Is there guidance concerning a recent requirement that health plans must disclose certain rate and billing information on a public website?
FMLA Proposed Regulations in Review as Notice Requirements Take Effect July 1
June 22, 2022
Proposed amendments to the Connecticut FMLA (CT FMLA) are expected to be reviewed and approved soon by the state’s Legislative Regulation Review Committee. Additionally, new notice requirements become effective July 1, 2022.
In 2019, the state passed two laws that resulted in the Connecticut Paid Family and Medical Leave (CT PFML) program. The first law expanded employee eligibility and other provisions of the existing FMLA program. The second law provided eligible employees with income replacement for up to 12 weeks of leave, funded through employee payroll deductions that commenced in 2021. The paid leave program is overseen by the state’s Paid Leave Authority. Please see our July 11, 2019article regarding the creation of the CT PFML program for further details.
Accordingly, the proposed regulations amend provisions of the prior CT FMLA regulations to incorporate the changes enacted in 2019 that took effect on January 1, 2022. The regulations also address several other outstanding issues. Among other items, the changes affect the definition of a covered employer, when an employee becomes eligible for leave, individuals for whom an employee can take leave to care for and the related documentation requirements, the amount of leave employees are entitled to, and the process for alleging a violation.
Additionally, each employer is required to provide written notice to each employee at the time of hire and annually thereafter: 1) of the entitlement to CT FMLA and the terms under which such leave may be used, 2) of the opportunity to file a claim for compensation under the program, 3) that retaliation by the employer against the employee for requesting or using such leave is prohibited, and 4) that the employee has a right to file a complaint with the Labor Commissioner for any violation. Fortunately, a model notice is available to satisfy the requirement, which takes effect July 1, 2022. Under the proposed regulations, an employer must also notify an employee of their eligibility to take CT FMLA leave no later than five business days after receiving a request to take such leave or learning that the employee is taking leave for a qualifying reason.
Employers should comply with the notice requirements and be aware of the proposed regulations, which are expected to be approved soon without major changes. Employers should consult with employment law counsel for further information and to ensure their leave policies reflect the regulatory updates.
Governor Signs Series of Bills Mandating Coverage of Certain Services
June 22, 2022
Through May and June of this year, Gov. Pritzker signed a series of bills into law mandating health insurers in the state provide certain coverage for the following services:
- SB2969 (signed June 15, 2022): medically necessary continuous glucose monitors for individuals with Type 1 or Type 2 diabetes, effective January 1, 2023
Press Release on SB2969
- HB5318 (signed June 10, 2022): annual prostate cancer screening and medically necessary follow-up testing without imposing a deductible, coinsurance, copayment or any other cost-sharing, effective January 1, 2024
Press Release on HB5318
- HB4430 (signed June 10, 2022): HIV pre- and post-exposure prophylaxis drugs (PrEP and PEP) when dispensed by a pharmacist and at no less than 85% of the rate when provided by a physician, effective January 1, 2023
Press Release on HB4430
- HB4349 (signed May 13, 2022): medically necessary treatment of cranial facial anomalies, effective January 1, 2024
- HB5254 (signed May 13, 2022): medically necessary hormone therapy to treat menopause induced by a hysterectomy, effective January 1, 2024
- HB5585 (signed May 13, 2022): access to home health services for the duration of medically necessary care, effective January 1, 2024
- SB3819 (signed May 13, 2022): community-based pediatric palliative care and hospice care, effective January 1, 2024
- HB4271 (signed May 6, 2022): medically necessary breast reduction surgery, effective January 1, 2024
These provisions will apply to policies amended, delivered, issued or renewed in Illinois on or after the respective effective dates. Employers sponsoring health plans issued in Illinois should be aware of these developments and contact their carrier for further information.
State Expands Qualifying Losses Under Bereavement Leave Law
June 22, 2022
On June 9, 2022, Gov. Pritzker signed the Illinois Family Bereavement Leave Act (FBLA) into law, expanding unpaid bereavement leave for Illinois employees to cover additional family member losses, pregnancy losses and failed adoptions. The FBLA amends the existing Child Bereavement Leave Act, which requires employers with at least 50 employees to provide up to 10 days of unpaid leave to parents and guardians after the loss of a child. Specifically, the FBLA expands the scope of family member losses covered by FBLA, requiring employers to provide leave to employees grieving the death of a spouse, domestic partner, sibling, parent, mother-in-law, father-in-law, grandchild, grandparent or stepparent. Covered losses will further include failed surrogacy agreements, unsuccessful reproductive procedures and other diagnoses or events impacting pregnancy and fertility.
Employee eligibility requirements for unpaid bereavement leave under Illinois’s FBLA mirror federal FMLA eligibility requirements. The law permits – but does not require – employers to require reasonable documentation of qualifying loss. For the loss of a family member, that may include a death certificate or published obituary. However, as to pregnancy, fertility, surrogacy and adoption losses, employers are prohibited from requiring the employee to identify the particular qualifying leave event. For these events, if the employer chooses to require documentation, the Illinois Department of Labor will provide a suitable form to be completed by an appropriate healthcare practitioner.
The FBLA becomes effective January 1, 2023. Illinois employers should review their bereavement leave policies with legal counsel and amend as appropriate to ensure compliance.
Coverage for HIV Prevention Prescription Drugs
June 22, 2022
On May 29, 2022, HB 970 was enacted. Effective January 1, 2023, the new statute prohibits health insurers from imposing a prior authorization requirement for prescription drugs used as post-exposure prophylaxis for the prevention of HIV, if the drug is prescribed in accordance with CDC guidelines. This prohibition will apply to group health insurance policies issued in the state and which provide coverage for prescription drugs. Employer plan sponsors should verify with their insurer that the appropriate changes are made to the policy and documents.
