GPAHU Pulse – October 2020

GPAHU - Monthly State and Legislative Updates

Employer group health plan sponsors are committed to their health benefits, even as the coronavirus pandemic means they’ll likely face higher costs in 2021. According to a poll by the National Alliance of Healthcare Purchaser Coalitions, 71% of employers will keep or accelerate their health benefit strategies for 2021, while 63% plan to do so for 2022.


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!

Recent Trump Administration Actions with Health Plan Impact

Several recent and significant federal executive actions could impact GPAHU members and their clients. These include a delay in the 2020 health coverage information reporting deadline, an extension of the public health national emergency period, a new regulation related to the Families First Coronavirus Response Act’s (FFCRA) paid leave provisions, and a presidential executive order about health care.

Internal Revenue Service (IRS) Notice 2020-76 gives applicable large employers (ALEs) and health insurance issuers (including self-funded-health plans) an extra month to distribute Forms 1095 B & C. These statements now must go out to eligible employees and covered individuals by March 2, 2021.  The notice gives all entities reporting penalty relief if they make a good-faith mistake when completing their 2020 Forms. Finally, the IRS stated that since the individual mandate penalty is now $0, it will not prioritize enforcing the Form 1095 B reporting requirement. However, to get the enforcement relief, health insurers and small self-funded plans will need to display a notice on their website and make paper statements available on request within 30 days.

The federal Department of Health and Human Services (HHS) recently extended the national COVID-19 public health emergency by 90 days. Unless the Secretary of HHS terminates it early, the emergency period will last through January 21, 2021. After that, depending on the circumstances, the federal HHS Secretary may extend it again. The length of the federal mandate to cover COVID-19 diagnostic testing, which applies to all individual and group health plans, is tied to the public health emergency length.  Once the emergency ends, group health plan sponsors no longer have to cover tests without applying cost-sharing and utilization management requirements.  Until then, health insurance carriers and employer plan sponsors must follow all COVID-19 testing coverage rules

The public health emergency only relates to the federal testing coverage mandate. The overall national emergency, which has no definite expiration date, impacts the end-date of the new COBRA election, HIPAA special enrollment period, and claims and appeals deadline extension rules. That emergency period only ends when the President decides it is over.

The Department of Labor made an update to the FFCRA paid leave regulation that could require employers with less than 500 employees to update their existing internal FFCRA leave procedures.  The new regulation is in response to the U.S. District Court for the Southern District of New York’s ruling that parts of the original rule are invalid. The new rule became effective on September 16, 2020, and changed or clarified the following points:

Work Availability—To be eligible to take either FFCRA paid sick leave or family/medical leave, a person must be an active employee. Further, the FFCRA leave qualifying event must be the only reason why the person cannot work.

Definition of Healthcare Provider—The FFCRA law allows employers of “healthcare providers” to exempt those employees from the law’s paid leave provisions.   The new rule narrows the definition of a “healthcare provider” significantly, so employers using that exemption need to check to see if it is still fully applicable.

Intermittent Leave—The new rule clarifies that employees must seek employer permission before taking FFCRA leave periodically.

Leave Documentation—Employees can provide leave documentation to their employer as soon as practicable. An employer cannot require it as a condition of allowing leave.

Leave Notification–The new regulations specify that employers can ask employees for advance notice if their need to take FFCRA leave is foreseeable.

President Trump issued an Executive Order titled An America-First Healthcare Plan. The order expresses many ideas and gives indicators about President Trump’s health care goals for the future, but it will not lead to any immediate policy changes. One of the only date-specific items discussed in the order is a directive for the Department of Health and Human Services (HHS) to work with Congress to pass surprise billing legislation by December 31, 2020. Failing that, HHS should address this issue through regulatory action.  The other substantive part of the order requires HHS to update the Hospital Compare website within 180 days to inform beneficiaries about hospital billing matters.

The City of Philadelphia Temporarily Expands Its Paid Sick Leave Law

Philadelphia Mayor Jim Kenney signed Bill No. 200303, which expands the city’s existing paid sick leave law. The amendment provides temporary leave to people employed by entities not covered by the Families First Coronavirus Response Act’s (FFCRA) paid leave provisions.  Effective immediately, the amendment requires qualified employers and other “hiring entities” to provide two weeks of “public health emergency leave” to eligible employees under certain conditions. Like FFCRA’s paid leave provisions, this measure expires on December 31, 2020.

In addition to providing the leave, applicable “hiring entities” (those that do not have to comply with the federal FFCRA’s paid leave requirements) must send their employees a “notice of rights” within 15 days after the amended ordinance becomes law (October 2, 2020). If there is a physical worksite, the notification can happen there.  If a workplace is closed, or employees have a telework arrangement, employers may provide information electronically.

To benefit from the expansion of the city’s existing paid sick requirements, a person must work in the city for at least 40 hours in one year for one or more “hiring entities” that do not have to comply with the FFCRA. The definition of “hiring entities” is broad – it covers everything from companies with more than 500 employees to private individuals that employ people in their residences. “Covered individual” applies broadly too. Beyond traditional employees, it includes almost any individual performing work for a hiring entity unless the hiring entity can demonstrate certain conditions apply.

Finally, while Philadelphia-based hiring entities need to take steps to address this measure now, keep in mind that it is temporary.  Just like the FFCRA paid leave requirements, it will expire on December 31, 2020.

Pennsylvania Insurance Department Ends COVID-19 Temporary Producer Licensing Program

In April of 2020, the Pennsylvania Insurance Department issued notice 2020-12, creating a temporary resident producer licensure program due to the coronavirus pandemic. Since test centers are now operating, and online remote testing is available for insurance license examinations in the Commonwealth, the PID believes the licensing disruption caused by COVID-19 is over. So, effective October 19, 2020, the PID will no longer accept applications for temporary licensure.

Anyone who holds a temporary producer license must convert the temporary license to a full resident producer license. Individuals will be required to take and pass the appropriate producer licensing examination. Producer licensing examination sites are available that follow COVID-19 precautions and the PID offers the option of remote testing for insurance license exams.

Anyone who holds an appointment with a temporary license needs to know that any appointment with the sponsoring insurer will be canceled when the individual’s full resident producer license is issued.

If individuals take and pass the producer licensing exam while their temporary license is active, they will get a full resident license when the PID receives the individual’s passing exam score.  Individuals will receive an e-mail notification with their resident producer license number.  Individuals do not need to submit a new application, pay a fee, or complete a fingerprinting/background check.

If someone takes and passes the producer licensing exam within six months after their temporary license expires, they will not need to submit a new application or pay a fee. However, they must complete a fingerprinting/background check at an Identogo enrollment center.

Suppose you pass the licensing exam seven or more months after the temporary license expires. In that case, you need to start over and submit a new application and pay a fee and complete a fingerprinting/background check at an Identogo enrollment center.

Check This Out!

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

Each month, the Pennsylvania Insurance Department issues a newsletter summarizing Department initiatives and industry and consumer activity. You can access all issues online or send an email to to subscribe.

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