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November 6, 2008

Here are the Web's best new links about compliance and cost aspects of plan operation, design and policy.


Today's sponsor is BeneCom Associates, LLC

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[Official Guidance] HHS Office of Inspector General Publishes 2009 Work Plan
The OIG conducts audits relating to the Medicare program and prepares reports to Congress about administration of Medicare. Areas listed in the work plan are those that OIG considers might be subject to abuse, so providers, hospitals, health plans and others might wish to be aware of those areas when developing compliance work plans for the next year. Information OIG gleans from its evaluations also can indicate areas in which OIC might direct future criminal investigations. Increasing emphasis and scrutiny is being placed on Medicare Advantage and Medicare prescription drug programs. (Office of Inspector General, U.S. Department of Health & Human Services)


[Guidance Overview] New Paid Sick Leave Law in D.C. (PDF)
3 pages. Excerpt: "New legislation will soon require D.C. employers to provide employees with paid sick and/or safe leave. The 'Accrued Sick and Safe Leave Act of 2008,' which was approved by the Washington D.C. Council earlier this year, takes effect on November 13, 2008. Under the Act, D.C. employers will be required to provide employees with paid leave for absences relating to personal illness, family member illness, and certain absences relating to domestic violence or se.xual abuse." (Powell Goldstein LLP)


[Guidance Overview] District Court Grants Plan Summary Judgment In ERISA Reimbursement Case
Excerpt: "A Georgia U.S. district court has awarded summary judgment to an ERISA plan on its claims to reimbursement from funds acquired in a personal injury settlement. In the Eleventh Circuit, plan language must conform to several requirements that are essentially judicial gloss on the ERISA statute. This case illustrates a successful clearing of each hurdle. The opinion rejects the argument that 'appropriate' equitable relief requires implicitly the incorporation of 'make whole' notions. As is necessary under existing Eleventh Circuit law, the plan language explicitly rejected the make whole doctrine, so no issue arose under Cagle v. Bruner." (Health Plan Law blog by Attorney Roy F. Harmon III)


[Guidance Overview] Proposed Cancer Treatment Deemed 'Experimental'
Excerpt: "This lengthy opinion provides analysis of a benefit denial under a medical necessity exclusion, with particular emphasis on the 'experimental' or 'investigational' aspect of the proposed treatment. The court decided the case under an abuse of discretion standard of review. [Reimann v. Anthem Ins. Cos., 2008 U.S. Dist. LEXIS 88562 (S.D. Ind. Oct. 31, 2008)]" (Health Plan Law blog by Attorney Roy F. Harmon III)


The Implications of an Economic Recession on Health Plans (PDF)
3 pages. Excerpt: "This article discusses how a recession and rising unemployment correlate with increased health care expenditures, and how plan sponsors can manage rising costs." (WorldatWork via The Segal Group, Inc.)


S&P Shifts Outlook on U.S. Health Insurers to Negative
Excerpt: "The rating agency cites several factors in lowering its outlook, including pressure on earnings, a weaker economic forecast and unfavorable results." (Workforce Management; free registration required)


Senate Investigating Some Niche Health-Insurance Plans
Excerpt: "A prominent member of the Senate Finance Committee is looking into some niche health insurance plans offered to AARP members to see if they mislead purchasers into thinking the coverage is greater than it actually is. The inquiry by U.S. Sen Chuck Grassley, R-Iowa, part of a wider investigation into health costs and coverage, centers on so-called limited-benefit plans . . . ." (The Star Tribune (Minneapolis) via NewsEdge via Human Resource Executive Online)


State Health Care Reform Update
Excerpt: "For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. Because of the potential impact of this ongoing activity on employer-provided health insurance benefits, Spencer's Benefits Reports provides regular updates about state health reform." (Wolters Kluwer)


