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August 7, 2009 \ Compliance \ Costs \ Administration \ Design \ Policy

International Foundation of Employee Benefit Plans (Advert.)

Need to train your staff annually on HIPAA Privacy? (clickable image)

Need to train your staff annually on HIPAA Privacy?

The HIPAA Privacy e-learning course has been completely updated with all of the new ARRA information. E-learning courses from the International Foundation of Employee Benefit Plans are a perfect way to get compliance education without leaving the office. Courses cover the entire benefits spectrum and include fun, interactive features that will help you fully understand concepts and practical applications and not just memorize terms. Learn more at www.ifebp.org/elearning.


[Guidance Overview]
IRS May Exercise Levy Power over HSAs

Excerpt: "When individuals do not pay all of their taxes, the IRS has several powers to collect the back taxes, plus penalties and interest. Recently, the IRS clarified that its powers extend to Health Savings Accounts (HSAs). Recall that HSAs differ from other benefit spending accounts (e.g., Health FSAs and Health Reimbursement Arrangements [HRAs]) in that the participant actually owns and controls the account, not the employer." (Infinisource)


[Guidance Overview]
Bizarre Case Teaches Key HIPAA Lessons

Excerpt: "The facts of a recent Minnesota lawsuit are so outlandish that they seem more appropriate for a tabloid cover or TV soap opera than a court opinion. After all, the old adage is that truth is sometimes stranger than fiction. The case of Yath v. Fairview Clinics involved a patient who came to a clinic and was diagnosed with a se.xually transmitted disease. She told the doctor that she had a new partner, even though she was still married at the time to her estranged husband. An employee at the clinic snooped into her records and disclosed this information to several others, including one person who displayed many of the details on a MySpace web page. Much of these disclosures were via the employer's e-mail system. Ultimately, the patient and her soon-to-be ex-husband found out." (Infinisource)


[Guidance Overview]
'Prevailing Healthcare Charges System' Rate Schedule Challenged In New Managed Care Litigation

Excerpt: "Chaffin v. Humana (S.D. Tex.) challenges Humana's use of the 'Prevailing Healthcare Charges System' to establish rates of reimbursement for out of network providers. The case is brought by members of Humana's 'National Point of Service' insurance plan, according to the complaint. The complaint alleges that Ingenix, a subsidiary of United Healthcare Group, operates a proprietary database system known as the 'Prevailing Healthcare Charges System.' PHCS purportedly derives a percentile -segmented survey of 'usual and customary' charges by factoring in insurers' billing information for similar types of medical services." (Roy Harmon III via Health Plan Law)


[Guidance Overview]
Seventh Circuit Hands Down Another Post-Glenn 'Tie Breaker' Decision

Excerpt: "Rather than examination all factors in 'combination', several courts have emphasized the 'tie breaker' reference in Glenn, and only view a conflict of interest as significant in close cases. The Sixth Circuit is a good exemplar the 'combination' approach wherein the Court looks at each action of the conflicted fiduciary in terms of whether the fiduciary's conduct, taken as a whole, reflects evidence of bias. The recent Seventh Circuit opinion in Fischer provides an example of the 'tie breaker' approach." (Roy Harmon III via Health Plan Law)


[Guidance Overview]
Third Circuit Holds Health Plan of Redevelopment Authority is Governmental Plan

Excerpt: "Benefit plans maintained by governmental entities are exempted from ERISA. However, sometimes the determination of whether an entity qualifies as a 'government' can be difficult. The Third Circuit in a recent case of Koval v. Washington County Redevelopment Authority held that the Washington County Redevelopment Authority ('WCRA') did constitute a 'political subdivision' of the state of Pennsylvania so that a health plan offered by the WCRA was then a governmental plan exempted from ERISA. The court's analysis is important as the Third Circuit adopted the Second Circuit NLRB test for determining what constitutes a 'political subdivision' . . . ." (Tax-Exempt/Governmental Plans Guidebook)


[Guidance Overview]
Towers Perrin Monthly Health & Welfare Regulatory Round-Up, July 2009 (PDF)

