Guidance Issued on Emergency Period Expiration

Ed MacConnell

** This Compliance Bulletin contains guidance released in FAQ 58; however, President Joe Biden subsequently signed a House Bill on April 10, 2023 immediately ending the National Emergency, which may change certain dates referenced below.  It is possible that FAQ 58 will be updated to reflect new dates.  The signed Bill did not change the end of the Public Health Emergency, which remains May 11, 2023.**  On March 29, 2023, the Departments of Labor, the Treasury, and Health and Human Services (collectively, “the Departments”) released FAQ 58, answering certain frequently asked questions regarding the announced end of the National Emergency and the Public Health Emergency (“PHE”) on May 11, 2023.… Read More

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10 Things to Know About Medicaid Managed Care

Cayla Widdop

Managed care is the dominant delivery system for Medicaid enrollees. With 72% of Medicaid beneficiaries enrolled in comprehensive managed care organizations (MCOs) nationally, plans have played a key role in responding to the COVID-19 pandemic and are expected to work with states in conducting outreach and providing support to enrollees during the unwinding of the continuous enrollment requirement. While managed care is the dominant Medicaid delivery system, states decide which populations and services to include in managed care arrangements which leads to considerable variation across states. Additionally, while we can track state requirements for Medicaid managed care plans, plans have flexibility in certain areas including in setting provider payment rates… Read More

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The End of COVID-19 Public Health Emergency: How will telemedicine be affected?

Cayla Widdop

On Jan. 30, 2023, the Biden Administration announce it will end the public health emergency (and national emergency) declarations on May 11, 2023. Telemedicine What’s changing: Some flexibilities associated with providing health care via telehealth during the public health emergency will end. What’s the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent. Have any questions regarding this notice?… Read More

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The End of COVID-19 Public Health Emergency: How will COVID treatments be affected?

Cayla Widdop

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. COVID Treatment What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government). Medicare beneficiaries may fact cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing. What’s the same: Any pharmaceutical treatment doses (e.g., Paxlovid) purchased… Read More

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Notice: White House announces COVID-19 PHE and National Emergency will be allowed to expire

Cayla Widdop

On January 30, 2023, the White House announced its plan to allow the COVID-19 Public Health Emergency (PHE) and National Emergency periods to expire on May 11, 2023. We have provided example scenarios in the Compliance Alert that demonstrate the impact of the national emergency period expiration. We encourage you to review each example to determine the impact on your specific plan(s). Although we encourage you to review the entire Compliance Alert, we have provided a summary of the content for your review: Public Health Emergency During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing or prior authorization or… Read More

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The End of COVID-19 Public Health Emergency: How will PCR and rapid tests be affected?

Cayla Widdop

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. PCR and rapid tests ordered or administered by a health professional What’s changing: Although most insured people will still have coverage of COVID tests ordered or administered by a health professional, these tests may no longer be free. What’s the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and therefore will continue to pay full price for tests unless they can get tested through a free clinic or community health center. Have any questions regarding this notice? Don’t… Read More

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The End of the COVID-19 Public Health Emergency: How will at-home COVID tests be affected?

Cayla Widdop

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. At-home COVID tests What’s changing: At-home (or over-the counter) tests may become more costly for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive free, at-home tests. Those with private insurance and Medicare Advantage (private Medicare plans) no longer will be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them. For those on Medicaid, at-home tests will be covered at no-cost through September 2024. After that date, home test coverage will vary by state. A temporary Medicaid… Read More

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The End of the COVID-19 Public Health Emergency: How will vaccines be affected?

Cayla Widdop

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. Vaccines What’s changing: Nothing. The availability, access, and costs of COVID-19 vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency. What’s the same: As long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status. Although a federal rule temporarily required private insurers to reimburse out-of-network providers for vaccine administration… Read More

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Emergency Periods Related to COVID-19 to End May 11 2023

Ed MacConnell

On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read More

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10 Things to Know About Medicaid Managed Care

Cayla Widdop

Managed care plays a major role in the delivery of health care to Medicaid enrollees. With 69% of Medicaid beneficiaries enrolled in comprehensive managed care plans nationally, plans have played a key role in responding to the COVID-19 pandemic and in the fiscal implications for states. This brief describes 10 themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights significant data and trends. Understanding these trends provides important context for the role managed care organizations (MCOs) play in the Medicaid program overall as well as during the ongoing COVID-19 public health emergency (PHE) and in its expected unwinding. CMS released guidance for state… Read More

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10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement

