Employee Benefits Compliance Resource Center

Our employee benefits compliance experts regularly examine state & federal insurance regulations to keep our clients from incurring costly fees or penalties. The Employee Benefits Compliance Resource Center is a repository of new laws/regulations, expert guidance and insightful news articles, where HR & Finance professionals gain actionable information for their benefit programs.

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12.28.2020 | Compliance Alert!

$900B COVID-19 Relief Package Signed into Law; Includes Rules to End Surprise Medical Billing​​
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12.28.2020 | Compliance Alert!

$900B COVID-19 Relief Package Signed into Law; Includes Rules to End Surprise Medical Billing​​
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Coronavirus Employer Insurance ResourcesCOVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics
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Below are our compliance resource postings over the last 6 months. For your convenience the sections are color-coded in chronological order. Orange Compliance Alerts discuss new guidance interpreted by our staff ERISA attorney and team. U.S. Policy postings represent new state and Federal laws and In the News articles convey current commentary from reputable news outlets.

Compliance Alert
Massachusetts Health Insurance Reporting Form Must be Filed by December 15​​

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Agencies Issue Healthcare Transparency Rules for 2022 and Beyond

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IRS Announces Health FSA and other 2021 Plan Limits ​​​​​

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IRS Releases Final Forms and Instructions for 2020 ACA Information Reporting ​​​​​

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IRS Extends Deadline for Distributing 2020 Forms 1095-C and 1095-B; Extends "Good Faith" Penalty Relief for One More Year​​​​

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New York Paid Family Leave Contributions and Benefits Set to Increase January 1, 2021​​​

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New York City Amends Paid Sick Leave Law to Align with State Law​​

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NY Sick Leave Law Goes Into Effect 9.30.20​

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DOL Revises COVID-19 Leave Regulation in Light of a Recent Court Decision​

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IRS Releases 2021 ACA Employer Mandate Penalty Amounts​

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Judge Blocks Key Provisions of New ACA Section 1557 Regulation

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Deadline for Medicare Part D Notice of Creditable Coverage Nears

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Court Eliminates Key Provisions of COVID-19 Leave Regulation​

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Supreme Court Upholds Religious and Moral Exemptions to ACA Contraceptive Mandate ​

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Agencies Issue Guidance on COVID-19 Testing and Treatment​

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Agencies Issue Plan Limits and other New ACA Rules for 2021 and Future Plan Years​

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HHS Removes ACA Rules Prohibiting Gender Identity Discrimination; Supreme Court Concludes That Title VII Prohibits Discrimination Against LGBTQ Employees​

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Insurers Issue Refunds Due to COVID-19

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The PCOR Fee Continues: IRS Issues Long-awaited PCOR Fee Update​

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Reminder: PCOR Fees for Non-calendar Year Plans are Due July 31, 2020 ​

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Internal Revenue Service Issues 2021 HSA Limits​

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IRS Guidance Gives Cafeteria Plans Flexibility During COVID-19 Pandemic​

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DOL Issues New COBRA Model Notices and FAQ Guidance​

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Agencies Issue COV​​ID-19-Rela​​ted Compliance Relief for Benefit Plans​​​

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President Signs Coronavirus Stimulus Package into Law​

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President Signs Coronavirus Stimulus Package into Law​

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Senate Approves Coronavirus Bill; Now Under Review by the House​

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DOL Guidance Clarifies Coronavirus Paid Leave Requirements​

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Important State & Federal Reporting and Enrollment Extensions

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Agencies Issue Guidance on Coronavirus Paid Leave Tax Credits

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Agencies Issue Guidance Relaxing Enforcement of Benefits Compliance Rules During Coronavirus Health Emergency

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Coronavirus Bill Requiring Paid Leave and Other Benefits Signed Into Law

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House Coronavirus Bill Awaits Senate Approval​

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COVID-19 Compliance Guidance, Insurance Carrier Notices & Infographics for Employees

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State "Individual Mandate" Law Impose New Compliance Requirements on Employers and Employees

