Health and Welfare Plans Archives - Page 35 of 129

Requirements Related to Surprise Billing: Policy Update

by Eric Zimmerman, Kristen O'Brien and Katie Waldo | Sep 9, 2021 | Employee Benefits, Health and Welfare Plans

The US Departments of Health and Human Services, Treasury and Labor, and the Office of Personnel Management issued an Interim Final Rule with comment implementing portions of the No Surprises Act, legislation enacted in December 2020 that bars surprise billing beginning January 1, 2022. Under the law, payers and providers (including hospitals, facilities, individual practitioners and air ambulance providers) are prohibited from billing patients more than in-network cost-sharing amounts in emergency and non-emergency circumstances. This IFR establishes regulations defining the payment methodology. The regulation proposes the methodology payers must use to determine cost sharing; the information payers must share with out-of-network providers; the process for submitting and receiving consumer complaints; and the format and details of the notice and consent requirements.

Mask Up, Vax Up: Illinois Governor Issues Immediate Face Covering Mandate for All, COVID-19 Vaccine Mandate for Healthcare, School and State Workers and Students

by Michelle S. Strowhiro, Dawn Peacock, Brian Mead and Michael J. Sheehan | Sep 2, 2021 | Employment, Health and Welfare Plans

On August 26, 2021, Illinois Governor J.B. Pritzker issued Executive Order 2021-20 (the Order). The Order mandates that all individuals in Illinois who are at least two years old and who are medically able must wear face coverings indoors and in other specified settings.

In addition, the Order mandates COVID-19 vaccination for certain professionals in healthcare and education, as well as for students and state employees, subject to certain exemptions which require regular COVID-19 testing.

Four Things To Know About COVID ‘Long-Haulers’ At Work

by McDermott Will & Emery | Aug 31, 2021 | Employee Benefits, Employment, Health and Welfare Plans

Research continues to shed light on COVID-19’s long-term health effects for some people, and these “post-COVID conditions” will create additional challenges for employers.

In this Law360 article, McDermott partner Carole A. Spink says employers should be aware that long-haul COVID symptoms mean additional accommodations for employees.

“As they have done throughout the pandemic, employers should have a plan for addressing potential long-term absences as a result of post-COVID effects. On the practical side, at some point employers may need to determine whether a particular situation has become such that providing a continuing reasonable accommodation would pose an undue burden,” Spink notes.

Access the article.

Pfizer’s Full Approval Triggers New Vaccine Mandates

by Michelle S. Strowhiro | Aug 26, 2021 | Employment, Health and Welfare Plans, Labor

The full US Food and Drug Administration (FDA) approval of the Pfizer-BioNTech COVID-19 vaccine has led to vaccine mandates by both governments and businesses. More companies will implement their own vaccine requirements in light of the FDA approval, according to McDermott partner Michelle Strowhiro in this The Hill article.

“What employers are trying to balance right now is implementing the right safety standards for their workforce while also being cognizant of the fact that the labor market is so difficult and many employers are already struggling with having the right number of people on staff,” Strowhiro said.

Access the article.

What Should Be in a Vaccination Policy?

by McDermott Will & Emery | Aug 17, 2021 | Employment, Health and Welfare Plans, Labor

Employers are facing a myriad of decisions as they consider vaccination requirements for their workforces.

Mandatory vaccine policies, for example, should include rationale for why they are required, McDermott partner Carole A. Spink said in this Society for Human Resource Management article. The scope of any policy should be clearly identified and explain which employees it applies to.

IRS Issues Guidance on Fertility Treatment Deductibility for Same-Sex Couples

by John Lutz | Aug 12, 2021 | Employee Benefits, Health and Welfare Plans

On April 9, 2021, the Internal Revenue Service (IRS) released PLR 202114001 (PLR), which provides guidance on the deductibility of medical costs under Section 213 of the Internal Revenue Code relating to fertility expenses for same-sex couples. The PLR disallows most of the costs incurred by a same-sex couple wishing to have a child.

However, according to McDermott partner John T. Lutz, the IRS’ distinction between deductible costs for medical procedures attributable to the taxpayer and non-deductible costs for medical procedures attributable to third parties raises unique concerns about the equitable treatment of different taxpayers.

Access the article.

California Requires Vaccines or Regular COVID-19 Testing for Certain Healthcare Workers and State Employees

by Michelle S. Strowhiro and Ludia Kwon | Aug 4, 2021 | Employee Benefits, Employment, Health and Welfare Plans

On July 26, 2021, the California Department of Public Health (CDPH) issued a new Order that impacts healthcare and state employers in California. According to McDermott’s Michelle S. Strowhiro, Ellen M. Bronchetti and Ludia Kwon, the CDPH Order requires that almost all healthcare employers verify the vaccination status of all of their workers.

The Order also requires workers who are not fully vaccinated to go through regular COVID-19 testing at specified intervals. These facilities also must have a plan in place for tracking verified worker vaccination statuses.

Access the article.

Obtaining Payer Coverage for New Tests Continues to Be Difficult

by Deborah Godes | Aug 3, 2021 | Employee Benefits, Health and Welfare Plans

Clinical laboratories continue to face challenges to obtain positive coverage decisions by government and private payers for new tests. According to McDermott+Consulting Senior Director Deborah Godes, payers require reasons to establish new coverage assays.

“[The] key to getting a positive coverage decision from payers is making a solid case through good quality evidence,” Godes notes in a recent Dark Report article. “Clinical laboratories need to demonstrate that a particular assay actually works as it is intended and also that it is used by clinicians to make decisions regarding patient care. ”

Not all payers will be persuaded by the same arguments. Each payer has its own coverage determination process, and clinical laboratories should be prepared to deal with each one individually.

“You need to determine what drives that payer’s denials and then present evidence to address those concerns,” Godes says.

Access the article.

Can Employers Offer COVID-19 Vaccine Incentives for Employees?

by Michelle S. Strowhiro and Ludia Kwon | Jul 28, 2021 | Employee Benefits, Employment, Health and Welfare Plans

Can employers offer incentives for employees to get a COVID-19 vaccine? In short, yes. Incentives may take many forms, such as a one-time bonus, a gift card or a few extra vacation hours. Employers can get creative.

According to McDermott’s Michelle S. Strowhiro, Judith Wethall and Ludia Kwon, there are two issues to consider when implementing a vaccine incentive program for purposes of complying with employment and benefits laws: the concepts of coercion and reasonable accommodation.

Access the article.

COVID-19 Laws and Regulations: A Midyear Update

by McDermott Will & Emery | Jul 22, 2021 | Employee Benefits, Employment, Health and Welfare Plans

As employers navigate evolving COVID-19 state and federal rules, workplaces will have to stay vigilant about changes throughout the second half of 2021. These include changes to mask mandates, the Occupational Safety and Health Administration’s Emergency Temporary Standard and the New York Health and Essential Rights (HERO) Act.

Recent US Equal Employment Opportunity Commission guidance, for example, confirmed what employment lawyers had already been counseling businesses to do, according to McDermott partner Carole A. Spink in a recent Law360 article.

“The guidance was important because it did clarify that employers can provide incentives for voluntary programs. [There] was a big open question about, ‘Am I going to get into trouble because I’m trying to incentivize people to be vaccinated?'”

Access the article.

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