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[Official Guidance]
CMS FAQs on Exchanges, Market Reforms and Medicaid (PDF)
17 pages of FAQs addressing state-based health insurance exchanges and market reforms; federally-facilitated exchanges; multi-state plans; the pre-existing condition insurance plan and other high-risk pools; the Basic Health Plan; consumer outreach; consumer eligibility and enrollment; Medicaid expansion issues; and coordination between the exchanges and other programs.
(Centers for Medicare & Medicaid Services)
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[Official Guidance]
HHS Letter Describing Health Insurance Exchange Implementation by U.S. Territories (PDF)
"[A] territory that establishes an Exchange will be allocated funding to provide premium assistance and cost-sharing assistance to residents who obtain health insurance through the territory's Exchange.... If a territory does not elect to establish an Exchange, the funding allocation for the territory's Medicaid program will be increased to the amount allocated to the territory ... in the form of federal Medicaid matching funds during the time period between 2014 and 2019."
(U.S. Department of Health and Human Services)
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[Guidance Overview]
Health Care Reform: An Implementation Timeline for Employers
"Here's a brief timeline highlighting important health care reform dates for employers.... [S]ome dates will change as 2014 draws nearer, and [the author] will update the timeline accordingly."
(BenefitsNotes, a blog by Leonard, Street and Deinard)
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[Guidance Overview]
IRS Releases Final Regs on Comparative Effectiveness Research Fee and Transitional Reinsurance Fee
"Consistent with the statutory provisions, the preamble to the final regulations emphasizes that the fees for individuals covered by an applicable self-insured health plan must be paid by the plan sponsor. The preamble also refers to the Department of Labor position that, except in limited situations, the fees may not be paid from assets of the plan (i.e., they are not a plan expense)."
(Proskauer Rose LLP)
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[Guidance Overview]
ACA Compliance Playbook for Employers: The Pre-Game Warm-Up for 'Pay or Play'
"Since [employers] are only required to either potentially pay (a penalty for) or play (offer coverage to) those individuals who are considered [their] full-time employees, [their] ability to substantiate whether an employee is or is not 'full-time' will be critical to successfully navigating the 'pay or play' provisions of the ACA. While [an employer] may have [its] own rules for determining whether an employee is classified as 'full-time,' it is the ACA definition of 'full-time employee' that controls the 'pay or play' requirements."
(Thorp, Reed & Armstrong)
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[Guidance Overview]
Additional Guidance Issued on Transitional Reinsurance Program Fee on Health Plans
"The transitional reinsurance program is intended to help stabilize premiums in the individual market during the first three years that the state-based Exchanges are in effect (2014, 2015 and 2016). The program will be funded based on contributions from health insurance issuers and third-party administrators on behalf of self-insured group health plans.... The proposed regulations provide more detail on the process for calculating and paying the transitional reinsurance program contributions. In particular, the proposed regulations provide ... information on the projected 2014 rates, payment responsibility, applicable coverage, and counting covered lives[.]"
(Faegre Baker Daniels)
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[Guidance Overview]
Determining 'Minimum Value' of an Employer-Sponsored Health Plan (PDF)
"To satisfy the [ACA's] minimum value requirement ..., a health plan's share of the 'total allowed costs of benefits provided under the plan' must equal or exceed 60% of such costs. '[P]ercentage of the total allowed costs of benefits provided under a group health plan' is determined under rules to be proposed by HHS. The determination of whether an employer-sponsored plan provides minimum value will be based on the [Actuarial Value] rules with appropriate modifications[.]"
(Chao & Company, Ltd.)
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[Guidance Overview]
'Minimum Essential Coverage' from the Employer-Sponsored Plan Perspective (PDF)
"Central to the Affordable Care Act is the Individual Responsibility feature where Applicable Individuals are required to maintain Minimum Essential Coverage each month or pay a penalty.... Employers who sponsor health plans should understand how they play a role in helping their employees in meeting their Individual Responsibility under the Affordable Care Act and what the financial consequences are if employees fail to have health coverage beginning in 2014."
(Chao & Company, Ltd.)