Coverage for Prescription Drugs to Treat Diabetes, HIV and AIDS
June 22, 2022
On May 16, 2022, Gov. Hogan signed HB 1397 into law. Effective for policies issued on or after January 1, 2023, the new law prohibits insurers from imposing a copayment or coinsurance greater than $30 for a 30-day supply of insulin drugs or $150 for a 30-day supply of a prescription drug to treat diabetes, HIV or AIDS. The requirements apply to group health insurance policies issued in the state and which provide coverage for prescription drugs. Employer plan sponsors should verify with their insurer that the appropriate changes are made to the policy and documents.
City of Bloomington Passes Earned Sick and Safe Leave Ordinance
June 22, 2022
On June 13, 2022, the Bloomington City Council adopted Ordinance 2022-31. Bloomington’s ordinance requires employers to provide certain amounts of sick and safe leave to employees working at least 80 hours per year in the city. Specifically, the law requires private employers with at least five employees to provide employees with one hour of paid leave for every 30 hours on the job, for up to 48 leave hours a year. Smaller employers are required to provide the same amounts of unpaid leave. The law applies to an employer regardless of whether the employer is physically located in Bloomington. Employers are only required to allow an employee to carry over 80 hours of leave into the following year. Once the law goes into effect, employees may use accrued leave after 90 calendar days of employment.
Accrued sick and safe time may be used for any of the following reasons:
- The employee’s mental or physical illness; injury; health condition; need for medical diagnosis; care, including prenatal care; treatment of a mental or physical illness, injury or health condition; or need for preventive medical or healthcare.
- The care of a family member with a mental or physical illness, injury or health condition who needs medical diagnosis; care, including prenatal care; treatment of a mental or physical illness, injury or health condition; or preventive medical or healthcare; or the death of a family member.
- An absence due to domestic abuse, sexual assault or stalking of the employee or employee's family member for any of the following reasons:
- A. Seeking medical attention or psychological or other counseling services related to physical or psychological injury or disability caused by domestic abuse, sexual assault or stalking.
- B. Obtaining services from a victim services organization.
- C. Seeking relocation due to domestic abuse, sexual assault or stalking.
- D. Seeking legal advice or take legal action, including preparing for or participating in any civil or criminal legal proceeding related to or resulting from domestic abuse, sexual assault or stalking.
- The closure of the employee’s place of business by order of a public official to limit exposure to an infectious agent, biological toxin, hazardous material or other public health emergency.
- To accommodate the employee’s need to care for a family member whose school or place of care has been closed by order of a public official to limit exposure to an infectious agent, biological toxin, hazardous material or other public health emergency.
- To accommodate the employee’s need to care for a family member whose school or place of care has been closed due to inclement weather, loss of power, loss of heating, loss of water or other unexpected closure.
A employer may require reasonable documentation verifying the need for leave if the employee’s absence is longer than three consecutive days; the employee’s leave is for reasons in 1, 2 or 3A above; and the employer provides health insurance benefits to the employee.
Employers must notify employees that they are entitled to sick and safe time, the amount thereof and the terms of its use under the law. Prior to July 1, 2023, the City of Bloomington’s Attorney’s Office will provide a sample notice to conspicuously post and include in employee handbooks. Employers must also keep records documenting hours worked as well as leave accrued and used.
At this point, employers should be mindful of upcoming compliance requirements and expect interpretative guidance from the City Attorney’s Office. Employers with employees in Bloomington should work with legal counsel to incorporate the new ordinance requirements into their overall leave policy.
Transitional Relief Extended for Grandmothered Plans
June 22, 2022
On June 8, 2022, the Department of Insurance issued Bulletin Number 2022-02 to announce an extension of transitional relief for certain non-grandfathered individual and small group policies known as “grandmothered” policies. The bulletin follows the recent CMS extension of the federal nonenforcement policy concerning specific ACA compliance requirements for these plans.
On November 14, 2013, CMS announced a transitional policy with respect to the healthcare reform mandates for coverage in the individual and small group markets. This nonenforcement policy provided relief from certain market reforms, including prohibitions of coverage exclusions based on pre-existing conditions and requirements to cover essential health benefits and limit annual out-of-pocket spending.
Under the policy, state authorities could permit health insurance issuers to continue coverage that would otherwise have been cancelled for failure to comply with the ACA requirements. The Department of Insurance has historically allowed insurers the option to continue such coverage. Bulletin 2022-02 represents the most recent extension of this policy and applies to renewals for plan or policy years beginning on or after October 1, 2022, and will remain in effect until CMS announces that all such coverage must come into compliance with the specified requirements.
Accordingly, small employers who are currently covered by such grandmothered policies issued in the state should be aware of the bulletin. These employers should work with their advisors and insurers regarding possible renewal of the coverage.
Commissioner Provides Health Plan Guidance in Response to Uvalde Shooting
June 22, 2022
On June 9, 2022, Commissioner Brown issued Bulletin B-0004-22 in response to Gov. Abbott’s disaster declaration concerning the Uvalde shooting. In order to ensure the fair and compassionate treatment of consumers in Uvalde County and to provide for fair competition, the commissioner encourages all health-benefit plans to:
- Provide coverage and reimbursement for covered mental health services that are delivered by a preferred or contracted health professional using telecommunications or information technology, including audio-only services, at the same basis and to the same extent as an in-person setting.
- Authorize payment to pharmacies for up to a 90-day supply of any prescription medication for individuals, regardless of when the prescription was filled.
Employers with plans issued by the state and employees in Uvalde should be aware of this bulletin.
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.