Compliance News to Know
Patriot Growth Insurance Services, LLC
Growth Capital for America's Best Insurance Agencies
Upcoming Deadlines
- June 1 – RxDC Report due File online via CMS Reporting Instructions
- July 31 – PCORI Fee due for self-funded plans. Complete IRS Form 720
- July 31 - File Form 5500 or Form 5558 for an extension via eFAST2
Access the 2024 Benefits Compliance Checklist or ask your Patriot Advisor.
Supporting Mental Health: Welfare Plans
As Congress reviews compliance analyses of group health plans under the Mental Health Parity & Addiction Equity Act, it’s becoming evident that many self-funded plans fail standards regarding whether coverage for mental health/substance use disorders (MH/SUD) are as rich as coverage for medical/surgical services. Congress outlined priorities, including impermissible exclusions of key treatments for MH/SUDs.
Because self-funded plans retain more flexibility due to ERISA preemption, they also retain greater compliance burdens for such flexibility. For self-funded plans that cannot afford for a third party to conduct a mental health parity analysis, the Dept. of Labor (DOL) created the Self-Compliance Tool for MHPAEA & ERISA Requirements (dol.gov). Regarding this tool, per the DOL:
“…plans that have carefully applied the guidance in the Self-Compliance Tool should be in a strong position to submit comparative analyses upon request.”
Read this 3rd party article (excerpt below) for insights on what types of MH/SUD barriers to avoid:
- Autism spectrum disorder, opioid use disorder and eating disorders are mental health conditions and therefore treatment of these disorders are mental health benefits covered by mental health parity laws.
- Methods that participants use to access care should be in parity. Prior authorization, gatekeepers such as EAP referrals and telehealth are impermissible barriers to accessing mental health benefits.
- Blanket exclusions of ABA therapy for autism spectrum disorder, nutritional counseling for eating disorders, & medication-assisted treatment (MAT) & medications for opioid use disorder (MOUD) are impermissible.
Avoid total exclusions of key treatments for MH/SUD conditions, such as
- Applied behavior analysis (ABA) therapy for treatment of autism spectrum disorder (ASD)
- Medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD)
- Nutritional counseling for eating disorders
Benefits Watch Webinars
Webinars are open to everyone; no registration required! Webinar topics are designed to address the most requested employee benefits compliance conundrums. May – July webinars review essentials of recent benefits compliance: fiduciary duties; CAA; and Transparency in Coverage requirements.
May 8th Webinar
The CAA Revisited at 1 pm EDT
Transparency, disclosures, & a pandemic. The past four years have been both a compliance beast & blur. With numerous regulations created during the pandemic, it’s worth 45 minutes to review group health plan requirements under the Consolidated Appropriations Act (CAA). These include broker compensation oversight; gag clause attestation; continuity of care requirements; & the RxDC reporting. Join Patriot’s Benefits Compliance Counsel, Olivia Ash, as she runs through a plan checklist for CAA compliance.
The Rundown
- CMS Fact Sheet: Short-term Limited Duration Insurance & Fixed Indemnity Plans – Final Rule
- Employers: Pregnant Workers’ Fairness Act – guidance for compliance at EEOC’s website.
- Blog: Contraceptive Coverage Guidance Expanded
- CMS: RxDC Reporting Resources
- External: Maryland’s Medical Leave Requirements
Pregnant Workers Fairness Act (PWFA) Eff. 4/19/24
Effective April 19th, 2024, the Pregnant Worker’s Fairness Act seeks to require a covered entity to make reasonable accommodations to a qualified employee’s or applicant’s known limitations related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, absent undue hardship on the operation of the business of the covered entity.
Covered employers must not:
- Fail to make a reasonable accommodation for the known limitations of an employee or applicant, unless the accommodation would cause an undue hardship;
- Require an employee to accept an accommodation other than a reasonable accommodation arrived at through the interactive process;
- Deny a job or other employment opportunities to a qualified employee or applicant based on the person’s need for a reasonable accommodation;
- Require an employee to take leave if another reasonable accommodation can be provided that would let the employee keep working;
- Punish or retaliate against an employee or applicant for requesting or using a reasonable accommodation for a known limitation under the PWFA, reporting or opposing unlawful discrimination under the PWFA, or participating in a PWFA proceeding (such as an investigation);
- Coerce individuals who are exercising their rights or helping others exercise their rights under the PWFA.