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January 15, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Executive Director
for Municipal Employer Insurance Trust in PA

Associate, Defined Benefit Plan Administration
for The Savitz Organization in PA

Broker Dealer Branch Examiner
for Great-West Financial in CO

Health and Welfare Benefits Manager
for Southern California Pipe Trades in CA

Chief Operating Officer
for Compliance Service Professional Company in MA

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for Diversified in IN

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[Official Guidance]

Text of Proposed CMS Regs on Exchanges: Eligibility Notices, Fair Hearing and Appeal Processes for Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment (PDF)
474 pages. "This proposed rule would: (1) set forth standards for adjudicating appeals of individual eligibility determinations and exemptions from the individual responsibility requirements, as well as determinations of employer-sponsored coverage, and determinations of SHOP employer and employee eligibility for purposes of implementing section 1411(f) of the Affordable Care Act, (2) set forth standards for adjudicating appeals of employer and employee eligibility to participate in the SHOP, (3) outline criteria related to the verification of enrollment in and eligibility for minimum essential coverage through an eligible employer-sponsored plan, and (4) further specify or amend standards related to other eligibility and enrollment provisions. The intent of this rule is to afford states substantial discretion in the design and operation of an Exchange, with greater standardization provided where directed by the statute or where there are compelling practical, efficiency or consumer protection reasons." (Centers for Medicare & Medicaid Services)


[Advert.]

Must-Attend Program for Those Who Serve Multiemployer Trust Funds

Sponsored by IFEBP (International Foundation of Employee Benefit Plans)

Developed by trustees, administrators and professional advisors, the Trustees and Administrators Institutes address the issues you face today and prepare you for what lies ahead. Attend February 18-20, 2013 in Orlando, Florida. Register Now!


[Guidance Overview]

Higher Health Insurance Premiums Likely Due to 2014 Changes in Allowed Rating of Insureds (PDF)
"In 2014, when the 'play or pay' provisions become effective, some employers may decide to discontinue group health plan coverage. Employers who choose to 'get out' may want to consider paying all or part of their employees' premium for non-subsidized individual coverage in the Exchange. Individual premiums will likely be much higher than the contributions for group health coverage. The new rating rules, the prohibition on medical underwriting and the requirement to cover essential health benefits will dramatically influence rates in the individual insurance market in 2014." (McGraw Wentworth)

[Guidance Overview]

Allowable Wellness Incentive Will Increase in 2014 (PDF)
"[The ACA] allows employers to increase incentives for health-contingent wellness programs. The latest guidance proposes rules on this increase and offers additional detail on the HIPAA nondiscrimination rules. This allowable incentive increase becomes effective on the first day of the first plan year occurring on or after January 1, 2014." (McGraw Wentworth)

[Guidance Overview]

Update on Essential Health Benefits and Actuarial Determinations (PDF)
"Beginning in 2014, non-grandfathered individual and small group health plans in or outside an Exchange must cover EHBs. The definition of a small group may differ from state to state. Most states will define it, in 2014 and 2015, as an employer with fewer than 50 employees. In 2016, small groups will be defined as fewer than 100 employees. Few states plan to adopt the 100-employee threshold in 2014." (McGraw Wentworth)

[Guidance Overview]

Tax Considerations in Implementing Donated Leave Policies
"Little guidance has been issued by the Internal Revenue Service ... with respect to the implementation and operation of donated leave programs. Employers interested in establishing such a program should be aware that unless their donated leave program meets certain specific requirements the tax implications of such a program could be confusing and unexpected for employees." (EisnerAmper LLP)


[Advert.]

Health Savings Accounts - Rules and Design Considerations

Sponsored by Lorman and BenefitsLink.com

Live audio conference explains rules and explores current studies on whether HSAs are reducing total health care costs through consumerism, as well as new design opportunities for employers considering how to implement a successful HSA program. Discounted pricing for BenefitsLink readers.


Text of CMS Press Release: Proposed Regs Issued for Health Insurance Exchanges
"[The] proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations.... The proposed rule also provides flexibility to state-based Exchanges by allowing them to choose to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals." (Centers for Medicare and Medicaid Services)

Chicago Panel Says Maintaining Taxpayer Subsidies for City Retirees' Health Care Is Not Viable
"A panel appointed by [Chicago Mayor] Rahm Emanuel to review taxpayer-subsidized health insurance for retired government workers suggested the city could drop coverage to help erase a financial shortfall. The option is the most severe of many the group offered ... that gives Emanuel potential leverage to force compromise from wary unions during talks about painful fixes of Chicago's severely underfunded employee pension systems. Whatever course the city chooses, the report states, the numbers 'very strongly suggest that continuing the existing financial arrangement is not a viable course of action.'" (Chicago Tribune; free registration required)

Your Medical Records, HIPAA, and the Illusion of Privacy
"HIPAA is supposed to protect our private medical records from prying eyes, but there are many exceptions and gaps as Michael P. Kassner found out while doing some research." (Tech Republic)

