Public Disclosure of Provider Reimbursement Rates Begins July 1, 2022
On July 1, 2022, enforcement of the machine-readable file requirement of the Transparency in Coverage (TiC) final rule begins. Under the rule, non-grandfathered group health plans and insurers must publicly post machine-readable files that disclose in-network provider negotiated rates and historical out-of-network allowed amounts and billed charges for plan years beginning on or after January 1, 2022. (Enforcement of the prescription drug rate file requirement is postponed pending regulatory review.)
The files must be in a specified format, updated monthly and posted on a public website accessible to any person free of charge. No conditions can be imposed to access the files, such as establishing a user account or password or submitting personally identifiable information.
Group health plan sponsors should be in consultation with their insurers or third-party administrators to ensure timely compliance with the July 1 deadline. For fully insured plans, the legal obligation can be contractually transferred to the insurer. For self-insured plans, the sponsor remains liable for TiC compliance even if a TPA contractually agrees to assist with the creation and implementation of the files.
For further information, please see:
Transparency in Coverage Final Rule »
FAQs on ACA and CAA, 2021 Implementation »
Governor Signs Adoption Promotion Act into Law
June 07, 2022
Recently, Gov. Ivey signed Senate Bill 31, the “Adoption Promotion Act,” into law. The act, which takes effect July 1, 2022, allows eligible employees to take up to 12 weeks of parental leave to care for and bond with a newborn or newly placed adopted child.
The act applies to covered employers and eligible employees under the FMLA. Accordingly, employers who employ 50 or more employees within 75 miles must comply. Employees are eligible after having been employed by the employer for at least 12 months and having worked 1250 hours in the 12 consecutive months prior to using the leave.
The leave must be taken within the first 12 months of the birth or placement of the child. Employees are expected to provide at least 30 days advance notice prior to taking the leave unless the leave is unforeseeable (in which case, notice should be provided as soon as practicable). Intermittent leave is permitted if agreed upon by the employer and employee.
Additionally, if the employer provides paid leave for birth and care of a child, the employer must provide equivalent paid leave for adoption for a period of two weeks or the duration of the employer’s paid leave, whichever is less. If both adoptive parents work for the same employer, the employer is only required to provide paid leave to one employee.
Employers must consider requests for additional family leave due to the adoption of an ill or disabled child on the same basis as they would for the birth of a biological child to an employee. However, employers are not required to provide leave beyond the employee’s FMLA entitlement.
Employers and their human resources staff should be aware of the new law and update their leave policies and procedures accordingly.
Registration for State-Sponsored Retirement Program Proceeds
June 07, 2022
Recently, the state’s new retirement savings program, known as MyCTSavings, opened for registration. The program was created by 2016 legislation (Public Act No. 16-29) and is designed to help private-sector employees without access to employer-sponsored retirement plans. The Connecticut Retirement Security Authority is responsible for overseeing the program.
MyCTSavings requires employers to either sponsor their own retirement plans or participate in the new state program. Specifically, an employer, whether for profit or not-for-profit, must facilitate the program if it:
- Employed five or more employees in Connecticut on October 1 of the previous calendar year, and;
- Paid at least five employees $5,000 or more in taxable wages in the previous calendar year, and;
- Does not currently provide a qualified, employer-sponsored retirement savings plan, such as a 401(k) plan, 403(b) plan or SIMPLE IRA plan. (Payroll deduction IRAs are not considered a qualified plan.)
Employers who participate in the program enroll employees who have been employed for at least 120 days. The employees make their own contribution and investment elections. However, automatic enrollment at 3% of pay applies to employees who do not opt out or choose a different contribution rate. Default investment elections also apply to those who do not make affirmative elections within a certain timeframe. Contributions under the program are made to Roth IRAs. Employees are responsible for determining their Roth IRA eligibility.
Significantly, the state requires all employers to register with the program regardless of whether they will be participating or claiming an exemption (e.g., because they sponsor a qualified retirement plan). According to the program website, throughout 2022 and early 2023, communications with unique access codes and instructions are being sent to employers who can use this information to register. For employers with 100 or more employees, the registration deadline is June 30, 2022. For employers with 26 – 99 employees, the deadline is October 31, 2022; for employers with 5 – 25 employees, the deadline is March 30, 2023.