Cayla Widdop

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the PHE ends, millions of people could lose coverage that could reverse recent gains in coverage. The current PHE is in effect until January 11, 2023, and the Biden administration has said it will give states a 60-day… Read More

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Medicare & Coronavirus

Cayla Widdop

Medicare covers the COVID-19 vaccine at no cost to you. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Be sure to bring your Medicare card. To learn more about Medicare and the COVID-19 vaccine and boosters, click here. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You may need to give them your Medicare Number for billing, but there’s… Read More

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HHS Extends Public Health Emergency Until October 13

Cayla Widdop

On July 15, 2022, the Secretary of Health and Human Services (“HHS”) renewed the COVID-19 pandemic Public Health Emergency, effective July 15, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 testing and vaccinations and other plan requirements. State and local emergency measures may expire at different times and could impact employee benefit plans (such as insured group health plans) and other state/or local programs (such as paid leave) differently than the timeframes… Read More

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HHS to Extend Public Health Emergency Once Again

Cayla Widdop

The Department of Health and Human Services (HHS) has repeatedly renewed the public health emergency since it was originally declared in January 2020. The most recent extension was set to expire July 15. However, it will now be extended again, commencing on Friday, July 15. The administration will give states 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to certain programs and regulatory authorities. HHS last extended the public health emergency in May of 2022. The designation of a public health emergency allows regulators to clear the way for vaccines, therapeutics, and diagnostics for use against the coronavirus. Should the designation expire, people… Read More

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COVID-19 Vaccines Now Available for Young Children

Cayla Widdop

A recent CDC announcement recommends that children six months through five years of age should get an age-appropriate dose of the Pfizer‑BioNTech or Moderna COVID-19 vaccine. Independence covers the cost of administering vaccines and booster shots with no cost-share (such as co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given. For Medicare Advantage members, the cost and administration of the vaccine and booster shots will be covered by Original Medicare so long as the health care provider administering the vaccine participates in the Medicare program. Please click here to learn more about the COVID-19 vaccines and boosters. As always, please contact your Total Benefit Solutions Inc health… Read More

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Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

Cayla Widdop

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

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Philadelphia Re-Enacts Emergency Paid Sick Leave Benefits

Ed MacConnell

On March 9, 2022, the Philadelphia City Mayor signed into law an ordinance amending the city’s existing public health emergency leave requiring covered employers to provide continuing paid COVID-19 leave through December 31, 2023. The law became effective on March 9 and is the third iteration of the COVID-19 paid leave mandate. Click the link below to download the bulletin. As always for more information contact your Total Benefit Solutions group account manager at (215)355-2121

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Horizon NJ: Covid-19 Resource Guide Update

Cayla Widdop

Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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INFLATION NOW TOPPING LIST OF EMPLOYER’S PANDEMIC CHALLENGES

Ed MacConnell

Employers have faced many challenges since the start of the pandemic, and now wage inflation may be at the top of the list. Using the law of supply and demand, as the supply of talent decreases, candidates can demand more money. The good news, according to the Department of Labor, the unemployment rate fell to 4.6% in October 2021, a new pandemic low. Click the link below to download the full bulletin. As always please contact your Total Benefit Solutions, Inc group account manager if you have any further questions or concerns.

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Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

Ed MacConnell

COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More

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Employers in Philadelphia Are Required to Provide Paid COVID Relief  

Ed MacConnell

Employers in Philadelphia, PA with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 related reasons. The new measure became effective on March 9, 2022 and will extend through the end of 2023. It covers employees who are unable to work for the following reasons: To care for self or a family member showing symptoms of COVID-19 To care for self or a family member exposed to COVID-19, in order to self-isolate As a result of childcare or school closures To obtain a COVID-19 test or vaccine, or to recover from injury,… Read More

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Philadelphia Passes New COVID-19 Paid Leave Law

Ed MacConnell

Philadelphia has enacted a new law that requires employers to provide paid time off for COVID-19 purposes. The ordinance, which took effect March 9, 2022, applies to employers with at least 25 employees. Covered EmployeesThe ordinance covers employees who: Work in Philadelphia; Normally work in Philadelphia but currently telework from any other location as a result of COVID-19; or Work from multiple locations or from mobile locations, provided that 51% or more of their time is in Philadelphia. There is no waiting period or accrual requirement for leave. Permitted Purposes for COVID-19 LeaveLeave must be allowed for specified COVID-19 reasons relating to an employee’s (or their family members’) exposure to, symptoms of or diagnosis with COVID-19. Leave… Read More

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Independence is covering OTC COVID‑19 test kits through pharmacy benefits

Ed MacConnell
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