2.20.2020 revised from 11.18.2019
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New Budget Law repeals ACA "Cadillac Tax"; Makes Significant Changes to the ACA and other Employee Benefits Laws​

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IRS Extends Deadline for Distributing 2019 Forms 1095-C; Provides New Penalty Relief for Coverage Providers​

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IRS' Draft Instructions for 2019 ACA Information Reporting are Nearly the Same as 2018​

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State "Individual Mandate" Laws Impose New Compliance Requirements on Employers and Employees​

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UPDATE: Massachusetts Health Insurance reporting Form Must Be Filed by December 15​​​​
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IRS Announces Health FSA and Other 2020 Limits​

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IRS and Treasury Issue Proposed Regulation on New "ICHRAs" Available in 2020

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Reminder: 2nd Year of Massachusetts Health Insurance Reporting Form Due November 30​

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New York Paid Family Leave Contributions and Benefits Set to Increase January 1, 2020​​​

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California Requires New FSA Notices in 2020​​​

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REVISED IRS Allows New Expenses for Chronic Conditions to Be Treated as Preventative Care under HSA Rules​​

9.20.2019 revised from 07.22.2019
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IRS Lowers ACA Affordability Percentage for 2020; Applies New Method for Determining Annual Percentage Adjustment

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New Jersey Issues Guidance on its Individual Mandate Reporting Requirements; Extends Reporting Deadline​

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Agencies Directed to Issue Rules on Healthcare Price and Quality Transparency​​
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Agencies Issue Final Regulation Expanding HRA Uses and Availability​
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For earlier Compliance Alerts, please contact your Corporate Synergies Account Manager.​

U.S. Policy

EEOC Issues Proposed Wellness Incentive Rules
01.07.2021 — Because the ADA and GINA do not define what constitutes a “voluntary” wellness plan, new regulations from the EEOC propose that, to comply with the ADA and GINA, employers may offer no more than a minimal incentive to encourage participation in wellness programs, except in certain wellness programs that would be permitted to offer the maximum allowed incentive under the 2013 HIPAA regulations.
New EEOC Proposed Regulations »
EEOC Press Release »

DOL Issues Final Rules Making it Easier to Provide Benefits to Independent Contractors
01.06.2021 — The new regulation, issued under the Fair Labor Standards Act, is designed to streamline and simplify the complex rules used to identify independent contractor status, making it easier to determine when such a worker should receive employee benefits. Scheduled to be implemented on March 8, 2021, the incoming Biden administration may freeze this rule and prevent it from going into effect.
DOL Final Regulation »
Morgan Lewis Labor & Employment Law »

IRS Releases Temporary COVID-19 Relief Rules for Employer-provided Automobile Benefit
01.04.2021 — Under the new rules, employers and employees will have increased flexibility about how they choose to calculate the value of an employee’s personal use of an employer-provided automobile for employment tax and tax reporting purposes.
IRS Notice 2021-7 »

California Updates Healthcare Information Reporting Guidance
01.01.2021 — The California Franchise Tax Board (FTB) recently clarified that employers sponsoring fully-insured health plans are required to report insurance information to the FTB by March 31, but only if their insurance providers do not report to FTB.
CA FTB Guidance »

New Jersey Division of Taxation Requirements
12.14.2020 — Employers sponsoring fully-insured health plans are required to transmit 1095 health coverage forms to the New Jersey Division of Taxation by March 31, but only if their insurance providers do not report it.
NJ Division of Taxation »

IRS Issues FAQ Guidance Clarifying COVID-19 Relief for Van Pool Benefits
12.10.2020 — The IRS guidance clarifies that, for 2020, the “80/50 rule” (defined in the guidance linked below) will be considered satisfied for a vehicle if, at the beginning of the 2020 calendar year, the employer reasonably expected the vehicle’s use would satisfy the 80/50 rule but the rule was not actually satisfied “due to the COVID-19 emergency.” The relief applies to van pools using employer-operated or employee-operated vehicles.

