GPAHU Pulse – March 2022

GPAHU - Monthly State and Legislative Updates

Here’s something to talk about when discussing plan design options and employer contribution strategy with group clients in the New Year.

A recent workplace survey shows that 70% of employees feel like they understand their health benefits extremely or very well. Just over half express the same level of understanding about other benefits. However, 64% of employees are confident in their ability to make informed decisions about employee benefits. Four in ten rely on information from a spouse or partner when making decisions about their benefits and one in four looks to their employer or Human Resources department. Just under six in ten say they would take advantage of advice from an online enrollment program.

Source 2021 Workplace Wellness Survey, Employee Benefits Research Institute and Greenwald Research,https://www.ebri.org/docs/default-source/wbs/wws-2021/2021-workplace-wellness-short-report.pdf?sfvrsn=c4553b2f_6

The Big Three

Each month GPAHU identifies three top public policy or legal developments that could impact our members and clients.  Here are this month’s big three!

Access to Telehealth Protections Included in Federal Omnibus Spending Legislation

President Biden just signed $1.5 trillion federal spending package that includes provisions to extend access to telehealth services supported by the National Association of Health Underwriters. GPAHU members who attended NAHU’s Capitol Conference in Washington, DC in early March were lobbying our lawmakers to reinstate telemedicine protections for people with coverage through health savings account (HSA)-qualified high deductible health plans (HDHPs), and now the measure is federal law!

The new law reinstates a safe harbor for people with HDHPs and HSAs and allows qualified HDHP plan sponsors to offer telemedicine coverage to all HDHP participants with no cost-sharing. Typically, HSA-qualified HDHPs may only cover specified preventive care services prior to the application of the plan’s deductible. Otherwise, plan participants lose their ability to contribute to the HSA. Earlier COVID-19 funding legislation allowed HDHPs to cover telehealth services pre-deductible through December 31, 2021. The new law reinstates these protections as of April 1, 2022, and allows them through the end of 2022. So now, HDHP plan sponsors may elect to reimburse telemedicine visits on a first-dollar basis for the rest of 2022.

Since there is a gap in the safe harbor, and it is unclear if the IRS will take enforcement action related to plan designs offering first-dollar HDHP telemedicine coverage during the first quarter of 2022, any groups that want to make a cost-sharing change relative to telemedicine for HDHP participants should do so on a prospective basis and limit the change to the period of April 1-December 31, 2022.

In addition to the HDHP provisions, the spending measure will allow Medicare and Medicaid to continue to cover certain telehealth services for 151 days after the COVID-19 public health emergency ends and expands the scope of telemedicine services covered under Medicare. 

Federal Surprise Billing Independent Dispute Resolution Process

Recently, a federal district court judge invalidated part of the federal regulation governing how the arbitration process related to the new federal surprise balance billing protections will work.  As a reminder these new protections take effect this year for every group health plan and health insurance issue on renewal. The law covers emergency care, air ambulance services, and almost all care performed by an “out-of-network” provider in an “in-network” facility. Facilities and providers must charge “in-network” rates for these services, and then providers and health plans need to work out the difference. If they cannot settle payment terms within 30 days of billing, either party may trigger an arbitration, or independent dispute resolution (IDR) process.  

The court ruling does not mean that surprising billing arbitrations will be put on hold. In fact, The Biden Administration issued a memorandum on February 28 emphasizing that all other provisions of the No Surprises Act are still in effect and the federal portal that providers and health plans may use to start an arbitration process is about to open. However, IDR entities overseeing arbitrations may not assume the appropriate rate for an out-of-network payment is the plan’s self-reported median in-network rate. Instead, they will need to equally consider other factors, such as the provider’s level of experience and training when choosing between each party’s best payment offer. 

GPAHU members should keep in mind that any group plans with January 1 or February 1 renewal dates are processing claims right now which are covered by the new protections. In the case of fully insured group plans, the carrier will handle any claims that may be subject to the new IDR process and make all related decisions. However, in the case of level-funded and self-funded groups, a best practice would be to review service agreements with clients and make sure that all involved know who the decision-makers will be on a day-to-day and overall level, when it comes to potentially disputed affected claims.

New Path to Pennie Program Gives Uninsured Tax Filers A Chance to Enroll in Health Coverage

The Pennsylvania state health insurance exchange, Pennie, if offering a new program for this tax season to connect uninsured Pennsylvanians with individual health insurance coverage and premium tax credits offered through the exchange marketplace. This year, when people are filing their state income tax returns, they can indicate they would like to receive more information about enrolling in coverage available through Pennie. Filers that make this indication will be prompted to complete Tax Form REV-1882 and submit it with their tax return. When an uninsured Pennsylvanian completes this form, they will gain access to a special 60-day enrollment period.

As a follow-up to submission of the form, Pennie will send information about the steps necessary to enroll in coverage through the marketplace. The notice allows tax filers to elect to receive information either electronically or through the U.S. mail (depending on their personal preference). The communication will include a unique access code to a Pennie online account, an estimated dollar amount of premium tax credit and/or cost-sharing assistance they may qualify for based on their income tax filing, and other enrollment information. Tax filers will then have 60 days from the printed date on the notice they receive from Pennie to enroll in coverage.

Tax filers who submit their Pennsylvania Personal Income Tax Return prior to March 31, 2022, should expect to receive a notice from Pennie in April 2022. Other filers should expect to get a notice approximately two weeks after they submit their taxes. While the notification for this special enrollment period will direct them to Pennie, certified agents and brokers may certainly assist these individuals with their coverage needs.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The recently released Pennsylvania State Health Improvement Plan for 2022 provides health outcome measures identified in the State Health Improvement Plan, and statistics including numbers of Pennsylvania primary care, dental, and mental Health providers, highlighting professional shortages areas. 


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