6 pages. Excerpt: "The Monthly Regulatory Round-Up is a high-level summary of legal and regulatory developments that occurred during July 2009 that may be relevant to large employers. Developments are sorted according to federal legislative developments, federal regulatory guidance, other developments (e.g., significant litigation, studies, select state law developments)." (Towers Perrin)


Democrats Say No to Cost Cap for Drug Makers
Excerpt: "Congressional Democrats said Thursday that they intended to push the Obama administration to back away from its deal with the drug industry to cap its share of the costs in a health care overhaul. A spokesman for Speaker Nancy Pelosi said she stood by her position that the House was not bound by any such agreement. Ms. Pelosi supports House efforts 'to squeeze more money out of the system, including from the pharma.ceutical industry,' her spokesman, Nadeam Elshami, said in a statement." (The New York Times; free registration required)


Reform Bill Would Stick $10 Billion Band-Aid on Retiree Health Plans
Excerpt: "The percentage of large employers (200 or more workers) offering retiree health benefits has fallen from 66% in 1988 to 31% in 2008, according to one survey. . . . Lawmakers to the rescue. To attempt to slow the erosion of such employment-based plans, the House Energy and Commerce Committee has included a reinsurance program in Section 164 of its reform bill. The provision establishes a temporary program to provide reimbursement to plans for part of the cost of providing health benefits to retirees and their families. The bill establishes a Retiree Reserve Trust Fund and appropriates $10 billion for the fund. The funds are available until expended." (Wolters Kluwer)


Basic Patient Safety Reforms Would Save 85,000 Lives and $35 Billion a Year, Public Citizen Report Says
Excerpt: "A report issued [August 6] by Public Citizen proposes 10 cost-cutting, patient safety measures that would save an estimated 85,000 lives and $35 billion a year. The report, 'Back to Basics,' analyzed the results of scientific studies of treatment protocols for chronically recurring, avoidable medical errors. In contrast to the high-tech tests and procedures that many experts blame for staggering increases in the nation's health care costs, most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations. Aside from the tragedy of needless deaths and injuries, the financial toll of failing to follow accepted safety procedures is astounding." (Public Citizen)


Big Business Group Urges Cost Cutting to Pay for Health Overhaul
Excerpt: "John Castellani, the president of the Business Roundtable, told reporters today that health reform legislation should include mechanisms to finance coverage expansions largely through cost savings inside the health care system and should preserve ERISA, the 1974 federal law that regulates most private employee health plans." (Kaiser Family Foundation)


To Lower Health Plan Costs, Massachusetts May Restructure Doctor Pay
Excerpt: "Massachusetts has the highest health costs in the country. 'The critical point is whether or not we can begin to do something about cost control,' says Dolores Mitchell, who heads a state commission that buys coverage for 310,000 government workers and their families. 'We've just got to do it.' Mitchell and nine other experts have a plan to bring Massachusetts health costs under control. They worked for nine months, under a legislative mandate, to come up with the official blueprint. . . . The first thing they decided -- unanimously and right off the bat -- was that the current way of paying doctors, hospitals and other medical providers has got to go." (Morning Edition via National Public Radio)


More Answers to Your Health Reform Questions in the WSJ
Excerpt: "While lawmakers are home for the August recess, they're likely to get plenty of questions from constituents about the big health bills being debated in Congress. Here's the newest batch of answers to questions we've received from readers about what those bills could mean. Keep in mind that the details of a final bill - if there is one -- are far from settled." (The Wall Street Journal)


Impact on ESOP Participants of S Corporation Status
In her latest column on the NCEO's site, Nancy Dittmer discusses the impact of the S corporation provisions of the Internal Revenue Code on ESOP participants. (National Center for Employee Ownership)


The ESOP Company Board Handbook
Serving on any corporate board is a serious responsibility. Serving on an ESOP company board adds the additional responsibility of understanding how ESOP law and best practices interact with corporate law and best practices. Special ESOP issues such as valuation, the repurchase obligation, S corporation anti-abuse rules, monitoring fiduciaries, executive pay considerations, and responding to takeover bids demand at least a working knowledge of ESOPs. This new book addresses all this and more. (National Center for Employee Ownership)


