Biden Administration Releases Executive Order on Protecting Access to Reproductive Healthcare Services
State Issues Guidance for Paid Sick Law
July 19, 2022
On June 24, 2022, the Department of Labor and Employment issued guidance for the state’s Healthy Families and Workplaces Act (the Act). The guidance focuses on how sick pay accrues and leave taken for public health emergencies. The Act was covered in our July 23, 2020, and September 3, 2020, editions of Compliance Corner.
Starting in 2021, the Act requires employers to provide employees one hour of paid sick leave for every 30 hours worked, up to 48 hours per year, and unused hours can carry forward into the next year. The guidance states that any unused hours carried over into a subsequent year can be counted against the 48 hour/year total in that year. This also means that if the employee carried over 48 hours from the previous year, then they do not earn any additional sick leave in the current year.
The Act also provides for public health emergency leave for use when leave is associated with a public health emergency, such as the COVID-19 pandemic. This leave supplements the paid sick leave under the Act with up to 80 hours. The paid leave already accrued as of the date the public health leave is requested will count towards the public health leave. For instance, if an employee requests public health leave due to COVID-19, and they have 10 hours of paid sick leave accrued as of the date of their request, the employer must add 70 more hours of supplemental leave. The employee can use the public health leave granted in this way before they use their accrued sick leave.
Employers in the state or with employees in the state should be aware of this guidance.
Commissioner Issues Directive on Self-Funded Plans Opting in to State Surprise Billing Law
July 19, 2022
On July 1, 2022, the Insurance and Safety Fire Commissioner (the Commissioner) issued Directive 22-EX-5 regarding self-funded healthcare plans electing to participate in the Surprise Billing Consumer Protection Act (the Act).
The Act (originally HB 888) was signed into law on July 16, 2020, and was designed to stop surprise billing to patients receiving out-of-network care for emergency services and non-emergency services at in-network facilities provided without patient consent. For covered items and services, an out-of-network provider may bill a patient only for the cost-sharing amount (e.g., deductible, coinsurance, copayment, etc.) that the patient is responsible for under the terms of his or her plan or policy. The Act specifies a formula to determine the amount the plan or insurer is required to pay the out-of-network provider and establishes an arbitration process for out-of-network providers who believe they should be entitled to additional funds. Subsequently, the Act was amended by SB 566 to clarify that a medical or traumatic condition, sickness, or injury includes a mental health condition or substance use disorder and that emergency medical services include post-stabilization services.
Generally, the Act applies to fully insured plans. However, on April 29, 2021, HB 234 was signed into law, allowing self-funded healthcare plans operating in Georgia to elect to participate in the Act. Directive 22-EX-5 provides the form and instructions for an electing self-funded healthcare plan to notify the Commissioner of its decision. Note that most non-electing self-funded plans would otherwise be subject to the federal No Surprises Act surprise billing prohibitions for plan years beginning on or after January 1, 2022. Electing plans may still be subject to the federal provisions for any items and services covered by the NSA that are not covered by the Act.
Self-funded employers should be aware of this bulletin and may want to consult with their counsel and service providers for further information and guidance.
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