Facing the Challenge of Unhealthy Weight: Recommendations for the Health Care Community (PDF)
32 pages. Excerpt: "Based on the work of the AHIP Expert Panel and other research and meetings sponsored by the AHIP Obesity Initiative, this report offers the following recommendations for the health care community: make routine body mass index (BMI) screening and interpretation a standard clinical practice for the care of adults and children; equip clinicians (physicians, physician assistants, nurses, dietitians, physical therapists, behavioral specialists, medical assistants and other medical professionals) with training and tools to communicate effectively with patients about BMI screening, overweight and obesity; connect BMI screening to evidence-based prevention and treatment options; build partnerships among health insurance plans, physicians and clinicians, employers and community groups, and disseminate promising practices; promote cultural competency and reduce racial, ethnic and cultural disparities; and measure and report progress in BMI screening through standardized measures such as the National Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS)." (America's Health Insurance Plans)


Innovations in Prevention, Wellness and Risk Reduction (PDF)
109 pages. Excerpt: "Health plans have long recognized their responsibility to work with the populations they cover and the communities they serve, developing initiatives that can make a real difference in people's lives and well-being. In this report we profile 37 of these initiatives, including: Programs that offer children healthier food choices and more opportunities for physical activity in their schools and neighborhoods. Health plans that are combining personal health assessments, health coaching, changes in the work environment, and lifestyle incentives to help employers and their employees tackle health risks that lead to illness, absenteeism, lost productivity and higher health care costs." (America's Health Insurance Plans)


Some Employers Viewing Consumer-Directed Health Plans as Retiree Savings Vehicles
Excerpt: "[T]he Towers Perrin survey of 321 of the nation's largest employers, covering 6.6 million employees, also suggests that large employers view CDH plans as a way to help their employees prepare for medical expenses in retirement. The final version of the report will be released in early January 2009. Towers Perrin says employers are viewing CDH plans as one solution to their continuing ability to offer affordable health benefits to their employees and, especially, retirees." (AISHealth.com)


Insurers Hire Radiology 'Benefits Managers' to Vet Scanning
Excerpt: "Health insurers are increasingly relying on outside firms to help rein in the skyrocketing costs of imaging scans like MRIs. But when these middlemen clash with doctors about what tests are needed, consumers can get caught in the crossfire. Big insurers including Aetna Inc., WellPoint Inc. and Cigna Corp. have hired so-called radiology benefits managers, or RBMs. Health plans say they want to ensure that doctors use high-tech scans only when it is clear that patients will benefit." (The Wall Street Journal)


Employers Less Generous with Thanksgiving Leave This Year
Excerpt: "The BNA Holiday Practices Survey indicates employers are less generous this year than they were in 2007 in granting paid time off during the Thanksgiving holiday season. However, BNA says the proportion of employers requiring some employees to work on Thanksgiving Day is at a 20-year low." (PLANSPONSOR.com; free registration required)



Sponsored by: Financial Research Associates

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Banner ad for Financial Research Associates

MADE IN AMERICA 2009: The 6th Annual Taft-Hartley Benefits Summit

Hot Topics in Pension Fund Performance and Investments:
Harnessing the ideal asset mix to boost your fund's performance
What we can learn from the corporate fund and endowment/foundation worlds
Updates on the Pension Protection Act
And much more!

Hot Topics in Health & Welfare:
Best practices in wellness & health initiatives to reduce cost and increase your members' health
HSAs, HRAs and VEBAs
Saving money by mining your PBM data
And much more!


