Pension & Benefits News CMS extends certain time frames related to group health plans
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Tuesday, May 26, 2020

CMS extends certain time frames related to group health plans

By Pension and Benefits Editorial Staff

The Centers for Medicare & Medicaid Services (CMS) has issued guidance providing a temporary period of relaxed enforcement of certain time frames related to group market requirements under the Public Health Service Act (PHSA) in response to the COVID-19 outbreak.

Joint notice. In response to the COVID-19 National Emergency, on April 28, 2020, the Department of Labor (DOL), the Department of the Treasury (Treasury Department), and the Internal Revenue Service (IRS) issued guidance so plan participants, beneficiaries, and employers have additional time to make critical health coverage and other decisions affecting benefits and to send certain required notices during the COVID-19 outbreak. In a Joint Federal Register Notice provides group health plans subject to ERISA and the Internal Revenue Code and plan participants and beneficiaries additional time to comply with certain deadlines affecting COBRA continuation coverage, special enrollment periods, claims for benefits, appeals of denied claims, and external review of certain claims.

EBSA disaster relief. EBSA Notice 2020-01 extends the deadlines under which other notices, disclosures and other documents required under the provisions of Title I of ERISA over which DOL has interpretive and regulatory authority must be furnished to participants and beneficiaries if the plan administrator acts in good faith and furnishes such notice, disclosure, or document as soon as administratively practicable under the circumstances.

Time frames extended. The guidance indicates that CMS concurs with the relief specified by DOL, the Treasury Department, and IRS in the Joint Federal Register Notice, as well as in EBSA Notice 2020-01 issued by DOL. Between March 1, 2020 and 60 days after the end of the COVID-19 National Emergency, or such other date announced by DOL or jointly by DOL and the Treasury Department/IRS in future guidance, CMS will adopt a temporary policy of relaxed enforcement to extend similar time frames otherwise applicable to non-Federal governmental group health plans and health insurance issuers offering coverage in connection with a group health plan, and their participants and beneficiaries, under applicable provisions of title XXVII of the PHSA.

Small Business Health Options Program (SHOP). Under this temporary policy, CMS also will not consider a SHOP, a SHOP issuer offering a qualified health plan (QHP) through a SHOP, or small business participating in a SHOP to be out of compliance with rules applicable to the SHOP, to the extent the SHOP, issuer, or small business operates in a manner consistent with this relief. To the extent there are different outbreak period end dates for different parts of the country, the relief provided by CMS will apply in a manner consistent with any additional guidance announced by DOL or jointly by DOL and the Treasury Department/IRS regarding the application of the relief to those different areas.

Non-federal government plans. While the extension of time frames is not mandatory for non-federal governmental plans, CMS encourages plan sponsors of non-federal governmental plans to provide relief to participants and beneficiaries similar to that specified in the Joint Federal Register Notice, and encourages, but does not require, states, SHOPs, and health insurance issuers offering coverage in connection with a group health plan to enforce and operate, respectively, in a manner consistent with the relief provided in the Joint Federal Register Notice and EBSA Notice 2020-01. CMS will not consider a state to have failed to substantially enforce the applicable provisions of title XXVII of the PHSA if the state takes such an approach.

SOURCE: cms.gov

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