Supreme Court Gives States Green Light to Regulate PBMs
12.10.2020 — The U.S. Supreme Court unanimously ruled to uphold an Arkansas law (Act 900) regulating pharmacy benefit managers (PBMs) in the state. Act 900 was enacted in 2015 to protect pharmacists when PBMs set their prescription reimbursement rates below wholesale costs. This ruling opens the door for other states to impose new rules and restrictions on PBMs.
Supreme Court Opinion »

Reminder: New SBC Requirements Effective for Plan Years Beginning On or After 1/1/2021
12.04.2020 — DOL and CMS updated their SBC materials which must be used for plan or policy years beginning on or after January 1, 2021. The updated materials reflect the Tax Cuts and Jobs Act’s (TCJA) reduction of the penalty for violating the ACA's individual mandate to zero dollars.
DOL Regulation »

CDC Issues Updated Guidance on When Quarantine Period Can End Rule
12.02.2020 — The CDC has offered additional guidance on the option to shorten quarantine periods for those who may have been exposed to the coronavirus, hoping to improve compliance and reduce the negative economic and psychological impact of long periods of isolation. The new guidance allows those without symptoms to end quarantine after seven days if they test negative or after 10 days without a negative test. The CDC still recommends a full 14 days of quarantine whenever possible.
CDC Guidance »

Cal/OSHA Emergency Regulations to Protect Workers from COVID-19 in Effect
12.01.2020 — The regulations require that employers implement a site-specific written COVID-19 prevention program to address COVID-19 health hazards, correct unsafe or unhealthy conditions and provide face coverings. When there are multiple COVID-19 infections or outbreaks at the worksite, employers must provide COVID-19 testing and notify public health departments. The regulations also require accurate recordkeeping and reporting of COVID-19 cases.
CA Dept. of Industrial Relations »

IRS Announces Annual PCOR Fee Adjustment
11.24.2020 — The new adjusted PCOR fees, applicable to health insurers and sponsors of self-insured health plans, for plan and policy years ending on or after October 1, 2020, and before October 1, 2021, is $2.66. This is a $0.12 increase from the previous amount.
IRS Notice 2020-84 »

CMS Issues Final Most-favored-nation Rule for Medicare Part B Drug Pricing
11.20.2020 — The final “most-favored-nation (MFN) rule” aims to reduce the cost of prescription drugs in Medicare Part B plans by tying prices to a new MFN model that relies on international price competition. The new pricing model is intended to be phased in over time but is expected to face significant legal challenges before implementation.
Centers for Medicare & Medicaid Services »
Health Affairs »

HHS Issues Final Drug Pricing Rebate Rule
11.20.2020 — The rule intends to force pharmacy benefit managers and insurers to pass rebates they receive from pharmaceutical companies to Medicare Part D patients at the point of sale – directly benefiting patients with high out-of-pocket costs – rather than using those rebates to lower overall premiums or provide other benefits. The rule is scheduled to take effect in 2022.
Department of Health & Human Services »
Health Affairs »

IRS Issues Informal Guidance Clarifying Rules for Unused Funds in Qualified Transportation Plans
11.19.2020 — Unused funds in qualified transportation plans can be applied to another qualified transportation fringe benefit if the other benefit is offered under the employer’s plan and the monthly maximum is not exceeded. However, the letter cautions that refunds of qualified transportation fringe benefits provided through a compensation reduction agreement are not allowed.
IRS Information Letter 2020-0024 »

UPDATE: Connecticut Paid Leave Effective 1/1/2021
11.16.2020 — On June 25, 2020, Connecticut signed into law a new paid family leave (PFL) insurance program funded through mandatory payroll deduction. Employers must begin withholding from employees’ paychecks for the PFMLA on January 1, 2021, however, no benefits will be paid to employees before January 1, 2022.
Connecticut Paid Leave FAQ »

