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New CMS Online Tool Displays Cost Differences for Certain Surgical Procedures

"The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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In the Wake of New Association Health Plan Standards, States Are Exercising Their Authority

"So far, nearly half of states have acted in response to the new federal standards, and more are likely to follow.... A state's approach is likely to be informed by the condition of its individual and small-group markets and laws that predate the ACA, many of which arose out of scandals associated with AHP fraud and insolvency.... While some have required only that these plans satisfy the federal minimum standards, most are putting in place additional requirements, generally applicable to both in-state and national AHPs, designed to protect consumers, providers, and health insurance markets." The Commonwealth Fund

New Proposed Regs Would Expand HRAs (PDF)

"These proposed rules will allow employers to offer HRAs that integrate with individual health insurance coverage. Any employer (not just small employers) can offer an HRA that integrates with an employee's or family member's individual insurance coverage. The insurance coverage could be purchased on or off the Marketplace. To receive a reimbursement from the HRA for health expenses or premiums, employees must verify they and any eligible family members have individual coverage." Marsh & McLennan Agency LLC

Certain Fringe Benefits for Not-for-Profits Taxed as Unrelated Business Income

"Effective for amounts paid or incurred after December 31, 2017... certain employee fringe benefits for not-for-profits are treated as unrelated business income unless they would otherwise be deductible ... These fringe benefit expenses include any: [1] Qualified transportation fringe benefit; or [2] Parking facility used in connection with qualified parking." WithumSmith+Brown, PC

Study Charts Recent Spike in Telehealth Usage, Particularly Within Primary Care

"Proposals from CMS aimed at broadening reimbursement for virtual services have received positive reviews from telehealth advocates. Those proposals have also met skepticism from some doctors, however. A research letter in the latest issue of JAMA suggests both groups have a point: the benefits of reimbursement appear to vary depending on the subspecialty involved." FierceHealthcare

The Rise of Outsourcing Leave Administration and What Employers Should Know About It

"While FMLA is the most common type of leave outsourced by employers today, employers are increasingly outsourcing the administration of other forms of leave including short and long term disability leave, ADA leave as an accommodation, employee assistance programs, group health, workers' compensation time, paid sick and parental leave, military, personal and bereavement leave." Miles & Stockbridge

CMS Announces Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage

"Enhanced direct enrollment provides a range of custom features and capabilities that allow consumers to apply, enroll, and manage their information through an approved partner website throughout the year. The enrollment partner's website will connect to HealthCare.gov in a manner that is invisible to the consumer. Through this new fully integrated platform, consumers and agents and brokers assisting consumers will be able to go directly to the approved enrollment partner's website to for the entire application and enrollment experience without being redirected to HealthCare.gov. In addition, consumers will be able download Exchange notices, get status updates, or follow up on actions they need to take directly through the partner's website. This great new opportunity enables the private sector to come up with innovative ways to create a uniquely tailored end-to-end user experience." Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Replacing Employer-Sponsored Health Insurance with Government-Financed Coverage: Considerations for Policymakers (PDF)

35 pages. "[This paper examines] the provenance, evolution, advantages and limitations of the leading source of coverage in the United States: employer-sponsored insurance (ESI). It will then examine some of the implications for health care financing and delivery were the U.S. government to supplant employers as the financer of medical care for most workers and their families.... The paper is not intended as a cost estimate or predictive model but rather as a way to identify and, in a more general sense, to quantify the implications of replacing ESI with government financing." Galen Institute

2018 Year End Checklist for Plan Administrators (PDF)

"[This] checklist addresses plan amendments, notices and other considerations for qualified retirement plans, welfare plans, and stock-based and performance-based plans. A chart showing benefit and contribution limits for 2019 is [included]." Williams Mullen

Pitfalls to Avoid When Negotiating Service Provider Agreements

"[1] Scope of services to be provided ... [2] Compensation and fee disclosures ... [3] Limitation of liability and indemnification applicable to both parties ... [4] Termination provision." Compliance Dashboard

Press Releases

PBGC Announces Leadership Appointments PBGC [Pension Benefit Guaranty Corporation]

JMM CPA Expands John Opsahl Role JMM CPA

Vitality-linked Insurers to Get 100 Million People 20% More Active by 2025 Vitality

Health Care Without Walls: A Roadmap for Reinventing U.S. Health Care Network for Excellence in Health Innovation [NEHI]

Principal Appoints Renee Schaaf as New Head of Retirement and Income Solutions Principal Financial Group

Northeast Business Group on Health Releases Updated Employer Guide to Digital Tools and Solutions for Diabetes Northeast Business Group on Health [NEBGH]

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Most Popular Items in the Previous Issue

Proposed Rule Expands HRA Usage and Forecasts Safe Harbors for ACA Employer Mandate Compliance Littler

Best Practices When Introducing a Qualified High Deductible Health Plan Findley

Text of Draft 2018 Instructions for IRS Form 8941: Credit for Small Employer Health Insurance Premiums (PDF) Internal Revenue Service [IRS]