Tuesday, May 19, 2020

Midweek Compliance & Benefit Updates | COVID-19, Workplace Reopening & How a Med Group CEO Deals with Surprise Medical Bills

Templates and Tools
Compliance Updates
Question: Some of our employees have said they don't feel safe returning to work. Can we just permanently replace them? We recommend extreme caution when deciding to replace an employee who refuses to work because of concerns about COVID-19. Generally, employees do not have a right to refuse to work based only on a generalized fear of becoming ill if their fear is not based on objective evidence of possible exposure. However, under the current circumstances, where COVID-19 continues to be a threat across the country, we think it would be difficult to show that employees have no reason to fear coming in to work... read our full answer here. And for another view on this topic see SHRM's summary in the next story-

Fear of Coronavirus Isn’t Covered by FFCRA - "If an employee chooses to self-quarantine out of fear, the worker would not be entitled to FFCRA benefits, even if the employer permits the employee to self-quarantine ... An employee who is experiencing COVID‑19 symptoms is entitled to leave under the FFCRA only if the employee seeks a medical diagnosis or if a health care provider directs or advises the employee to stay home."
Legislative Watch, New California Bill Would Mandate Up to 10 Days of Bereavement Leave - "Assembly Bill (AB) 2999 was introduced to mandate bereavement leave as a new form of protective leave in California. The bill would require employers in California to provide employees with “up to 10 business days of unpaid bereavement leave,” and to refrain from interfering with or restraining employees from taking such leave. The days of leave would not need to be consecutive; however, the leave must be completed within three months following the death of a spouse, child, parent, sibling, grandparent, grandchild, or domestic partner. Under the current draft, AB 2999 would apply to all employers, regardless of size."
QuestionWill a borrower’s PPP loan forgiveness amount (pursuant to section 1106 of the CARES Act and SBA’s implementing rules and guidance) be reduced if the borrower laid off an employee, offered to rehire the same employee, but the employee declined the offer?
Answer: No. As an exercise of the Administrator’s and the Secretary’s authority under Section
1106(d)(6) of the CARES Act to prescribe regulations granting de minimis exemptions from the Act’s limits on loan forgiveness, SBA and Treasury intend to issue an interim final rule excluding laid-off employees whom the borrower offered to rehire (for the same salary/wages and same number of hours) from the CARES Act’s loan forgiveness reduction calculation. The interim final rule will specify that, to qualify for this exception, the borrower must have made a good faith, written offer of rehire, and the employee’s rejection of that offer must be documented by the borrower. Employees and employers should be aware that employees who reject offers of reemployment may forfeit eligibility for continued unemployment compensation. For more information, visit SBA.gov.

California Expands Workers’ Compensation Eligibility for COVID-19 - California Gov. Gavin Newsom issued Executive Order N-62-20, declaring that a COVID-19-related illness of an employee shall be presumed to have occurred in the place of the employment for purposes of awarding workers’ compensation benefits, but only if specific requirements are satisfied. The order eases employee access to workers’ compensation benefits by shifting the burden of proof to employers who, in order to avoid a claim, must prove employees did not contract COVID-19 at work. 
Benefit News
Here is How Medical Group Presidents Deal with Surprise Out of Network Emergency Room Bills - "When Stacey Richter’s husband recently landed in a New Jersey emergency room, fearing a heart attack, she had an additional reason for alarm: a potential big bill from the hospital if the E.R. wasn’t in his insurer’s network.

So she took an unusual step. Instead of simply signing the hospital’s financial and treatment consent form, Ms. Richter first crossed out sections calling for her to pay whatever amount the hospital charged. She wrote in her own payment rate of a 'maximum of two times' what the federal government would pay under Medicare, which is in the ballpark, experts said, of what hospitals might consider an acceptable rate.

'And then I signed it, took a picture of it and handed it back to them,' said Ms. Richter, co-president of the consultancy Aventria Health Group. ...legal scholars question the premise that hospitals’ financial consent forms are themselves valid contracts. That’s because contract law requires 'mutual assent,' which Barak Richman, who studies contract law and teaches at Duke University Law School, said patients can’t really give because they are seldom told the true price of care upfront, before signing....
'If patients alter the wording with their own terms — so long as they agree to pay what is considered a reasonable amount — then judges may also look to that added language,' said Mr. Richman."

