End of COVID-19 National Emergency Outbreak Period Fast Approaching
Now that the COVID-19 National Emergency has ended, employers must prepare for the end of the Outbreak Period. Based on DOL FAQ guidance and subsequent commentary, the Outbreak Period will end on July 10, 2023. This means that the tolling of certain ERISA plan deadlines (e.g., COBRA elections, payments and certain notices, HIPAA special enrollments, and claims and appeals filings) will no longer be required.
Accordingly, employers should work with legal counsel, TPAs, COBRA vendors and other service providers to ensure related plan documents, procedures and systems are updated to accommodate the Outbreak Period end and subsequent reversion to pre-pandemic election, notice and payment timelines after July 10, 2023. Additionally, employers should ensure appropriate communications are provided to plan participants and COBRA beneficiaries regarding the approaching deadlines and upcoming changes.
An employer considering extending the tolling past July 10, 2023, should consult with legal counsel and ensure express permission is obtained from the carrier or TPA.
For further information, download a copy of End of COVID-19 Emergency Declarations: A Guide for Employers.
Governor Signs New Healthcare Bills into Law
June 21, 2023
Recently, Gov. Bel Edwards signed numerous healthcare bills into law.
Act 336 (previously HB 41) requires a health plan to pay for covered occupational therapy services provided via telehealth equivalent to the coverage and payment for the same service provided in person. Generally, the new law’s provisions prohibit coverage maximums, cost-sharing, and other conditions relative to telehealth services that are inapplicable to in-person services.
Act 299 (previously HB 186), known as “The Medically Necessary Fertility Preservation Act,” requires health plans to cover medically-necessary expenses for standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility. Iatrogenic infertility is a fertility impairment caused by surgery, chemotherapy, radiation or other medical treatment. Coverage for standard fertility preservation services includes costs associated with storing oocytes and sperm for certain periods. The plan cannot require preauthorization; however, certain cost-sharing and maximum benefit limitations are permitted.
Under Act 270 (previously HB 272), a health plan that provides benefits for maternity services must include coverage for maternity support services provided by a doula to pregnant and birthing women before, during and after childbirth. A doula is an individual who has been trained to provide physical, emotional, and educational support, but not medical or midwifery care, to pregnant and birthing women and their families.
The new law also requires health plans to provide up to two months of coverage for medically necessary pasteurized donor human milk as prescribed by an infant's pediatrician due to certain conditions.
Act 281 (previously HB 578) requires a health plan to include coverage for smoking cessation benefits for a minimum period of six months if a licensed physician recommends and certifies that the smoking cessation benefits may help the person to quit smoking. Smoking cessation benefits means smoking cessation treatments and services, including individual counseling, group counseling, nicotine patches, nicotine gum, nicotine lozenges, nicotine nasal spray, nicotine inhaler, and the medications bupropion and varenicline. The required coverage cannot be subject to annual deductibles, coinsurance, copayment, or any other out-of-pocket or cost-sharing expense provisions.
Under Act 324 (previously SB 104), a health plan must cover biomarker testing for purposes of the diagnosis, treatment, appropriate management or ongoing monitoring of an individual's disease or condition when such testing is supported by certain medical and scientific evidence. Biomarker testing is used in cancer treatment and involves the analysis of an individual's tissue, blood or other biospecimens for the presence of a gene mutation or other characteristic that can be evaluated to assess how an individual may respond to a particular course of therapy. The coverage can be subject to annual deductibles and cost-sharing.
Plans are not required to cover biomarker testing for screening purposes.
Generally, the above new laws apply to health policies and plans issued or delivered in the state on and after January 1, 2024. Additionally, any health policy or plan in effect prior to January 1, 2024, is required to conform to these new laws on or before the renewal date but no later than January 1, 2025.
Employers should be aware of these coverage updates and contact their carriers for further information.
State Protects Access to Preventive Healthcare Services
June 21, 2023
On May 24, 2023, Gov. Walz signed an omnibus bill that includes provisions requiring health insurers regulated by the state to provide preventive services (as specified in the federal ACA) at no cost. The intent of this law is to preserve the preventive services provisions of the ACA in light of current litigation seeking to remove those provisions from federal law.
Employers with plans regulated by the state should be aware of this new law.
Superintendent Reminds Managed Care Plans of Requirement for Reasonable Access to Out-of-Network Providers
June 21, 2023
On May 30, 2023, the Office of Superintendent of Insurance released Bulletin 2013-013 as a public reminder to New Mexico health insurance carriers that the state’s Patient Protection Act (PPA) obligates managed healthcare plans to provide “reasonably accessible health care services that are available in a timely manner,” including coverage of out-of-network services when “medically necessary covered services are not reasonably available through participating providers.”
The bulletin indicates that the superintendent has knowledge of recent incidents where carriers are administratively denying coverage by out-of-network providers, contrary to the PPA’s requirements, and makes clear that violations are subject to enforcement actions which include administrative penalties of up to $10,000 per violation, suspension of any certificate of authority or license issued under the Insurance Code, and private remedies available to both patients and providers.
Employers that offer managed healthcare plans in the state to their employees should be aware of this recent bulletin.
State Passes VT Saves Retirement Program
June 21, 2023
On June 1, 2023, Gov. Scott signed SB 135, establishing VT Saves, a mandatory state-run payroll-deduction Roth IRA program to take effect in 2025. Employers who do not otherwise offer a qualified retirement savings program will be required to enroll in VT Saves and allow employees to make contributions via automatic payroll deductions. Employers will be responsible for enrolling employees and coordinating salary deductions but are not required to make additional contributions. Employer enrollment deadlines have been set as follows:
- Employers with 25 or more employees — July 1, 2025
- Employers with 15 to 24 employees — January 1, 2026
- Employers with 5 to 14 employees — July 1, 2026
Employers who have not been in business during both the current and preceding calendar year are exempted. It is unclear whether employers with fewer than five employees will be required to enroll.
In general, an employee will be eligible to participate in VT Saves if they are at least 18 years old and paid Vermont-taxable wages from a covered employer. Future regulations will determine whether part-time, seasonal, or temporary employees will be included as covered employees. Participating employees are automatically enrolled with the default contribution of a 5% payroll deduction that increases by 1% annually with an 8% cap. Employees can opt out of the program, change their contribution rates, and choose their investments.
Employers with employees in Vermont should be aware of this new program. Since this is a new program, there are not many details about how the state will administer it. We will report new information concerning the program in future editions of Compliance Corner.
Long-Term Care Program (“WA Cares Fund”) Implementation Begins July 1, 2023
June 21, 2023
As a reminder, after an 18-month delay, WA Cares Fund premium collections from employee wages are set to begin on July 1, 2023. The WA Cares Fund is the state’s new long-term care (LTC) program that will be funded through a payroll tax on employees. The premium amount for 2023 is 0.58% of gross wages with no maximum limit.
Employers do not contribute to the program but are responsible for reporting employee wages and hours and paying the premiums to the Employment Security Department on a quarterly basis using the same process they use to report Paid Family and Medical Leave premiums.
In addition to the delay of the premium tax collection start date, the benefits’ availability for the LTC program has been delayed until July 1, 2026, from January 1, 2025.
Employers with employees working in Washington should be aware of the imminent implementation of the WA Cares Fund on July 1, 2023, communicate with employees, and coordinate with their payroll vendors as necessary to report and collect required premiums.
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.