Nfp Benefits Compliance Podcast

In this episode, Chase Cannon and Suzanne Spradley discuss a recent IRS memo on wellness benefit payments via employer-funded fixed indemnity plans. Chase outlines the various iterations and structure of vendor-promoted wellness programs, which usually purport huge employment tax savings for employers. Chase and Suzanne outline the relevant tax rules and where these programs usually run afoul of those laws. The two close with a discussion on the recent IRS memo and what it means for employers considering these types of programs.

In this episode, Suzanne Spradley and Chase Cannon review the CAA’s prohibition on gag clauses in TPA and service provider contracts, as well as the employer’s obligation to attest to the removal of gag clauses (due December 31, 2023, for the first time). Suzanne outlines the challenges employers and plans face when working with TPAs, and explores how recent guidance attempts to address those challenges. Additionally, Suzanne and Chase discuss two recent cases between plans and their TPAs. They examine how these cases may impact employers’ paths forward in complying with the CAA gag clause prohibition and attestation requirements.

In this episode, Chase Cannon and Suzanne Spradley discuss updates on the ACA preventive care mandate litigation, including a stay issued by the Fifth Circuit Court of Appeals. HSA contribution limits become a topic of discussion, as the IRS recently published updated numbers. Chase and Suzanne also discuss a common problem for employers filing Form 5500 with respect to missing Schedule A information from carriers.

In this episode, Suzanne Spradley and Chase Cannon have a look at the national debt and debt ceiling and how they impact employers and their group health plans. Suzanne leads off with a discussion on the national debt and how Congress sets the debt ceiling. Suzanne and Chase go in depth on what a failure to raise the debt ceiling and/or default on debt could mean for the healthcare industry. Suzanne closes with a discussion on mandatory and discretionary spending and how the tax exclusion for employer-provided benefits could potentially be at risk.

In this episode, Chase Cannon and Suzanne Spradley review several recent HIPAA violation settlements from the HHS Office for Civil Rights. Chase starts off by reviewing the general HIPAA obligations of fully and self-insured plans, including the importance of a HIPAA risk assessment. Chase and Suzanne discuss three real-life scenarios outlining ways in which companies experienced HIPAA breaches. Chase emphasizes the importance of a solid IT and technology team as part of a company’s HIPAA privacy and security strategy, including the development and implementation of certain policies and procedures. The two also discuss lessons learned from the settlements in the context of an employer group health plan.

In this episode, Suzanne Spradley and Chase Cannon discuss a recent Texas court ruling that invalidates a portion of the ACA’s preventive services coverage requirement. Suzanne provides a background of the plaintiffs and their arguments, including a Constitutional problem with the way the government appointed officers under the ACA and a religious freedom violation. Suzanne and Chase discuss the court’s decision, including the potential for a stay (hold) on the decision and the decision’s impact on fully and self-insured plans.

In this episode, Chase Cannon and Suzanne Spradley address recent IRS guidance that mandates electronic filing of certain tax forms – including Forms 1095-C – for smaller employers. Chase describes the background from Congress and the IRS and explains what it means now that any employer filing 10 or more forms (previously, this was 250) will be required to do so through the IRS electronic filing system. Suzanne and Chase discuss the impact on smaller employers, along with updated employer mandate penalties and certain state filing requirements for employers. Chase closes with an outline of a proposed bill in Congress addressing benefits continuation for employees locked out or participating in a strike.

In this episode, Suzanne Spradley and Chase Cannon discuss potential activity at the federal and state level relating to PBM transparency. Suzanne begins the discussion by outlining a few proposals from Congress that attempt to hold PBMs accountable for unfair and deceptive practices that may be driving up prescription drug costs. Suzanne then addresses a few state proposals that attempt to regulate PBMs. Suzanne and Chase close by discussing the potential impact on employers and their group health plans.

In this episode, Beth Allen and Chase Cannon look at several new developments for plan compliance in 2023. The two start with the recent announcement on the end of the COVID-19 public health emergency, which impacts the outbreak period and extension of timeframes for certain compliance deadlines. Chase then dives in on the CAA 2023 extension of relief for telehealth services in conjunction with HSA eligibility. Chase and Beth close by outlining several state compliance challenges, including state law interaction with telehealth services and the ever-evolving landscape of state paid family and medical leave laws.

In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take effect in 2023. Suzanne and Chase discuss state compliance challenges, including abortion travel coverage, paid family and medical leave, and new legislation aimed at providers (but could indirectly impact employers). Suzanne closes by addressing the extension of telehealth relief with respect to HSA eligibility and what to look for in 2023 on the mental health parity analysis requirement.

