May 10, 2023 | Employee Benefits, Health and Welfare Plans

On April 20, 2023, McDermott’s Alden Bianchi was a speaker at the ERISA Industry Committee’s 2023 Annual Spring Policy Conference, which was held at the National Press Club in Washington, D.C. The panel in which he participated was entitled “From Clinic to Courtroom – Legislation and Litigation Limiting Prescription Practices,” and it covered three main topics: state regulation of telehealth; the regulation of specialty pharmacy supply chains and delivery measures (“brown bagging,” “white bagging” and “clear bagging”); and state-level efforts to regulate pharmacy benefit managers (PBMs) following the US Supreme Court’s 2020 Rutledge decision, which held that an Arkansas law regulating the costs of prescription drugs was not preempted by the Employee Retirement Income Security Act of 1974 (ERISA).

Here are some of the program’s key takeaways and predictions:

While telehealth is here to stay, the high cost of Medicare reimbursements presents an immediate barrier to widespread adoption, and the particulars of how telehealth will be regulated will be left largely to the states.
The battle over the delivery of specialty prescription drugs is heating up as PBMs seek to capture some of the margins previously available only to providers. State laws regulating pharmacies and pharmacists will be at the center of the battle, and future legislative efforts will likely be subject to challenge.
State legislatures have read the Rutledge decision broadly in ways that virtually guarantee a good deal of future litigation. It might take as long as a decade, and it may well take more than one trip to the Supreme Court before plans, issuers, providers, state legislators and regulators, and other stakeholders have a reliable understanding of the contours of ERISA preemption in the pharmacy context.

Accompanying this post are copies of Mr. Bianchi’s panel materials, including:

Federal Government to Wind Down Vaccination Mandates

by Sandra M. DiVarco, Kristen O'Brien and Rachel Stauffer | May 9, 2023 | Employee Benefits, Health and Welfare Plans

The Biden administration has announced that the federal government will wind down its remaining COVID-19 vaccination mandates (including those for federal workers, contractors and international air travelers) effective May 11, 2023. This action coincides with the conclusion of the COVID-19 public health emergency (PHE). Additionally, the US Department of Health and Human Services (HHS) will initiate steps to terminate the vaccination prerequisites for healthcare facilities that are certified by the Centers for Medicare & Medicaid Services (CMS).

Read more here.

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