Focus on Obamacare Delays Mental Health Parity Law
"Mental health advocates say a landmark 2008 law meant to expand access to millions of Americans has gotten back-burner treatment by the Obama administration because of its relentless focus on the Affordable Care Act. As a result, key details are missing from the Mental Health Parity and Addiction Equity Act, awaiting a final rule from the administration that supporters say is 'imminent.'" (Politico)

Colleges Roll Back Faculty Hours in Response to Obamacare
"Adjunct faculty from at least four universities will also see their hours cut as colleges try to reduce the number of full-time employees whose health care they need to cover.... Only contingent faculty -- as opposed to full-time, tenure-track faculty -- would be affected by the change in policy.... Teachers' associations like AAUP and AFT are bracing for the shift.... [B]oth organizations are hoping the federal government will require universities to count time spent outside the classroom as part of adjunct faculty's work hours." (msnbc)

The Rush to Digitize Patient Records Has Not Cut Costs
"It's possible that computerization may actually have increased spending. Between 2006 and 2010, Medicare payment to hospitals receiving federal dollars for electronic records grew faster than payments to hospitals that did not take advantage of the incentives ... What IT's boosters did not anticipate was how hard it would be to develop a truly 'inter-operable' system -- that is, one that enables various providers to access a patient's data no matter who created the record." (The Washington Post; free registration required)

Kaiser Family Foundation Creates Interactive ACA Implementation Timeline
"The implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years. You can show or hide all the changes occurring in a year by clicking on that year. Click on a provision to get more information about it. Customize the timeline by checking and unchecking specific topics." (Kaiser Health Reform)

States Will Be Given Extra Time to Set Up Health Insurance Exchanges
"[HHS] secretary, Kathleen Sebelius ... said she would waive or extend the deadline for any states that expressed interest in creating their own exchanges or regulating insurance sold through a federal exchange.... [T]his strategy ... allows the administration to keep working with even the most recalcitrant states.... It now appears that federal officials will have the primary responsibility for running exchanges in at least half the states -- far more than expected when the law was passed in 2010." (The New York Times; free registration required)

2012 Deloitte Survey of Health Care Consumerism
"Conducted annually since 2008, Deloitte's longitudinal study of heath care consumers seeks to provide a comprehensive view of health care consumerism, a view that goes beyond the conventional boundaries of what health and health care are commonly thought to encompass.... This report provides data-driven insights gleaned from the Deloitte 2012 Survey of U.S. Health Care Consumers as well as a look back at five years of findings that point to untapped potential for increased health care industry engagement with consumers and, with that, new challenges and opportunities for providers, health plans, employers, and government." (Deloitte)

Insurance Companies Say Individual Mandate Isn't Enough -- Want Stronger Incentives for Healthy Enrollees
"The individual mandate penalties will be pretty weak as they are phased in over two years -- only $95 when they start in 2014, much less than it costs to buy insurance. And yet, everyone with pre-existing conditions will have to be accepted for coverage right away. That's why insurance companies are telling the administration the mandate won't be enough for the first two years. They want more incentives -- such as a late enrollment fee -- to get healthy people to sign up quickly. Without getting the healthy folks in, the fear is that everyone's health insurance premiums could shoot through the roof when all those sick people get their coverage." (Politico)

Not Too Early to Plan for Health Taxes, H&R Block Says
"Even if you owe Affordable Care Act taxes, you probably won't have to start paying them until next year. But H&R Block wants you to come in and talk about them now.... 'When we talked to consumers it was very apparent that they are very confused about what's going on,' says Meg Sutton, senior adviser for tax and health-care services at Block.... The penalty, which the Supreme Court ruled is a tax, starts at $95 and rises to $695 in 2016." (Kaiser Health News)

Health Law Offers Dental Coverage Guarantee for Some Children
"Starting in 2014, the [ACA] requires that individual and small-group health plans sold both on the state-based health insurance exchanges and outside them on the private market cover pediatric dental services.... The requirement ... doesn't apply to health plans offered by large companies, although they are much more likely to offer dental benefits than small firms. Eighty-nine percent of firms with 200 or more workers offered dental benefits in 2012, compared with 53 percent of smaller firms[.]" (Kaiser Health News)

ACA Litigation: 2012 Year in Review
"[I]mplementation of the ACA has continued at the federal level and in some of the states. But legal wrangling over the law has also continued. Litigation has focused on the requirement that most employers provide health insurance coverage that includes access to contraceptives, and on the requirement that most Americans purchase health insurance. [This article] is a summary of the most significant cases." (Wolters Kluwer Law and Business)

Health Care Prices Still Rising, But Rate of Growth Falls During 2012 (PDF)
"The 12-month moving average [as of November 2012] at 2.1% is fractionally above its 14-year low, and with one month to go, 2012 may come in lower than 2011 (the lowest year since 1998)... Year-over-year, hospital prices -- a key health care index driver -- accelerated to 2.7% in November (from 2.6% in October). Physician and clinical services rose 0.7% (the lowest since 0.6% in August 2008), but nursing home price growth jumped to 2.6% from 2.3% in October[.]" (Altarum Institute)

