GPAHU Pulse – May 2023

GPAHU - Monthly State and Legislative Updates

Here is something to mention when discussing cost and benefit trends with clients in the month ahead.

In addition to being the most reported reason for not offering health insurance, cost is also a critical problem for those offering health insurance. Almost all (98%) of small employers offering health insurance are concerned that the cost of providing health insurance to their employees will become unsustainable in the next 5-10 years. Fifty-eight were very concerned, 27% moderately concerned, and another 13% mildly concerned. Two percent are not concerned at all and 1% did not know.
Source:National Federation of Independent Businesses, Small Employer Health Insurance Survey, March 2023 https://strgnfibcom.blob.core.windows.net/nfibcom/Health-insurance-survey-NFIB.pdf

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!

New Law Mandates First-Dollar Coverage of Cancer Screening Tests

Pennsylvania Governor Josh Shapiro recently signed S.B. 8 into law, which will require all fully insured health plans in the state to cover certain cancer screenings at no cost. All fully insured major medical policies issued in Pennsylvania after December 27, 2023, will need to comply with these requirements.

The measure will prevent the application of out-of-pocket costs for genetic testing for hereditary breast, ovarian, prostate, and other cancers. In addition, plans will be required to include first-dollar coverage of one supplemental breast screening, such as an MRI or ultrasound, for women with a high lifetime risk of breast cancer. Plans can still subject coverage of these screenings to utilization management to ensure they are medically necessary. Also, if there are related claims beyond these specified screenings, then plan cost-sharing requirements may apply to those parts of the claim.

PID Issues New Guidance Regarding Medicare Eligible Individuals Affected by Medicaid Redeterminations

Now that the COVID-19 public health emergency has ended, Pennsylvania’s Medical Assistance program (Medicaid) is beginning an income redetermination process that will continue well into 2024. Many individuals who will lose Medicaid coverage will qualify for individual and group coverage special enrollment rights. However, some individuals became Medicare-eligible during the pandemic. Some of these people did not enroll in Medicare Part B and/or Medicare supplemental coverage because of their Medicaid eligibility. An individual enrolled in Medicaid is not permitted to be sold Medicare supplemental coverage.

The federal Medicare program is allowing a special exemption from the Medicare Part B enrollment penalty for people whose Medicare Part B enrollment was affected by their access to Medicaid coverage during the pandemic. In addition, the Pennsylvania Insurance Department (PID) announced that each insurer issuing Medicare Supplement coverage in the Commonwealth must treat impacted individuals as having a guaranteed issue enrollment period for Medicare supplemental coverage consistent with federal and state law. To help insurers and health insurance agents and brokers who may be assisting affected Medicare-eligible individuals with their enrollment in both Part B and supplemental coverage, the PID has released these FAQs.

NJ Enacts Temporary Worker Bill of Rights

Legislation recently enacted in New Jersey creates a new “bill of rights” for many temporary workers, which includes both new protections for the state’s approximately 125,000 temporary employees and creates significant new obligations for their employers and entities like staffing agencies operating in the state. Most of the new law will take effect on August 5, 2023, but some provisions affecting newly hired employees and provisions prohibiting retaliation against workers accessing their new rights became effective May 7, 2023.

The protections in the new law do not apply to every type of temporary worker but are limited to the types of temporary workers the state believes are most likely to be exploited. They include only those temporary workers who are assigned by a temporary help service firm to perform work in the following occupational categories as designated by the federal Bureau of Labor Statistics:

  • Other Protective Service Workers (33-9000)
  • Food Preparation and Serving Related Occupations (35-0000)
  • Building and Grounds Cleaning and Maintenance Occupations (37-0000)
  • Personal Care and Service Occupations (39-0000)
  • Construction Laborers (47-2060)
  • Helpers, Construction Trades (47-30000)
  • Installation, Maintenance, and Repair Occupations (49-0000)
  • Production Occupations (51-0000)
  • Transportation and Material Moving Occupations (53-0000)
  • Any successor categories designated by the Bureau of Labor Statistics

Affected temporary workers are defined as people who contract for employment with a temporary help service firm. A “temporary help service firm” means any person or entity that operates a business consisting of employing individuals directly or indirectly for the purpose of assigning the employed individuals to assist the firm’s customers in the handling of the customers’ temporary, excess, or special workloads, and who, in addition to the payment of wages or salaries to the employed individuals, pays federal social security taxes and state and federal unemployment insurance; carries workers’ compensation insurance as required by state law; and sustains responsibility for the actions of the employed individuals while they render services to the firm’s customers.

Some of the new law’s key provisions include:

  • A wage notice requirement that applies to all covered temporary workers. The notice must be printed in English and in any other language the worker identifies as their primary language. The state published a template for employers and temporary service firms to use.
  • A prohibition on retaliation against temporary workers who exercise their rights under the law. The law specifies that termination or disciplinary action by a temporary help service firm within 90 days of the person exercising their rights would raise a rebuttable presumption of retaliation. Employees who are successful in a claim of retaliation may receive the greater of damages and appropriate legal costs, or $20,000 and attorneys’ fees and costs per incident, plus reinstatement if appropriate.
  • A requirement that affected temporary workers be paid the same average rate of pay as a permanent employee of the third-party client who performs the same or substantially similar work for the employer, as well as the “average cost of benefits, or the cash equivalent thereof.”
  • A mandate that if there is a change in a schedule, shift or location for a multi-day assignment, the temporary help service firm must provide at least 48 hours’ notice to the temporary worker whenever possible.
  • A specification that temporary workers who do not have work available at their assigned third-party worksite must be paid for a minimum of four hours a day by the temporary help service firm. Even if the temporary laborer can work at another location during the same shift, the temporary laborer still must be paid for a minimum of two hours of pay at the agreed-upon rate of pay for the initial assigned location.
  • A mandate that temporary service firms provide each affected worker with a detailed itemized statement on each paycheck stub or on a form approved by the Commissioner of Labor and Workforce Development.
  • A prohibition on wage deductions for transportation, background checks, and cashing paychecks. Employers may deduct the cost of meals and personal equipment if they have written authorization from the temporary employee, but those deductions cannot cause a temporary laborer’s hourly rate to fall below the state minimum wage.
  • A requirement for temporary service firms to retain records for six years, including copies of notices provided to temporary employees, and contracts and contact information for all third-party employer clients.
  • A mandate for employers who use a third-party service firm to provide that firm with specific information about their temporary workers, including contact information, the specific location they worked, the type of work, hours, rate of pay, and dates of work no later than seven days following the last day of the work week. If an employer fails to do this, they may be subject to civil penalties.
  • A private right of action for temporary workers with individual claims, or those who wish to file a class action lawsuit. These suits may be against a third-party service firm, the employers who use such firms, or both, and the statute of limitation is six years.

Check This Out!

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

Ever wonder how employer-sponsored healthcare premiums are spent? Then check out the health care dollar, created by America’s Health Insurance Plans and the Coverage@Work Coalition.


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