(Please visit our sponsors. We try to make sure their products and services will be of interest to you. Thanks! --Editor)

Links to Items on Executive Comp, Benefits in General

[Guidance Overview] President-Elect Obama's HR-Related Proposals (PDF)
14 pages. Excerpt: "Hewitt's post-election report . . . provides specific information on President-elect Obama's positions on health care, retirement benefits, tax policy and employment practices. " (Hewitt Associates)


[Guidance Overview] Links to 2008 Q&As Submitted by Benefits Attorneys to Various Benefits-Related Federal Agencies
These links are not new, but the documents are interesting and useful enough that we wanted to be sure you know about them. Especially interesting are DOL answers about claims procedures and IRS answers about section 409A. Excerpt: "Each year, the Joint Committee on Employee Benefits (JCEB) of the American Bar Association meets with officials of federal agencies in Washington, D.C., to discuss issues of interest to employee benefits practitioners. This year the JCEB met with the IRS, DOL, SEC, PBGC, EEOC, HHS and CMS. . . . The question and answer transcripts listed below are based on these informal discussions between private sector representatives of the JCEB and agency officials." (Joint Committee on Employee Benefits, American Bar Association)


[Guidance Overview] Impact of Early EESA Guidance on Executive Pay (PDF)
5 pages. Excerpt: "[The target page] is a summary of Treasury guidance issued to date on the executive compensation restrictions that apply to financial institutions participating in the Capital Purchase Program ('CPP') under the recent 'bailout' legislation. While these rules are of immediate interest to banks and other potential participants in the CPP, many are concerned that Congress will try to impose these or similar restrictions on many more companies in the future so it may be helpful to be generally familiar with them." (Groom Law Group)


FASB Postpones Until 2009 Further Disclosure of Postretirement Benefit Plan Assets
Excerpt: "The Financial Accounting Standards Board (FASB) has agreed to postpone until 2009 the effective date of the changes it is making in Financial Accounting Statement (FAS) No. 132(R)-a, Employers' Disclosures about Postretirement Benefit Plan Assets. In coming to this decision at its September 24, 2008 board meeting, the FASB members acknowledged that their deliberations have been slower than expected." (Wolters Kluwer)


How Will Obama's Tax Plans Work in This Economy?
Excerpt: "Most of the ideas were floated before credit markets froze and the economy faltered. By the time the Obamas and their new puppy settle into the White House, things could be even worse. Pundits say this could force Obama to shelve his tax plans while he focuses on the economy. 'Most of his tax proposals will be deferred because they don't have a stimulus effect and some of them will make the economy worse,' says Roberton Williams, principal research associate with the nonpartisan Tax Policy Center." (San Francisco Chronicle)


South Carolina Voters Reject State Constitutional Amendments on Stock Investments for Government Benefits
Excerpt: "The Associated Press reported Tuesday night that with 79% of precincts reporting, 58% of voters rejected the constitutional amendment allowing the state to invest in stocks to pay for future retirees' health care and pensions. Fifty-six percent voted no on the amendment for local governments." (PLANSPONSOR.com; free registration required)


Chart: Compensation Costs in State and Local Government, September 2008
Excerpt: "Wages and salaries for State and local government rose 1.0 percent for the June to September 2008 period, compared with 0.9 percent in the prior quarter. Benefit costs increased 0.7 percent from June to September 2008, less than the 1.1-percent increase in the previous quarter. Compensation costs (also known as employment costs) include wages, salaries, and employer costs for employee benefits." (U.S. Bureau of Labor Statistics)



Newly Posted Events
(Post Yours!)

Fee Disclosure Issues: Special Considerations for Trust Organizations
Nationwide on December 11, 2008
presented by Goldleaf Partners



Newly Posted Press Releases
(Post Yours!)

Still River Announces Updated 403(b) Loan & Hardship Withdrawal Software for Rev. Proc. 2007-71 Compliance
Still River Retirement Planning Software, Inc.

Vanguard Strategic Retirement Consulting Expands Capabilities with Hiring of Actuary
Vanguard Group, The

Peoria Unified School District Partners with Gilsbar, Inc. for 360° Benefit Plan Management®
Gilsbar, Inc.

Council Reacts To Democratic Presidential, Congressional Victories
American Benefits Council

CRR Funding Opportunity: 2009 Dissertation Fellowship Program
Center for Retirement Research at Boston College

HealthFitness Launches New Preventive Health Solution for Small Employers
Health Fitness Corporation



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