Health and Welfare Plans Archives - Page 46 of 126

HHS Proposes Changes to 2016 Regulations for ACA Non-Discrimination Rule

by Jacob Mattinson | May 28, 2019 | Employee Benefits, Health and Welfare Plans

On Friday, March 24, 2019, the US Department of Health and Human Services issued a proposed rule (along with a related fact sheet) under Section 1557 of the Affordable Care Act (ACA) that would make significant changes to the final regulations issued in 2016. Section 1557, in effect since the ACA was enacted in 2010, provides that an individual shall not—on the grounds prohibited under Title VII of the Civil Rights Act of 1964 (race, color, national origin), Title IX of the Education Amendments of 1972 (sex), the Age Discrimination Act of 1975 (age) or Section 504 of the Rehabilitation Act of 1973 (disability)—be excluded from participation in, be denied the benefits of or be subjected to discrimination under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an agency established under Title I of the ACA.

The proposed rule addresses a broad range of changes to the previously issued rule. These changes would include eliminating the non-discrimination notices and “tagline” translation notices in significant communications and revising prior guidance on sex discrimination to no longer include gender identity and termination of pregnancy, among other changes. Interested parties are invited to submit comments on the proposed rule through the period ending 60 days after publication in the Federal Register.

DOL Offers Interim Relief for Employers’ Association Health Plans

by Megan Mardy and McDermott Will & Emery | May 7, 2019 | Employee Benefits, Health and Welfare Plans

Last week, the Department of Labor (DOL) responded to the district court decision striking down the final regulations expanding the ability for a group of unrelated employers to form an organization in order to offer health care to its members. The DOL’s statement setting forth policy positions regarding association health plans (AHPs) indicated its intent to fight the district court decision, and offered interim relief for those employers who have obtained health coverage from AHPs relying on the DOL’s final regulations. The DOL noted that the agency is committed to taking all appropriate action within its legal authority to minimize undue consequences on employees and their families. Thus, employers participating in insured AHPs can generally maintain that coverage through the end of the plan year or, if later, the contract term. During this time, the DOL will not pursue enforcement actions involving AHP in reliance of the DOL’s final rules.

Fridays With Benefits Webinar | The Triage Unit: Cutting Health Plan Costs Without Sending Benefits to the Emergency Room

by McDermott Will & Emery | Apr 11, 2019 | Employee Benefits, Health and Welfare Plans

Join us Friday, April 19 as Erin Turley and Judith Wethall discuss some of the innovative strategies organizations are employing to achieve transparency, reduce fees and provide enhanced offerings when negotiating multi-year health and welfare benefit plan contracts.

Our lively 45-minute discussion will cover emerging trends you can leverage at the negotiating table, including

Pharmacy Pricing Transparency
Data Access/Ownership Rights
Performance Guarantees and Other Rebates

Friday, March 15, 2019

10:00 – 10:45 am PST
11:00 – 11:45 am MST
12:00 – 12:45 pm CST
1:00 – 1:45 pm EST

Register Now.

Court Puts Association Health Plans in Limbo

by Jacob Mattinson and Megan Mardy | Apr 9, 2019 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

On March 28, a District of Columbia federal court agreed with a New York-led challenge by a group of 11 states and the District of Columbia and found that the Department of Labor’s (DOL) 2018 association health plan (AHP) rule (the Final Rule):

Is contrary to the Employee Retirement Income Security Act of 1974 (ERISA)’s text and purpose; and
Circumvents the protections and standards of the Affordable Care Act (ACA).

The decision, penned by Judge Bates, may act to deal a significant blow to the Trump administration’s attempt to expand coverage for small employers. Crafted in response to the October 12, 2017, executive order directing the DOL to promote the availability of AHPs, the Final Rule materially relaxed the standards for qualifying as an AHP under ERISA.

As further described here, the Final Rule sets forth the criteria pursuant to which a “bona fide group or association of employers” may establish a single-employer AHP under ERISA. Under the Final Rule, employers, associations and sole proprietors (referred to as “working owners”) can participate in AHPs provided certain arguably subjective requirements are satisfied. The states challenged the Final Rule, arguing that the DOL unreasonably expanded ERISA’s definition of employer. Applying the Chevron standard, the court agreed with the states to hold that the DOL unlawfully expanded ERISA’s definition of employer by failing to provide a “meaningful limit on the associations that would qualify as ‘bona fide’ ERISA ‘employers.’” The court vacated the bona fide association and working owner provisions of the Final Rule, but also provided some specific critiques and ordered the DOL to determine whether any part of the Final Rule can be salvaged; for now, the Final Rule is in limbo.

In a set of Questions and Answers issued April 2, 2019, the DOL noted that it disagrees with the court’s decision, and is considering all available options in consultation with the Department of Justice (DOJ). The DOJ has until May 28 to file a notice of appeal. The Trump administration could seek a stay of the order pending resolution of any appeal. Unless a court issues a stay, the regulations in effect prior to the Rule would be in effect. Stay tuned for further guidance and developments.

