Let our team help you navigate the ever-changing benefits compliance landscape each month. Check out this month’s latest alerts, additional updates, and resources – hot off the press:

Employee Benefits Compliance Alerts

Washington State Long-Term Care Is Now in Effect

  • Originally established in 2021, the Washington Cares Fund provides long-term care for Washington workers.
  • Payroll deductions of .58% of wages began July 1, 2023.
  • Most employees can no longer apply for a private-plan exemption, although some exceptions are available.
  • Workers who contribute the required length of time may apply for benefits starting in July 2026.
  • Learn more about the urgency for Long-Term Care (LTC) strategy on Thursday, August 17 in our next Benefits Curve: Insights to Action webinar – register today!

Proposed Rule on Short-Term Limited Duration Insurance and Fixed Indemnity

  • The Departments recently issued proposed rules for short-term limited duration medical insurance and fixed indemnity plans.
  • The proposed rules would once again limit the time period for short-term limited duration medical policies to three months.
  • The proposed rules clarify the tax treatment of pre-tax fixed indemnity benefits and change how fixed indemnity plans can provide payment.
  • The Departments are requesting comments on the proposed rules.

Gag Clause Prohibition Attestation Due Later This Year

  • The Consolidated Appropriations Act of 2021 (CAA) prohibits group health plans and health insurance carriers from entering into agreements with providers, third-party administrators (TPAs), or other service providers that include language that constitutes a “gag clause.”
  • The gag clause prohibition became effective on December 27, 2020, but the gag clause prohibition compliance attestation (attestation) requirement was delayed pending the release of further guidance.
  • The first attestation is due December 31, 2023, and then annually.
  • The Departments have provided instructions for completing the attestation on the CMS webform.
  • Plan sponsors should be ready to comply with the first attestation.
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Additional Updates & Resources

FAQ Provides Guidance on the No Surprises Act

On July 7, 2023, The Departments released a set of joint agency frequently asked questions (FAQs) clarifying guidance on the No Surprises Act (NSA) and the Transparency in Coverage (TiC) requirements. The guidance clarifies that claims subject to the NSA prohibition on balance billing are subject to out-of-pocket maximum limits under the Affordable Care Act (ACA), even if those services would otherwise be considered out-of-network. As a reminder, services subject to the prohibition against balance billing are air ambulance claims, emergency services, and services provided by an out-of-network provider at an in-network facility.   

Additionally, the FAQs clarify that any contractual arrangement with an air ambulance provider, direct or indirect, makes the air ambulance provider a “participating provider” for purposes of the NSA. Separately, the FAQs indicate that facility fees fall under the definition of “items and services” which are protected under the NSA (and subject to in-network cost-sharing) and must also be disclosed for cost comparison purposes under the TiC requirements (e.g., price transparency tools and any advanced explanation of benefits).   

CMS Publishes Letter to Plan Sponsors on Medicaid Unwinding

On July 20, 2023, the Departments released a letter to employers and plan sponsors regarding the end of the Medicaid moratorium on Medicaid coverage terminations. The Medicaid continuous enrollment condition expired on March 31, 2023, under terms of the Consolidated Appropriations Act of 2023 (CAA 2023). Due to the exceptional circumstances surrounding the end of the COVID-19 pandemic public health and national emergency periods, the Departments anticipate that many former Medicaid enrollees will need more than the standard 60-day window after the loss of Medicaid or Children’s Health Insurance Program (CHIP) coverage to enroll in other coverage. The Departments encourage employers and plan sponsors to extend the period for special enrollment in their plans beyond the minimum 60 days required by statute after the loss of Medicaid or CHIP. The Departments further encourage employers and plan sponsors to help communicate Medicaid unwinding to their employees and remind employees of other healthcare options that may be available to them such as employer-sponsored coverage and healthcare.gov plans.

Departments Release Proposed Regulations for Mental Health Parity

On July 25, 2023, the Department of Labor (DOL), the Internal Revenue Service (IRS), and the Department of Health and Human Services (HHS), collectively known as the Departments, released proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). The regulations amend MHPAEA rules surrounding requirements implemented as part of the Consolidated Appropriations Act of 2021 (CAA). Released on the same day, was the 2023 Mental Health Parity Report to Congress outlining findings and enforcement of the CAA regulations. EPIC is working on digesting the details of the proposed regulations and will provide a detailed analysis in the next Compliance Matters release.

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