In this episode, Suzanne Spradley and Chase Cannon discuss several recent COBRA cases. Suzanne starts by outlining several class action lawsuits filed against employers and plan sponsors relating to deficiencies in an employer health plan’s COBRA election notice. Suzanne and Chase discuss the use of the DOL’s Model Election Notice and how that usage interacts with potential DOL regulatory fines and participant lawsuits, and how employers can get into trouble by not including the appropriate information in the model or other election notices. Suzanne then describes a lawsuit against a single employer relating to a COBRA election notice delivery failure, including the involvement of a TPA.

In this episode, Chase Cannon and Suzanne Spradley discuss three recent court rulings—all at the district court level. Chase outlines the first case relating to a COBRA election notice failure, including takeaways for employers to enhance their notice distribution procedures. Chase and Suzanne dive into an ACA-related case challenging gender-affirming care guidance published by HHS earlier in 2022. The two close with a review of a third case challenging certain aspects of the ACA’s preventive care mandate.

In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health services, such as required behavioral health monitoring for suicide ideations and the need for interventions such as detoxification for substance abuse. Suzanne and Chase walk through proposals from the House on coverage for forensic medical exams relating to sexual assault. Suzanne and Chase close with a discussion of provider network proposals and the Senate’s reauthorization of funding for the Jackie Walorski Maternal and Child Home Visiting Act, which promotes healthy pregnancy practices, language development and early learning at home.

In this episode, Chase Cannon and Suzanne Spradley discuss the benefits provisions of the recently-enacted Inflation Reduction Act. Chase walks through the extension of premium tax credit expansions through 2025, and the impact on employers with respect to the employer mandate penalties. Next, Chase and Suzanne discuss Medicare prescription drug cost reductions and a formalization of prior IRS guidance that allows HDHP coverage of insulin in certain circumstances without impacting HSA eligibility. The two close the podcast by outlining the new law’s increased funding of the IRS and how that might impact compliance enforcement on employer group health plans.

In this episode, Chase Cannon and Suzanne Spradley recap the past few weeks’ guidance relating to Post-Dobbs considerations on employer coverage and reimbursement of abortion-related services. Chase starts by comparing the approaches of two different states – Texas and New Jersey – with respect to the legality of abortion services. New laws and developments in each of those states highlight the challenge of navigating state law for employers. Suzanne and Chase then discuss the directives from the most recent executive order, aimed at protecting abortion access. Chase dives in on two new pieces of HHS guidance relating to abortion coverage. The two close with a discussion on the importance of time and patience and how court decisions will shape the future environment for employers and group health plans.

In this episode, Suzanne Spradley and Patrick Myers discuss recent guidance concerning the interaction between FMLA and mental health conditions. Suzanne provides some context for this guidance and a brief refresher on FMLA itself. Suzanne and Patrick then discuss how mental health conditions can apply in a FMLA context, including when a mental health condition is a “serious health condition” or a disability. Suzanne continues with a discussion about how mental health conditions and FMLA apply to an employee’s family members, FMLA military caregiver leave, and retaliation. Suzanne and Patrick close with a reminder that other state and federal laws may also apply in this context, and employers should review their FMLA and leave policies to make sure that mental health conditions are provided for.

In this episode, Suzanne Spradley and Chase Cannon discuss hospital prices and their impact on employer group health plans. Suzanne describes this issue as it relates to the new transparency in coverage rules. Suzanne and Chase review a recent study that reviews hospital prices nationwide, including Medicare-certified, short-stay and other facility types. Suzanne discussing the findings of the study, price consistency among the various states, and what it all might mean for employer-sponsored group health plans. Suzanne and Chase close with a discussion of what other means might be available for controlling healthcare costs.

In this episode, Chase Cannon and Suzanne Spradley look at the recent rise in so-called “point solution programs.” These add-on programs enhance or expand on a group health plan offering and have benefits such as mental health, musculoskeletal, life coaching and fertility. Chase explains some of the compliance challenges that arise from offering the programs, including ERISA, COBRA, and ACA issues when the programs include components of medical care. Next, Chase and Suzanne discuss the challenges surrounding HSA eligibility and taxation, and the two close with general comments on these types of programs.

In this episode, Suzanne Spradley and Chase Cannon update us on employer compliance obligations under the Transparency in Coverage (TIC) rules. Suzanne begins with an overview of the TIC rules and how they are meant to address consumerism and rising health care costs. Suzanne and Chase then hone in on the actual requirements, including posting of plan information, with both in-and-out-of-network rates. Next, Suzanne dives in on the different challenges for fully and self-insured plans, and the importance of employers working closely with their carriers and TPAs. The episode closes out with a discussion on provider and TPA contracting.

In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on March 22, 2022. Next, they address the impact of this decision on future mental health claims litigation and the Department of Labor’s MHPAEA enforcement efforts. The episode closes with MHPAEA compliance reminders for employer plan sponsors.