Health Spending Growth in November 2012 Is Near Low Rate Reported by CMS from 2009 Through 2011 (PDF)
"Over the first 11 months of 2012, national health expenditures (NHE) grew at an annual rate of 4.3%, compared to the 3.9% increase for 2011 that is reflected in data just released by [CMS]. NHE in November 2012 grew by 4.1% relative to November 2011. The health spending share of GDP was 18.0% in October 2012, slightly higher than the 17.9% share reported by CMS for 2011." (Altarum Institute)

[Opinion]

Who Should Control the Obamacare Exchanges?
"Republican governors' failure to adapt to the fact that ObamaCare will not be repealed will hinder, not help, any future patient-centered reforms.... The deadline for applying for approval of a state-based exchange has passed, and states which failed to apply have missed a significant opportunity to have any influence over ObamaCare's future. They should reconsider and ask for extensions." (John Goodman's Health Policy Blog)

[Opinion]

Unleashing Innovation in Healthcare Markets
"Even as the industry changes the way it does business, one critical aspect of change is missing. The faces are all the same. The same large systems that dominated the fee for service world seem poised to dominate the shared savings world, and the same insurers that dominated the traditional employer-based insurance market stand ready to dominate exchanges. Value might be created when old businesses play by new rules, but even more value is created when new players are free to enter and perhaps even break the rules." (The Health Care Blog)

Benefits in General; Executive Compensation

[Opinion]

Like Eastwood Talking to a Chair: The Good, the Bad, and the Ugly of the Obamacare Ruling
"The constitutional challenge to Obamacare was a case that comes along once every generation, if not less often. Not because it could affect a presidential election or was otherwise politically significant, but because it reconsidered so many aspects of our constitutional first principles ... If Congress can avoid the Constitution's structural limits by 'taxing' inactivity, its power is no more limited and liberty no better protected than if it were allowed to regulate at will under the Commerce Clause. The ultimate lesson to draw from this two-year legal seminar, then, is that the proper role of judges is to apply the Constitution regardless of whether it leads to upholding or striking down legislation. And a correct application of the Constitution inevitably rests on the Madisonian principles of ordered liberty and limited government that the document embodies." (Ilya Shapiro, in Texas Review of Law & Politics)

New Tax Act Affects Nonqualified Deferred Compensation
"Generally, the rise in tax rates increases the attractiveness of deferring income into the future through nonqualified plans.... Each person's situation is different, however, and you should make projections involving various factors: your calculation of current and future tax rates for both ordinary income and capital gains; the investment return on the compensation you defer; [and] the growth of alternative investment(s) for the after-tax amount of the compensation without deferral[.]" (myStockOptions.com)

[Guidance Overview]

NYSE and NASDAQ Amend Compensation Committee Proposals
"NASDAQ proposes to clarify that a compensation committee is not required to conduct the independence assessment required by proposed Listing Rule 5605(d)(3)(D) with respect to a compensation adviser that acts in a role limited to: consulting on any broad-based plan ... and/or providing [certain] information ... The NYSE has proposed a similar amendment to its proposal, together with amendments addressing transition when smaller reporting companies are no longer eligible for that status." (Dodd-Frank.com, a blog by Leonard, Street and Deinard)

[Guidance Overview]

NASDAQ and NYSE Amend Proposed Compensation Committee Independence Listing Standards
"Among other things, the amendments clarify that the proposed standards would not require compensation committees to conduct an independence assessment with respect to any compensation adviser that only: [1] Consults on a broad-based plan that does not discriminate in scope, terms or operation in favor of executive officers or directors and that is generally available to all salaried employees. [2] Provides information that is not customized for a particular company or that is customized based on parameters that are not developed by the adviser, and about which the adviser does not provide advice." (Practical Law Company)

Nonqualified Retirement Plans Key Component of Pay for Executives at Tax-Exempt Organizations
"According to Mercer's 2012/2013 Executive Benefit and Perquisite Practices Survey for Tax-Exempt Organizations, more than half (58%) of participating organizations offer top executives an employer-paid nonqualified retirement plan -- a plan that does not qualify for tax advantages under the Internal Revenue Code (IRC) -- up from 49% two years ago. These plans are most popular among healthcare organizations (67%) followed by foundations and charities (53% and 39%, respectively). Among all tax-exempt sectors, the prevalence of nonqualified plans significantly decreases when moving down the executive rank." (Mercer)

Employer Action Required to Preserve FICA Refund Claim on Severance Pay
"[E]mployers that have paid a substantial amount of severance in recent years should consider filing a protective claim with the IRS for a refund of FICA taxes paid. Such a filing will extend the period of time for which FICA contributions on severance could be recovered, should the Supreme Court eventually rule against the IRS." (VedderPrice)

Press Releases

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