[Opinion]
Fixing Healthcare, Part One: An Inventory of Cost-Containment

Excerpt: "For the past few weeks, I've been talking with healthcare experts with a variety of perspectives, trying to discover coherent principles for overhauling American healthcare. This requires, in my view, testing every idea against its likely effect on the real people who provide healthcare services and on the real people who need those services. What's ultimately required is to change the culture of healthcare delivery. Congress doesn't seem to be tethered to the realities of healthcare delivery, and its proposed bills seem to have been tossed in a storm of special interests. The refusal of the Democratic leadership to consider pilot projects for more reliable systems of justice--see my recent op-eds in the Wall Street Journal and Washington Post--is just one example of special interests trumping the needs of the common good." (The Atlantic)


[Opinion]
Senate's Proposed Employer Mandate Has 'Deep Flaws,' According to Policy Organization

Excerpt: "The Senate Finance Committee proposal to impose an employer mandate to either provide health insurance to workers or subsidize their health costs has 'deep flaws' that would make it too expensive to hire lower-wage earners, minorities, women, and disabled workers, according to a new analysis by the Center for Budget and Policy Priorities. 'The fact that low-income workers would cost an employer up to several thousand dollars more to perform the same job could not easily be overcome,' according to the analysis." (HealthLeaders Media via HCPro, Inc.)


[Opinion]
Eight Myths About Health Care Reform and Why We Can't Afford to Believe Them Anymore

Excerpt: "Americans spend more on health care every year than we do educating our children, building roads, even feeding ourselves -- an estimated $2.6 trillion in 2009, or around $8,300 per person. Forty-five million Americans have no health insurance whatsoever. These staggering figures are at the heart of the current debate over health care reform: the need to control costs while providing coverage for all. As John Lumpkin, M.D., M.P.H., director of the Health Care Group for the Robert Wood Johnson Foundation, says, 'There is enough evidence that it is now time to do something and to do the right thing.' The key is to focus on the facts - and to dispel, once and for all, the myths that block our progress." (Robert Wood Johnson Foundation)



ALM (Advert.)

Complete Benefits Law Guidance from Law Journal Press (clickable image)

Complete Benefits Law Guidance from Law Journal Press

The nation's workforce and health care system are constantly evolving and so are the legal issues. Law Journal Press helps you handle any benefits law question with up-to-date, authoritative books on all aspects of the field. Get legal and practical advice from leading experts on everything from COBRA to ERISA, "contingent" employees to family and medical leave, and more. Browse our product listings for detailed information and special offers.

Links to Items on Executive Comp, Benefits in General

[Guidance Overview]
Towers Perrin Monthly Regulatory Round-Up on Executive Compensation, July 2009 (PDF)

4 pages. Excerpt: "The Monthly Regulatory Round-Up is a high-level summary of legal and regulatory developments that occurred during July 2009 that may be relevant to large employers. Developments are sorted according to federal legislative developments, federal regulatory guidance, other developments (e.g., significant litigation, studies, select state law developments)." (Towers Perrin)



Webcasts and Conferences

Everything You Wanted to Know About Cash Balance Plans
in New York on August 13, 2009
presented by ASPA Benefits Council of New York

(Click to post your webcast or conference)

Press Releases

Business Manager of Alabama Anesthesia Practice Sentenced for Failure to File Required Annual Report for Profit-sharing Plan
U.S. Department of Labor, Employee Benefits Security Administration (EBSA)

ERIC Urges Appeals Court to Uphold District Court Ruling Against Alleged 401(k) Fiduciary Breach Claims
ERIC (ERISA Industry Committee)

(Click to post your press release)

Employee Benefits Jobs

401(k) Wholesaler
for Howard Simon & Associates, Inc.
in IL

Senior Plan Administrator
for The Newport Group
in FL

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