Supreme Court Justices Indicate a Possible Save of the ACA, Despite Individual Mandate Being Held Unconstitutional
11.10.2020 — Based on comments from the Supreme Court judges, it appears likely that the ACA will survive the challenge to its constitutionality, but the Individual Mandate is likely to be severed from the rest of the law, and it’s not a guarantee that the judges will vote based on their comments during oral argument.
Reuters »

Agencies Issue Rules Clarifying CARES Act Requirements for COVID-19 Vaccines & Testing
11.06.2020 — The IRS, DOL, and HHS have issued interim final regulations implementing the CARES Act requirement that most group health plans cover, without cost-sharing, qualifying coronavirus preventive services, including immunizations, within 15 days after the CDC’s recommendation, regardless of whether the service or immunization is recommended for routine use and whether it is provided by an in-network or out-of-network provider.
Interim Final Regulation »
CMS Fact Sheet »

New Jersey Executive Order Imposes COVID-19 Workplace Safety Measures
11.5.2020 — Effective November 5, 2020, every business, nonprofit and governmental entity that requires or permits employees to be physically present at a worksite in New Jersey must comply with Executive Order 192’s safety standards, including mandatory social distancing and the daily screening requirement.
NJ Executive Order 192 »
NJ Governor Office's Press Release »

Colorado Paid Family Leave Voted into Law
11.3.2020 — Voters in Colorado have approved Proposition 118 that requires the state to launch a Paid Family Leave (PFL) program with contributions beginning in 2023 and benefits available in 2024. The PFL program will provide partial wage replacement for 12–16 weeks of leave for reasons similar to the federal Family and Medical Leave Act (FMLA).
Proposition 118 Text »
Colorado Public Radio »

IRS Issues Final Instructions for 2020 ACA Information Reporting
10.15.2020 — Aside from new rules regarding new individual coverage health reimbursement arrangements (ICHRAs), the 2020 instructions do not contain significant changes from prior years. Filing of 2020 Forms 1094-C and 1095-C is due by March 1, 2021 (paper) or March 31, 2021 (electronic). Furnishing of Form 1095-C is due by March 2, 2021.
Forms 1094-/1095-C Final Instructions »
Other 2020 Forms & Instructions »

California’s New COVID-19 Legislation Creates New Requirements for Employers
10.6.2020 — Three new recently-passed COVID-19-related labor laws in CA affect employer labor compliance requirements involving workers’ compensation, family leave rights and workplace exposure reporting.
Senate Bill 1383 »
Senate Bill 1159 »
Assembly Bill 685 »
Alston & Bird »

HHS extends the COVID-19 Public Health Emergency
10.2.2020 — The U.S. Department of Health and Human Services (HHS) extended the COVID-19 Public Health Emergency (PHE) period until January 21, 2021. This is the third 90-day extension. The PHE, separate and distinct from the COVID-19 “National Emergency” declared by the President, requires health insurance carriers to provide certain enhanced medical benefits without cost sharing, including coronavirus testing. .
U.S. Department of Health & Human Services »

IRS Extends Deadline for Furnishing 2020

10.2.2020 — The IRS has extended the due date for furnishing the 2020 Form 1095-C to March 2, 2021. This also extends the “good faith” reporting relief for one additional year but does not extend the filing deadlines for 2020 forms.
Notice 2020-76 »

In The News

Biden Selects Marty Walsh to Head U.S. Dept. of Labor
01.07.2021 — President-elect Joe Biden has named Boston Mayor Marty Walsh to be Secretary of the U.S. Department of Labor (DOL). If confirmed, Walsh will work with the Biden administration on significant issues, including an emergency standard to protect workers from on-the-job COVID-19 infection, and coordinating states’ payment of unemployment insurance benefits to millions of unemployed workers.
Bloomberg »

President-elect Biden will Halt Agency Rules Described as “Midnight Regulations”
12.30.2020 — President-elect Joe Biden will issue a memo on Inauguration Day seeking to halt or delay so-called “midnight regulations” issued by the Trump administration that have not taken effect by Inauguration Day.
The Hill »

