Compliance Corner: Podcasts

In this episode, Suzanne Spradley and Chase Cannon address the hot issue of surprise medical billing. Suzanne outlines what is a surprise medical bill and how common of an issue it is to receive one. Suzanne and Chase discuss the challenges for patients that receive out-of-network provider services and bills at in-network facilities. Suzanne outlines three different bills that address surprise medical billing that have been discussed by Congress at the federal level, as well as state legislative action. Suzanne and Chase round out the podcast by talking about different approaches in each proposal, and what to expect down the road in 2020 from states and Congress.

In this episode, Chase Cannon and Suzanne Spradley address two lawsuits, and discuss some new state employer reporting obligations. The first lawsuit relates to one covered in Episode 66 on COBRA notice failures—the Sixth Circuit weighed in and overturned the District Court on whether a change in the premium payment turns constitutes a COBRA triggering event. The second lawsuit relates to the ACA’s employer mandate. A court recently approved a settlement in a case where the employer intentionally reduced hours for employees who were previously eligible for or enrolled in the company’s group health plan; the employer’s intent was to avoid offering those employees affordable coverage under the mandate. Chase outlines the settlement, and the reasons why the employees in the case were able to assert an ERISA 510 claim against the employer to the point of a settlement, even if the court did not ultimately resolve the 510 legal issue. Chase and Suzanne discuss the importance of continued compliance with the mandate and reporting, and dig into several states’ new requirements for employers to report in conjunction with state individual mandates.

In this episode, Suzanne Spradley and Chase Cannon look at three recent lawsuits, two of which are class action suits, against employers relating to COBRA notice failures. Suzanne describes the lawsuits, and explains that the failures related to the content of the notices themselves, rather than the more common issue of failure to send COBRA notices. Suzanne outlines the particular failures, and how the employer could’ve avoided the issue. The two discuss the importance of using model notices and things to consider when working with a third party vendor for COBRA administration

In this episode, Chase Cannon and Suzanne Spradley review the end-of-2019 spending bill, which includes several provisions relating to employee benefits and group health plan/employer compliance. Chase starts by describing the bill, and then jumping in on a discussion relating to the full repeal of the Cadillac Tax. The two then discuss the health insurance tax (HIT), and the impact of its repeal beginning in 2021. Chase outlines three other provisions that are less directly impactful — the repeal of the medical device tax, the repeal of a commuter benefit tax for tax-exempt organizations, and a one-year extension of the tax credit for employers that provide paid medical and family leave. Chase and Suzanne then turn their attention to a surprise in the bill: A 10-year extension of the PCOR fee. The two close with a discussion of things employer might’ve wanted in the bill, and a look at what’s ahead in 2020.

In this episode, Suzanne Spradley and Chase Cannon dig in to the issue of health care costs in the U.S. as compared to other countries. Suzanne begins the discussion by outlining the Organization for Economic Cooperation and Development (OECD) data that has been tracking the cost of health systems in the world since 1986. Suzanne explains the different factors and variances, and the importance of defining terms when it comes to making such comparisons. Suzanne and Chase discuss the OECD findings that the U.S. spends far more than other countries, and they outline the exact dollar numbers and percentages. Suzanne digs in on the different areas where the U.S. spends more, and the two conclude the episode discussing the relationship between health care spend, health care resources, and health care outcomes.

In a welcome turn of events, the DOL has proposed a new rule that would allow for electronic disclosure of many retirement plan documents. Beth Allen and Carol Wood discuss the proposed rule — beginning with how the DOL got to this point, explaining the details of the rule, and highlighting the rule’s limited application. Ultimately, the discussion will give retirement plan sponsors a better idea of how they may be able to distribute documents, should this rule be adopted.

In this episode, Chase Cannon and Suzanne highlight four considerations to help avoid compliance issues resulting from open enrollment periods. First, Chase outlines the importance of documenting offers and waivers of coverage, and how that can help employers avoid IRS scrutiny and employee misunderstandings. Second, Chase and Suzanne discuss challenges that can arise during open enrollment on HSA eligibility, and how employees can easily step into excess contribution issues when enrolling in benefits. Third, Chase describes challenges in open enrollment relating to absent and remote employees, including those out on FMLA or state-protected leave, and those that are working from different locations or from home. Chase and Suzanne close with a discussion of important notices that must go out during open enrollment, and how to distribute those notices.

In this episode, Suzanne Spradley and Chase Cannon dig in to a trending topic, particularly for self-insured plans: reference-based pricing (RBP). Suzanne begins with a description of RPB, including an example to help illustrate how it works. Next, Suzanne explains the process and the pros and cons of RBP, which leads to a discussion on pricing and billing, including balance billing to unsuspecting plan participants. Suzanne outlines employer considerations when implementing an RBP design, including several issues with respect to the ACA and out-of-pocket maximums, and lessons learned from litigation relating to RBP strategies (including one case that made it to court with over $300K in claims at stake). The two close by discussing related ERISA fiduciary issues and administrative practicalities for employers to consider when adopting an RBP design.

In this episode, Chase Cannon and Suzanne Spradley look at a few ACA topics that are a bit up in the air. The first is the health insurance tax (HIT), a tax on health insurance carriers that has been on and off moratorium the past few years, but is coming back into effect for 2020. Chase breaks down the HIT, its impact on health insurance rates and on employers and employees, and whether Congress might add a moratorium for 2020 or repeal the HIT entirely. The second is the Cadillac Tax, a tax on plans that provide richer benefits. Chase and Suzanne discuss the potential issues and burdens associated with the Cadillac tax, why it was enacted, and whether the Senate might follow the House’s lead on repealing it. The third is Texas vs. the U.S., the lawsuit challenging the constitutionality of the ACA’s individual mandate. Chase breaks down the lawsuit, the validity of the arguments on either side, and gives a prognosis on how and when the Fifth Circuit might rule on the case. The two close the podcast by looking to the case’s potential impact on the 2020 elections.