Employers should be aware of MyCTSavings and visit the program website, which includes helpful employer FAQs, for further details. Large employers should be mindful of the upcoming June 30, 2022, registration deadline.
Illinois Governor Signs Health Insurance Consumer Protection Bills
June 07, 2022
On May 26, 2022, Gov. Pritzker signed two bills into law to increase health insurance protections and access for Illinois consumers, building on existing protections under the federal No Surprises Act. For more information on the federal No Surprises Act and the interim final rules, see the articles published in the July 8, 2021, and November 11, 2021, editions of Compliance Corner.
First, HB 4703 (effective July 1, 2022) grants the Illinois Department of Insurance (IL DOI) additional authority to assist consumers who were billed at out-of-network rates after receiving care they believed was in-network, a billing practice prohibited by the No Surprises Act. Employers sponsoring health plans in Illinois should verify their carriers are complying with these requirements and are aware of the additional state enforcement authority.
Second, SB 3910 (effective January 1, 2023) requires health, prescription drug, and dental plan member ID cards to identify the regulatory entity that holds authority over the plan, whether the plan is fully insured or self-insured, and include any applicable deductibles or out-of-pocket maximums and plan contact information. This bill grants the IL DOI authority to enforce similar ID card transparency requirements embedded in the federal No Surprises Act. Employers sponsoring fully insured health, prescription drug, and dental plans in Illinois should verify their carriers are preparing to issue cards meeting the new requirements, many of which mirror the No Surprises Act.
Paid Leave Oregon Announced 2023 Contribution Amount
June 07, 2022
The Oregon Employment Department has recently announced that the contribution rate for the state’s paid family and medical leave program (a.k.a., “Paid Leave Oregon”) will be at 1% when contributions begin in 2023.
As a reminder, starting January 1, 2023, employees in Oregon will contribute 60% through payroll withholding, and employers will contribute 40% of the combined contribution rate of 1% of employee wages up to the annual maximum of $132,900. Employers with fewer than 25 employees are not required to contribute. Further, employers have the option to pay some or all of their employees’ portion.
Similar to other states’ paid family and medical leave programs, Paid Leave Oregon will provide paid time off for qualified reasons, including the birth or adoption of a child, employees’ own serious illness or injury, taking care of a seriously ill family member, and safe leave for up to 12 weeks for all combined covered leave reasons in a benefit year.
Employers with at least one employee working in Oregon should be aware of the 2023 contribution amount and start communicating with their payroll vendor and internal payroll department to prepare for the Paid Leave Oregon contributions and other requirements.
Paid Leave Oregon May Bulletin Announcement »
Paid Leave Oregon Main Site »
Crime Victim Leave Law Revised
June 07, 2022
Vermont’s crime victim leave law requires employers to provide unpaid job protected leave for eligible employees to attend a deposition or court processing related to a criminal processing when an employee is an alleged victim. Employees who have been continuously employed for at least six months for an average of at least 20 hours per week and who are the victims of crimes are eligible to take the leave. The eligible employees are allowed to use accrued sick, vacation, and other paid time off leave during the crime victim leave.
Additionally, employers with Vermont employee(s) are required to post a written notice regarding an employee’s right to crime victim leave. The Crime Victims Rights poster can be retrieved from the following state’s site, Vermont Department of Labor.
The revised legislation (HB 477) expands the current crime victim leave to include relief from stalking or abuse. The term “alleged victim” also includes a family member.
Employers who have an employee(s) in Vermont should be aware of this added new change.
WA Paid Family and Medical Leave Updated Providers’ Certification Forms
June 07, 2022
The Employment Security Department has updated their certification of a serious health condition forms. With new updated certification forms, employees can complete a medical certification form with their healthcare provider by the type of leave they are taking.
The available new forms are as follows:
- Certification form (pregnancy and birth)
- Certification form (family leave)
- Certification form (medical leave)
Additionally, employers subject to the WA PFML program should verify whether their wage report status for the first quarter has a credit or balance on their employer accounts. To check their wage report status, employers can log in and view their “Wage Submission History.” Further information is available in the Compliance Corner edition issued on March 3, 2022.
Employers with at least one employee in Washington State should be familiar with the new certification forms.
Washington Paid Family and Medical Leave Documents and Forms »
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.