Lawmakers strike deal to end 'surprise' medical bills
12.11.2020 — The “No Surprises Act” calls for parties to negotiate an agreed-upon rate or bring their dispute to a mediator. However, providers would still be allowed to bill patients to make up the difference if they inform patients the services won’t be covered and they provide an estimate of charges 72 hours before care.
No Surprises Act »
Politico »

FDA Panel Votes to Approve Pfizer COVID-19 Vaccine for Emergency Use
12.10.2020 — A U.S. Food and Drug Administration advisory committee voted Thursday to approve an emergency use authorization request from Pfizer and BioNTech for their COVID-19 vaccine, clearing the way for some groups to start getting vaccinated as early as next week. Under the CARES Act, the vaccine will be covered under all employer-sponsored group health plans without cost sharing.
U.S. Food and Drug Administration»

FDA Authorizes Monoclonal Antibody for Treatment of COVID-19
11.9.2020 — The U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy bamlanivimab for the treatment of mild-to-moderate COVID-19 in adult and pediatric patients. Under the CARES Act, treatments with EUA are covered under all group health plans without cost sharing.
U.S. Food and Drug Administration»

CDC Says Airborne Transmission Plays a Role in Coronavirus Spread
10.5.2020 — The Centers for Disease Control and Prevention acknowledged that people can sometimes become infected with the novel coronavirus through airborne transmission, especially in enclosed spaces with inadequate ventilation.
The Washington Post »

Pelosi, Mnuchin Talk Coronavirus Aid as Presidential Illness Complicates Picture
10.5.2020 — The renewed effort in the U.S. Congress to reach a fresh deal to pump coronavirus relief funds into the pandemic-hit economy has been further complicated by the news that President Donald Trump and three Senate Republicans have tested positive.
Reuters »

Former Vice President Joe Biden Urges Americans to Vote to Protect the ACA
9.26.2020 — In response to President Trump's nomination of Judge Amy Coney Barrett to the U.S. Supreme Court, Democratic nominee Joe Biden urged Democrats to vote in the presidential election to protect the Affordable Care Act.

Dr. Fauci Advises Americans to Hunker Down During Flu Season
9.10.2020 — As the country heads into flu season, Americans can't let up in the fight against the coronavirus pandemic, said Dr. Anthony Fauci. Although the number of new daily cases of coronavirus has slowly declined over the last two weeks, the country is still closing in on 200,000 deaths from COVID-19 and more than 6 million confirmed infections.
NBC News »

U.S. Senate Fails to Advance GOP Coronavirus Relief Bill
9.10.2020 — The Senate failed to advance a Republican proposal to address the health and economic crises caused by the pandemic, four months after House Democrats passed their $3 trillion plan. But the narrower Senate bill could help Republican senators in tough reelection races by giving them a rebuttal to Democratic challengers attacking their delayed response.

AstraZeneca Halts Vaccine Trial After Patient Becomes Sick
9.9.2020 — AstraZeneca Plc halted phase 3 testing of its experimental coronavirus vaccine after a person participating in one of the company’s studies became ill. The study participant’s adverse reaction could delay or derail efforts to speed an immunization against COVID-19.
Bloomberg »

N.J. Health Insurance Tax: What It Means for Employers
9.8.2020 — New Jersey Governor Phil Murphy recently signed a new law levying a 2.5% health insurance tax on insurance carriers based on net premiums they collect for individual and large business plans across the state. Premiums for small businesses, non-profit dental plans, Medicaid, Medicare and certain self-funded coverages are not included.
Corporate Synergies “Our Take” »
nj.com »

Bad Flu Season Colliding with COVID-19 Could Be Overwhelming
9.5.2020 — Doctors and health officials are urging Americans to get vaccinated against influenza in record numbers this fall to avoid a dreaded scenario: flu colliding with a raging coronavirus pandemic. They worry that tens of millions of ¬flu-related illnesses could overwhelm hospitals, doctor offices and laboratories that test for both respiratory illnesses.
Washington Post »

