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No Surprises Act Part II Interim Final Rule: The Independent Dispute Resolution Process

… estimates of expected charges, the independent dispute resolution (IDR) process, the patient-provider dispute resolution process for uninsured and self-pay patients, and the new external review requirements. The comment period for the new final interim rule closes on December 6, 2021. The Centers for Medicare & Medicaid Services (CMS) and Employee Benefits Security Administration (EBSA) created Surprise Billing webpages that provide information on the NSA. HHS created the IDR Entity Certification Application Web Form Quick Reference Guide that explains the process for an arbitration organization to become a certified IDR entity. To be certified, an IDR entity must possess (directly …

https://www.epicbrokers.com/insights/no-surprises-act-part-ii-independent-dispute-resolution/

Latest Wave of Healthcare Systems Seeks Direct Sales to Northeast Employers

The New York metro area is seeing another resurgence in healthcare delivery systems attempting to sell their services directly to employers offering benefits programs. These systems are looking to work with their existing medical insurers or even bypass them entirely – getting into direct competition for insured members and patients. Viewpoints from Adam Okun Kaiser Permanente pioneered a new model for healthcare financing and delivery 60+ years ago in California. They created a healthcare system for their workers, later opening their insurance product to other employers using the Kaiser network and securing a captive member base for its doctors and hospitals …

https://www.epicbrokers.com/insights/healthcare-systems-seek-direct-sales-northeast-employers/

Washington State Creates the WA Cares Fund

… care (LTC) benefits. An employee payroll tax will provide funding for the WA Cares Fund. Washington employees may opt out of the payroll tax if they meet certain criteria by the exemption deadlines. However, exemption from the WA Cares payroll tax disqualifies a worker from ever receiving future WA Cares benefits. The newly created WA Cares Fund provides eligible Washington workers with state payroll tax-funded LTC insurance benefits beginning January 1, 2025. Employee premiums completely fund the WA Cares benefits. Employers are not required to contribute to any portion of the WA Cares premium – a 0.58% ($0.58 …

https://www.epicbrokers.com/insights/washington-state-creates-wa-cares-fund/

Missouri Passes the Victims’ Economic Safety and Security Act

… of employees. Covered employees receive: One week of unpaid leave, if the employer has 20-49 employees; and Two weeks of unpaid leave if the employer has 50 or greater employees. Employees may take this unpaid leave intermittently or on a reduced work schedule. VESSA also entitles covered employees to benefits and employment protection. Employees cannot lose any accrued benefits while on leave, and their employer must maintain their healthcare coverage. Additionally, employers must return employees to their same or an equivalent position upon their return from leave. Finally, VESSA requires employers to make reasonable safety accommodations for employees who …

https://www.epicbrokers.com/insights/missouri-passes-victims-economic-safety-security-act/

IRS Updates the Health Plan Affordability Percentage for 2022

… plan coverage that is affordable. Coverage is generally considered affordable if the employee contribution for employee-only (single) coverage does not exceed a set percentage (9.61% in 2022) of household income. NOTE: Coverage is considered affordable for dependents as well, regardless of the contribution amount, as long as the employee-only (single) coverage is affordable. Coverage is also considered affordable for purposes of satisfying §4980H(b) requirements if the employee contribution satisfies at least one of three available safe harbors (i.e., federal poverty level (FPL), rate of pay, or Form W-2). Required Contribution Percentage   Originally, for 2014 …

https://www.epicbrokers.com/insights/irs-updates-health-plan-affordability-percentage-2022/

Executive Order Requiring COVID-19 Vaccine Mandates or Frequent Testing for Workers

Quick Facts In September 2021, President Biden directed the Occupational Safety and Health Administration (OSHA) to create rules requiring U.S. employers with 100 or greater employees to require COVID-19 vaccinations or weekly testing before coming to work. At the time of publication of this document, OSHA is still working to develop rules. President Biden will require COVID-19 vaccinations for workers in most healthcare settings that receive Medicare or Medicaid reimbursement. President Biden extended vaccine requirements for federal workers and contractors to be vaccinated against COVID-19. Background On September 9, 2021, an Executive Order from President Joe …

https://www.epicbrokers.com/insights/executive-order-covid-vaccine-mandates-frequent-testing/

COVID-19 Vaccine Incentives Employer Guide

Quick Facts Generally, employers are allowed to provide incentives to employees who obtain the COVID-19 vaccine. Employers that implement vaccine incentives must comply with wellness program rules under the Health Insurance Portability and Accountability Act (HIPAA) and the Equal Employment Opportunity Commission (EEOC). Employers that implement vaccine incentives must make considerations on issues such as Affordable Care Act (ACA) affordability, grandfathered status and Title VII discrimination. Overview Now that COVID-19 vaccinations are readily available to all but young children, more employers are looking to encourage, and in some cases mandate, employees and their family members to get vaccinated …

https://www.epicbrokers.com/insights/covid-19-vaccine-incentives-employer-guide/

Reminders About Upcoming Changes to Healthcare Spending Related to the COVID-19 Pandemic

The Coronavirus Aid, Relief, and Economic Security (CARES) Act was enacted on March 27, 2020. The law permitted flexibility to healthcare spending related to high-deductible health plans (HDHPs). The CARES Act also modified the rules that apply to various tax-advantaged spending accounts so that additional items are considered qualified medical expenses which spending accountholders and plan participants may reimburse from those accounts. The spending flexibility permitted under the CARES Act expires on December 31, 2021. On March 11, 2020, the Internal Revenue Service (IRS) issued a notice allowing HDHPs to cover testing for, and treatment of, COVID-19 …

https://www.epicbrokers.com/insights/reminders-upcoming-changes-healthcare-spending-covid-19-pandemic/