ERISA Health Plan Fiduciaries Defeat DOL’s Excessive Fee Claims

by Erin Steele, Megan Mardy and Richard J. Pearl | Mar 26, 2019 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

In one of the first ERISA cases to address claims against fiduciaries for excessive health plan fees, the court entered judgment in favor of the defendants on all counts. The decision addresses health plan fiduciary standards for reviewing plan fees and expenses.

Access the full article.

ERISA Plan Controversy | Rising Stakes for Those Unprepared

by Chris C. Scheithauer and Ted Becker | Mar 21, 2019 | Benefit Controversies, Employee Benefits, Employee Stock Ownership Plans (ESOPs), Fiduciary and Investment Issues, Health and Welfare Plans, Retirement Plans

In a presentation at McDermott’s Employment and Employee Benefits Forum, Ted Becker and Chris Scheithauer explored the various ways that disgruntled employees file lawsuits with plaintiffs’’ lawyers. Lawsuits have been brought in cases alleging, imprudence in the management of plans, challenging fees, involving company stock, actuarial equivalence and more. They used recent cases such as, NYU, American Century Services and IBM, as examples of the various types of lawsuits and the important lessons employers can take away from them. In addition, they provided attendees with key strategies to minimize exposure to lawsuits, including demonstrating a thoughtful and deliberative decision-making process.

Looking ahead to 2019, they touched on ERISA issues to watch for including, venue/forum selection clauses in plan documents, arbitration agreements and impact on fiduciary duty claims, statute of limitations and burden of proof issues.

View the full presentation.

ERISA Plan Documents Must State Procedures for Authorizing a Representative under a Plan

by Jacob Mattinson and Megan Mardy | Mar 19, 2019 | Benefit Controversies, Employee Benefits, Health and Welfare Plans, Retirement Plans

In an Information Letter dated February 27, 2019, the Department of Labor (DOL) clarified that an ERISA plan must include any procedures for designating authorized representatives in the plan’s claims procedure and summary plan description (SPD) or in a separate document that accompanies the SPD. In response to a request by a patient advocate and health care claim recovery expert for plan participants and beneficiaries, the DOL reiterated that the claims procedure regulations permit authorized representatives to receive notifications in connections with an ERISA plan’s claim and appeal determinations, and noted that a plan’s claims procedure cannot prevent claimants from choosing who will act as their representative for purposes of a claim and/or appeal. ERISA plan sponsors should review plan documents to ensure that the applicable documents clearly outline any steps a participant or beneficiary must take to validly designate an authorized representative under the plan.

Trends in Qualified Plans and Health & Welfare Plans

by Jeffrey Holdvogt | Mar 15, 2019 | Employee Benefits, Executive Compensation, Health and Welfare Plans

In a presentation at McDermott’s Employment and Employee Benefits Forum, Jeffrey Holdvogt discussed qualified plans, including student loan repayment benefits and the rise of DOL/IRS/PBGC plan activity. He also commented on the scrutiny on plan governance and fiduciary process materials. He addressed the legal challenges and mandates, such as state laws protecting against balance billing by out-of-network providers.

View the full presentation.

Event | Benefits Emerging Leaders Working Group

by McDermott Will & Emery | Feb 26, 2019 | Employee Benefits, Employment, Fiduciary and Investment Issues, Health and Welfare Plans, Retirement Plans

Join us on March 7 in Chicago for our annual Benefits Emerging Leaders Working Group, which provides benefit professionals with tools to better serve employees in an ever-changing benefits landscape.

Our presentations will tackle the latest benefits hot topics and best practice solutions and will be supplemented with important networking opportunities aimed to connect tomorrow’s benefit leaders with a broad network of professionals.

Speakers from The Art Institute of Chicago, Alera Group Inc. and McDermott will lead interactive discussions around a range of topics, including:

Affordable Care Act (ACA) Penalties – Marketplace Letters
Investment Committee Meetings – Red Flags and Best Practices
Developments in Parental and Caregiver Leaves – A Case Study Approach
Legislative Rundown – What’s Happening in Washington
Around the Horn – A Group Discussion

Register Now.

Digital Health Drives Forward – A Roadmap of Regulations

by McDermott Will & Emery | Feb 21, 2019 | Health and Welfare Plans

New digital health regulations arose at the federal and state level in 2018, bolstering the existing legal framework to further support and encourage digital health adoption in the context of care coordination and the move to value-based payment. McDermott’s 2018 Digital Health Year in Review: Focus on Care Coordination and Reimbursement report – the second in a four-part series – highlighted these developments within the digital health landscape. These efforts brought changes to coverage of telehealth and other virtual care services, as well as information gathering for regulatory reform, and can help bridge the gap between research, funding and implementation as regulations build a framework within which companies can deploy their products, receive reimbursement and demonstrate value to patients. Here we outline digital health developments from the second half of 2018 and how they can help drive digital health forward in 2019. For a closer look at key care coordination and reimbursement developments that shaped digital health in 2018, along with planning considerations and predictions for the digital health frontier in the year ahead, download our full report.

To view the first report in the series, 2018 Digital Health Year in Review: Focus on Data, click here.

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