FDA Issues Emergency Use Authorization for Blood Plasma Treatment Despite Scientists' Objections
8.23.2020 — The Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for blood plasma as a coronavirus treatment, one day after President Trump attacked the drug regulator for moving too slowly to back the treatment. The agency held off on the decision last week over concerns from government scientists that evidence for the treatment's effectiveness is thin, prompting Trump to accuse the FDA of slow-walking the therapy to harm his reelection chances without offering any evidence to support his claim. On 8/25/2020, FDA Commissioner Stephen Hahn issued an apology for overstating the effectiveness of the blood plasma treatment at the press conference to announce the EUA.
Politico »

$400 COVID-19 Unemployment Checks May Take Weeks to Reach Individuals
8.14.2020 — The extra $400 in weekly COVID-19 unemployment insurance benefits, authorized by President’s Trump’s recent executive order, is designed to be retroactive to August 1. But the checks may take several more weeks to reach individuals.
CBS News »

U.S. Chamber Raises Concerns about Implementing Payroll Tax Deferral
8.14.2020 — The U.S. Chamber of Commerce, the largest lobbying group for U.S. businesses, asked the Treasury Department to clear up uncertainty about how Trump's executive order initiating a payroll tax deferral could be implemented by firms, their employees and payroll processors. The payroll tax deferral is scheduled to go into effect on September 1, 2020.

HHS Posts State COVID-19 Testing Plans
8.10.2020 — The U.S. Dept. of Health & Human Services (HHS) has publicly posted the July through December COVID-19 Testing Plans from all states, territories, and localities on its website, HHS.gov. The State Testing Plans serve as a roadmap, developed in partnership with the federal government, for each jurisdiction's monthly 2020 COVID-19 testing strategy. The plans include details on responding to surges in specific cases and reaching vulnerable populations, including minorities, immunocompromised individuals and older adults.
HHS News Release on COVID-19 Testing Plans »
State-by-State COVID-19 Testing Plans »

President Signs Measures to Provide Additional Benefits during Pandemic
8.9.2020 — President Trump signed an executive order and three memoranda designed to provide economic aid to those struggling during the coronavirus pandemic, with additional benefits for the unemployed and tax cuts for workers. The executive actions are intended to bypass Congress — which has been deadlocked in negotiations to extend relief — and could face legal challenges. These executive actions, if implemented, would provide $400 in added unemployment benefits for those out of work because of the pandemic, and defer payroll taxes for those earning less than $100,000 a year. Unemployed workers had been receiving a weekly unemployment insurance supplement of $600, a benefit that expired on July 31, 2020.
CBS News »

Encryption and Tracking Failure Leads to $1,040,000 HIPAA Settlement
7.27.2020 — An HHS Office for Civil Rights (OCR) News Release has announced a $1,040,000 settlement with a health system (a HIPAA covered entity) to resolve alleged violations of HIPAA’s security rule. OCR’s investigation followed the theft of an unencrypted laptop computer from an employee’s car. The laptop contained electronic protected health information (ePHI) including: patients’ names, medical record numbers, demographic information, and medication information. The breach affected 20,431 individuals. The non-profit health system, based in Rhode Island, will also implement a corrective action plan to settle potential violations of the HIPAA Privacy and Security Rules.
HHS News Release »

New Jersey Reforms its State Health Plan for Teachers
7.1.2020 — The new law overhauls healthcare benefits and could save teachers, school districts and the state of New Jersey about $1 billion annually. The law pares down healthcare plan options to two of the most popular offerings, while introducing two lower-cost plans.
NJ State FAQ Guidance »
S2273 »
nj.com »

Supreme Court Agrees to Hear Case on the Constitutionality of the ACA
3.2.2020 — The U.S. Supreme Court will hear the case of Texas v. U.S., a decision on the constitutionality of the Affordable Care Act. The 5th Circuit Court of Appeals had ruled that part of the law, the Individual Mandate, was unconstitutional and raised questions about whether the law in its entirety must fall. The Supreme Court will likely hear the case in October 2020.
Washington Post »

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