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Action Item for Employers with HSA-Eligible Health Plans in Oklahoma

Beginning November 1, 2021, a new Oklahoma state insurance law requires health insurers providing pharmacy benefits and pharmacy benefit managers (“PBMs”) to count any amount paid on behalf of a participant towards that participant’s out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing arrangement. The law appears to be intended to apply only to pharmacy benefits. Counting such third-party payments, such as a prescription drug manufacturer’s coupon, towards a participant’s deductible could cause the participant to be ineligible for a health savings account (“HSA”). The Oklahoma Insurance Department has stated it is seeking clarification from the Oklahoma legislature regarding the conflict between the state statute and the federal rules governing HSA eligibility. Employers may want to contact their health insurers and PBMs (i) to determine whether any third-party payments are being applied toward the deductible under an HSA-eligible health plan and (ii) to communicate any relevant information to participants who may be affected. This new law… Continue Reading

New Federal Reporting Requirements for Prescription Drug and Health Care Spending

The Consolidated Appropriations Act of 2021 (“CAA”) requires employer-sponsored group health plans to submit certain information about prescription drug and health care spending, premiums, and enrollment to HHS, the DOL, and the Treasury on an annual basis. Interim final rules were issued implementing this requirement, with enforcement delayed so that reporting for 2020 and 2021 is not due until December 27, 2022. However, employers are advised to contact their third party administrators and pharmacy benefit managers soon to determine if they will submit these reports on behalf of the group health plan and will be ready to do so by the deadline.  Although an employer with a self-funded group health plan may contract with a third party administrator and/or pharmacy benefit manager to handle these reporting requirements, the employer remains liable if there is a compliance failure.  The interim final rules are available here. 

Keep Mental Health Parity Compliance Documentation at the Top of Your Compliance To-Do List

As discussed in our prior blog posts, available here, here, and here, an employer must maintain documentation demonstrating that its group health plan is compliant with mental health and substance use disorder parity rules. The DOL has made compliance with these rules a high priority, and DOL enforcement efforts have begun. Employers should follow up with their medical, network, prescription drug, and other third-party service providers to define expectations and set deadlines for the production of information that employers need for the required reporting. Given the amount of detail, effort, and coordination that this compliance documentation requires, employers should ensure that a compliant report can be timely provided if there is a DOL inquiry.

Departments Solicit Comments regarding Consolidated Appropriations Act of 2021 Prescription Drug Reporting Requirements

Under the Consolidated Appropriations Act of 2021 (the ?Ç£CAA?Ç¥), employer-sponsored group health plans will be required to submit to the DOL and/or Treasury Department a new annual report containing information pertaining to plan participation and prescription drug coverage provided under the plan during the previous plan year (the ?Ç£Rx Report?Ç¥). Among other items, the Rx Report must include information regarding (i) claims paid under the plan for the 50 most frequently dispensed brand prescription drugs (?Ç£Claims Paid Items?Ç¥), (ii) annual spending for the 50 most costly prescription drugs (?Ç£Spending Items?Ç¥), and (iii) rebates, fees, and other remuneration paid by drug manufacturers to the plan, its administrators, or service providers (?Ç£Rebate Items?Ç¥).  The first Rx Report is due by December 27, 2021, and each subsequent Rx Report is due by each June 1. Recently, the DOL, Treasury Department, and HHS (the ?Ç£Agencies?Ç¥) jointly issued a ?Ç£request for information?Ç¥ (the ?Ç£RFI?Ç¥) seeking public… Continue Reading

Updates on Employee Benefits Regulations Impacted by the Biden Administration?ÇÖs Regulatory Freeze

On January 20, 2021, the Biden Administration issued a memorandum (the ?Ç£Memo?Ç¥) calling for a 60-day freeze on regulations that had not taken effect as of the date of the Memo, which included certain regulations related to employee benefits (see our prior blog post regarding the Memo here). The Memo also authorized additional postponement of such regulations following the 60-day period where deemed necessary for further review. Listed below are some of the previously discussed proposed and final regulations related to employee benefits that were impacted by the Memo and updates to their effective dates: Independent Contractor Status Under the Fair Labor Standards Act. Final Rule. Effective date is delayed until May 7, 2021. There is also a proposed withdrawal of this rule with comments due by April 12, 2021. Medicare Program; Secure Electronic Prior Authorization for Medicare Part D. Final Rule. Effective date was delayed until March 30, 2021.… Continue Reading

Employee Benefits Regulations Potentially Impacted by the Biden Administration?ÇÖs Regulatory Freeze

On January 20, 2021, the Biden Administration issued a memorandum (the ?Ç£Memo?Ç¥) announcing a regulatory freeze on regulations that have not taken effect as of the date of the Memo. Specifically, the Memo recommends postponing the effective date of any regulation that has been issued, but has not taken effect, for 60 days from the date of the Memo. The Memo further directs that regulations not yet published in the Federal Register be immediately withdrawn for review. Listed below are some of the proposed and final regulations related to employee benefits that may be subject to withdrawal or postponement under the Memo: Prohibited Transaction Exemption 2020-02 ?Çô Improving Investment Advice for Workers & Retirees. Final Rule. Application of the Employer Shared Responsibility Provisions and Certain Nondiscrimination Rules to Health Reimbursement Arrangements and Other Account-Based Group Health Plans Integrated with Individual Health Insurance Coverage or Medicare. Final Rule. Pension Benefit Statements-Lifetime… Continue Reading

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