30 pages. "This memo provides summary information on issuers' reissued 2019 benefit year HHS-RADV results and on issuers' 2020 benefit year HHS-RADV results. The 2019 benefit year HHS-RADV results are being reissued in response to actionable discrepancies under 45 CFR 153.630(d)(2), which challenged the calculation of the 2019 benefit year error rates under the HHS-RADV error estimation methodology."

• Appendix A: National Program Benchmarks -- 2020 Benefit Year HHS-RADV Compared to Reissued 2019 Benefit Year HHS-RADV (XLSX)
• Appendix B: 2020 Benefit Year RA State Market Risk Pool Weighted Average Error Rate from the Reissued 2019 Benefit Year HHS-RADV Results and the 2020 Benefit Year HHS-RADV Result (XLSX)
• Appendix C: 2020 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)
• Appendix D: 2019 Benefit Year HHS-RADV Failure Rate Group Definitions (XLSX)

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"The 2023 plan year will have the lowest [ACA] affordability threshold to date, 9.12 percent.... [T]his article will explore the details employers need to be aware of for the 2023 plan year and discuss some strategies employers can implement to minimize IRC section 4980H exposure."   MORE >>

"At bottom, the new rule appears to be more provider-friendly than the prior versions. However, more than 46,000 disputes have been filed since the Departments opened their online portal for submissions in April 2022, a figure far outpacing the Departments’ initial estimates for the entire first year."   MORE >>

"If signed, AB 152 will extend the COVID-19 SPSL requirements through December 31, 2022 -- three months beyond the current expiration date. The bill would not increase the amount of leave employees may take, but it would give employees an additional three months to use any SPSL for which they may be eligible. The Governor has until September 30, 2022 to sign or veto the bill. If the bill is not enacted, SPSL will expire as currently scheduled."   MORE >>

"After an evaluation of the financial health of the PFL program, the State has decided that it is able to expand benefits under the program, while reducing the employee contribution rate. The 2023 premium amount will be 0.455% of employee's gross wages (down from 0.511% in 2022), capped at an annual maximum employee contribution of $399.43 (down from $423.71 in 2022)."   MORE >>

"The court noted that GINA allows an employer to obtain genetic information if the employee provides 'prior, knowing, voluntary, and written authorization.' Whether the wellness program is 'voluntary' in light of the financial penalty for nonparticipation is to be determined in further proceedings." [ Williams v. City of Chicago , No. 20-0420 (N.D. Ill. Jul. 25, 2022)]   MORE >>

"Two in 10 employers (20%) added dollars to their healthcare plan without reallocating funds from other benefits or pay. Another 30% expect to do so in the next two years.... Four in 10 employers (41%) reported using a defined contribution strategy with a fixed dollar amount provided to all employees that differs by employee tier. Another 11% are planning or considering doing so in the next two years....A quarter of respondents (27%) used programs to combat fraud, waste and abuse. Another 22% expect to do so by 2024."   MORE >>

"Evaluation of a traditional RFP or PBM contract should begin with financial analysis of the following four key elements: discount guarantees (typically understood as point-of-sale ingredient costs), dispensing fees, rebate guarantees, and PBM administrative fees. This paper addresses various points of consideration when attempting a financial analysis of these contract elements."   MORE >>

"As Dec. 27, 2022 -- the deadline to report detailed data to [CMS] about prescription drug pricing and healthcare spending -- approaches, employers should consider whether they must report costs associated with third-party point solutions that provide medical care and are offered to employees. Given the wide range of point solutions available -- from technology to drive engagement, to disease management, fertility benefits, and behavioral health carve-outs -- there isn't a simple answer."   MORE >>

"The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and March 31, 2022.... The data include Medicare Part B Fee-for-Service Claims for services. All data are preliminary."   MORE >>

"HHS-OIG identified 1,714 providers who had 'concerning billing on at least one of seven measures… that may indicate fraud, waste, or abuse of telehealth services' and referred these providers to CMS for further investigation. While this could be read to suggest that billing data for the vast majority of providers has a clean bill of health, the report indicates that HHS-OIG identified only the most significant outliers on each metric."   MORE >>

"The results of this study highlight the convenience of teletherapy, positive experiences patients have and its increase in popularity across generations. The results also confirm ... that most participants (76%) reported being very or extremely satisfied with their most recent telehealth visit. Health insurers and health systems should recognize these positive sentiments and continue to offer and enhance such services."   MORE >>

"[A] short-term funding fix set to run to December probably won't include proposals to extend temporary telehealth flexibilities for employers, improve mental health care and provide more COVID-19 aid.... [A]ction on these issues now isn't likely until late this year in a crowded lame-duck session, complicating the outlook for final passage."   MORE >>

"Closing the gap between data and decisions is critical to building and delivering defensible and effective total rewards programs. Robust compensation and benefits data combined with experience, keen analysis, modern tools and a human touch all contribute to data, analysis and insights that are delivered quickly and accurately. And this is what equips HR teams with powerful insights that influence and inform top management decisions while attracting and retaining critical talent."   MORE >>