At Least for a While, It Pays Better to Be Unemployed (MAP) - Massachusetts generous unemployment policies combined with the stimulus means all workers making under $73,996 would receive more a week unemployed than they do from working. Many of these salaries outstrip the state's median income, meaning the majority of workers would receive more from an unemployment check than a paycheck.

Top 1% of Spenders Account for 22% of Health Care Expenses - "15 percent of the U.S. civilian noninstitutionalized population had no health care expenditures in 2016, and only 5 percent of the population accounted for half of health care spending. This includes all sources of payment for medical care, including private insurance payments, Medicare, Medicaid, out-of-pocket spending, and other sources....The bottom 50 percent accounted for only 2.8 percent of total health care expenditures. Persons in this group spent less than $971 during the year."
Coronavirus will be the largest loss on record for insurers, Lloyd’s of London says - The British insurance and reinsurance market projected that its own Covid-19 casualty and property (C&P) claims could reach up to $4.3 billion as at June 30, and warned that this could rise further if the pandemic continues for another quarter. In a broader economic assessment report on the impact of Covid-19 for the non-life insurance industry, Lloyd’s estimated that the 2020 underwriting losses covered by the industry will hit $107 billion.

How a single insurance company came to dominate Gavin Newsom’s COVID-19 testing team - "As Gov. Gavin Newsom navigates one of his most vexing problems during the pandemic, supplying the state with enough tests for COVID-19, he has relied heavily on a single company: insurance giant Blue Shield of California, a generous campaign contributor and supporter. Nearly half of the leadership positions on Newsom’s high-priority task force on coronavirus testing are filled with Blue Shield executives. Its CEO, Paul Markovich, is the co-lead, alongside the assistant director of the state Department of Public Health. All told, employees of the insurance company make up 22 percent of the 68-position team."
Health & Wellness

(Finally some good news!) Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows - "Researchers are finding evidence that patients who test positive for the coronavirus after recovering aren’t capable of transmitting the infection, and could have the antibodies that prevent them from falling sick again. Scientists from the Korean Centers for Disease Control and Prevention studied 285 Covid-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The so-called re-positive patients weren’t found to have spread any lingering infection, and virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles."
A Doctor's Diary From a COVID ICU (A Mayo Clinic doctor heads to New York for a week on the front lines) - "I arrived last night to find that two of my patients had died during the day. It was expected. My night wasn’t going to get much better from there.

In my first 30 minutes, I had four patients abruptly decompensate and nearly code (where we do chest compressions, give powerful meds, and potentially shock the heart with electricity—“clear!”). I had a team of six so everyone took a patient and I pinballed from one patient to the next, assessing, directing, and working the problems. Codes can actually be quite nice because they are (usually) very formulaic and you work your way through an algorithm. Not so just before a code. In the moments before a code you have a window to alter the care and prevent a code from happening, but the clock is ticking. In my case I had four clocks. Fortunately, the team stepped up; unfortunately, we had some limited resources and we were just getting settled into the night.

One patient threw a massive blood clot into his lungs and we had to push very strong drugs to break it up. Another patient had the opposite—she was bleeding out from her lungs and we had to administer drugs down her breathing tube and through her IV to stop the bleeding."
'Weird as hell’: The Covid-19 Patients Who Have Symptoms for Months - "Days later, he found himself fighting a raging infection. It’s one he likens to being 'abused by somebody' or clubbed over the head with a cricket bat. 'The symptoms were weird as hell,' he says. They included loss of smell, heaviness, malaise, tight chest and racing heart. At one point Garner thought he was about to die. He tried to Google 'fulminating myocarditis' but was too unwell to navigate the screen....He had a muggy head, upset stomach, tinnitus, pins and needles, breathlessness, dizziness and arthritis in the hands. Each time Garner thought he was getting better the illness roared back. It was a sort of virus snakes and ladders. 'It’s deeply frustrating. A lot of people start doubting themselves,' he says."