[Guidance Overview]
When Is Exhaustion of Administrative Remedies Required? A Reappraisal of the Division of Authority
"The district court found Morales-Cotte v. Cooperativa de Ahorro y Credito Yabucoena ... instructive. There, the court examined a similar denial of COBRA benefits and found that the exhaustion requirement applies only where the matter in contention concerns an interpretation of the terms of the plan ('plan-based' claims), and not the terms of the statute itself ('statute-based' claims)."
(Health Plan Law)
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Workers Willing to Trade Health Insur.ance for Raises?
"A minority of big companies offered extra pay to workers who waived their health benefits last year. This practice, which was common decades ago, could see a resurgence once the biggest parts of President Barack Obama's health care reform law take effect in 2014 and start to rearrange the health insur.ance market."
(Huff Post)
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Justice Department Responds to Judge's Request to Clarify President's Remarks on Scope of Judicial Review
"Responding to statements [the judge] apparently believes could be viewed as a challenge to the authority of the Federal courts or to the appropriateness of judicial review, he asked for a letter stating the position of the Attorney General and the Justice Department regarding the authority of the Federal Courts in that regard. The request was made of a Department of Justice lawyer who was before the Judge in another case in which different provisions of the Act (i.e., Medicare self-referral rules) are being challenged."
(Deloitte)
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Focusing on Quality of Life Helps Medical Providers See Big Picture, Produces Healthier, Happier Patients
"People are more likely to manage their condition properly when they have more accessible, personal goals, like being able to do more at work or keep up with their kids, instead of focusing only on comparatively abstract targets like blood-sugar levels. And that, in turn, leads to much better health. Numerous studies show that when people have a higher sense of well-being, they have fewer hospitalizations and emergency-room visits, miss fewer days of work and use less medication. They're also more productive at work and more engaged in the community."
(The Wall Street Journal)
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Second Annual Conference on Managed Care Litigation, May 22-23 [Advert.]
Managed Care Organizations represent “deep pockets” for potential plaintiffs and classes; defense requires meticulous planning. Only the ACI forum provides the opportunity to share defense strategies and tactics to enhance your litigation toolkit.
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Health Care Reform Memo, April 16, 2012
"The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups."
(Deloitte)
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Out-of-Network Care Is Expensive but Some New Options Help
"Some recent developments put consumers in a slightly stronger position if they go out of network: A new database lets consumers learn the prevailing rates for medical procedures in their area, and the 2010 health-care overhaul provides better protection when people receive out-of-network emergency care."
(Kaiser Health News)
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Examining the Requirement for Offering Multi-State Plans under the Affordable Care Act (PDF)
"New state health insur.ance exchanges that are developing under [ACA] will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs.... This paper, based on interviews with federal and state policy makers and others, examines key implementation issues."
(The George Washington University Medical Center)
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Proposed Health Plan Identifier Requirement Could Cost Health Plans More Than $1 Bil.lion
"'The [Health Plan Identifier] is expected to yield the most benefit for [health care] providers, while health plans will bear most of the costs,' HHS flatly states in the preamble to the proposed rules. 'Costs to all commercial and government health plans together ... are estimated to be $650 mil.lion to $1.3 bil.lion,' the agency explained, but 'plans are expected to make up those costs in savings.'"
(Thompson)
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Health Plans Invest in Trigger-Based Communications With Focus on Health and Wellness
"More than 50 percent of health plans will invest in trigger-based communications to prompt consumers to take action, according to a new IDC Health Insights research study ... Trigger-based communications use data analytics to detect a consumer's current status, and automatically initiate relevant communications to inspire consumer action."
(MarketWatch)
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Views Differ on Adequacy of Federal Antitrust Policy for Collaboration Among Health Care Providers
"[The health care] providers in a collaborative arrangement may be able to negotiate higher prices with health plans than would otherwise be expected in a competitive market merely because they have agreed to act together in setting fees. While higher prices benefit providers, consumers are adversely affected if higher prices for providers result in higher health plan premiums."
(U.S. Government Accountability Office)
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[Opinion]
How Unequal Health Care Coverage for Women Increases the Gender Wage Gap, and How Health Care Reform Can Help Close It
"[W]omen earned 77 cents for every dollar earned by men in 2011, an average of $10,622 in lost wages every year. Yet that earnings ratio actually understates the extent of women's disparate treatment in the workforce. Why? Because women are also less likely than men to receive health care coverage though their employer and are more likely to have higher out-of-pocket medical costs, resulting in a health insur.ance compensation gap on top of the pay gap."
(Center for American Progress)
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[Opinion]
Economists Ask, 'Is the Health Care Mandate a Tax?'
"The legal distinction between the individual mandate and a tax is an important one. To satisfy two different legal standards, the federal government argued first that the penalty associated with the individual mandate is not a tax but the next day argued that it is. But as economists, we also know there is also an economic distinction between a mandate and a tax that is at the heart of the rationale for the individual mandate: efficiency."
(Brookings)
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[Opinion]
U.S. Chamber of Commerce Testimony on the Individual and Employer Mandate (PDF)
"The [Chamber] applauds [House Committee on Ways and Means Subcommittee on Health chairman's] efforts to highlight the harmful economic impact that the employer mandate is having on our country now two years after the enactment of [PPACA], despite the fact that the mandate will not become fully effective for another two years. Your hearing regarding the Individual and Employer Mandates in the Democrats' Health Care Law on March 29, 2012 importantly showcased the ongoing harm that the mandate is having on business, jobs and the economy. The Chamber continues to support the repeal of the employer mandate and agrees that the employer mandate is discouraging employers from hiring, a fact that our members have verified in survey after survey."
(U.S. Chamber of Commerce)
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Benefits in General; Executive Compensation
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[Guidance Overview]
Fiduciary Exception to Attorney-Client Privilege Does Not Apply to Top Hat Plan
"The court considered an employee's motion to compel documents with respect to her employer's nonqualified pension benefit plan called the 'Wealth Accumulation Plan.' The employee asserted that the lawsuit turned on the single issue of whether the Wealth Accumulation Plan was a valid 'top hat' plan exempt from certain ERISA requirements."
(Haynes and Boone)
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[Guidance Overview]
JOBS Act Expands Registration Exception for Private Companies and Employee Stock Plans
"The JOBS Act also requires the SEC to adopt safe harbor provisions that companies can follow when determining whether holders of their securities received the securities pursuant to an employee compensation plan in transactions that were exempt from the registration requirements of Section 5 of the Securities Act."
(Haynes and Boone)
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GSA Boosts Mileage Reimbursement Rate for Federal Employees
"The General Services Administration is increasing the 2012 mileage reimbursement rate for federal employees who use their private vehicles for work, according to the agency. The rate for cars will be 55.5 cents per mile, an increase of 4.5 cents over the current rate."
(Government Executive)
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Press Releases
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