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ACA's 2013 Provisions Near Implementation
"The major PPACA provision impacting Medicare Part D closes the 'donut hole' or gap between coverage limits and out-of-pocket spending on the cost of prescription care, but the law also changes the retiree drug subsidy program.... Now, [Troy Filipek, a principal and consulting actuary for Milliman] explains, the money that employers receive from the government for these subsidies is subject to taxation."
(BenefitsPro)
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When a Health Plan Overpays a Service-Provider, Must the Covered Participant Reimburse the Plan?
"In a hypothetical situation in which the insurance company overpaid a patient who then sent along the payment to the provider, 'our general feeling is that ... the insurance company has no business coming back to the insured and asking for the money back,' says [an] associate commissioner for insurance for the D.C. Department of Insurance, Securities and Banking. In many states, an insurer can pursue most overpayments for no more than a couple of years. But self-insured companies -- those that pay their own employees' health claims directly rather than buy insurance for that purpose -- aren't bound by such laws, nor are the health plans offered through the Federal Employees Health Benefits Program[.]"
(Kaiser Health News)
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Several Agencies, But Not EEOC, Propose Wellness Program Regs (PDF)
"While these proposed rules provide needed guidance with respect to HIPAA-compliant wellness programs, a HIPAA-compliant wellness program also will have to address compliance under other applicable laws, including the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), as enforced by the [EEOC]. The EEOC did not join the [DOL, HHS and Treasury] in issuing these regulations."
(Aon Hewitt)
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Taxes and Fees to Finance Obamacare: A Partial List
"For the vast majority of people, the health care law won't mean sending more money to the IRS. But the wealthiest 2 percent of Americans will take the biggest hit, starting next year. And roughly 20 million people eventually will benefit from tax credits that start in 2014 to help them pay insurance premiums. A look at some of the major taxes and fees, estimated to total nearly $700 billion over 10 years."
(The Washington Post; free registration required)
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Employers Complain About 'Sleeper' Fee to Stabilize Insurance Market in Obamacare
"Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health care overhaul. The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers."
(The Washington Post; free registration required)
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White House to States: On Medicaid Expansion, It's All or Nothing
"If a state decided to cover, say, everyone up to the federal poverty line, they would be working with a smaller, more manageable population. Those living above the poverty line, meanwhile, wouldn't be left in the lurch. The [ACA] allows them to receive very generous subsidies in the private insurance market.... Health and Human Services came back with its answer: The health-care law will not fund partial Medicaid expansions."
(The Washington Post; free registration required)
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IRS Releases Guidance For Employers and Others on 2013 Additional Medicare Tax
"Employers must begin withholding the Additional Medicare Tax in the pay period in which an employee's wages are first in excess of $200,000, during a calendar year. To the extent an employer pays an employee a single payment of wages in excess of $200,000, the employer must withhold Additional Medicare Tax on the amount in excess of the $200,000 withholding threshold, taking into account other wages paid by the employer to the employee in the calendar year."
(Proskauer Rose LLP)
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IRS Issues Guidance on Withholding of the 0.9% Additional Medicare Tax
"From an employer's perspective, the Additional Medicare Tax must be withheld from all of an employee's Medicare wages in excess of $200,000 paid during a calendar year, regardless of the employee's marital or tax-filing status. An employer has this withholding obligation even though a given employee may not be liable for the Additional Medicare Tax -- because, for example, the employee's wages, together with those of his or her spouse, do not exceed the $250,000 threshold for married taxpayers filing a joint return."
(Spencer Fane)
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Extended FMLA Leave May Be Protected by ADA
"A recent ruling by the U.S. District Court for the Eastern District of California serves as a reminder that leave and reassignment to a vacant position may be reasonable accommodation under ADA. Moreover, the decision reiterates the risk of not engaging in the ADA interactive process when an employee is unable to return to work after she has reached her FMLA leave limit." [Maharaj v. California Bank & Trust, 2012 WL 5828552 (E.D. Cal., Nov. 15, 2012)]
(Thompson SmartHR Manager)
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HHS Says Progress Continues in Setting up Health Insurance Marketplaces
"Ten months from today, Americans in every state can begin to choose health insurance in new state marketplaces where they will have access to affordable coverage. Many will have never had health insurance, or had been forced to make the decision to go without insurance after losing a job or becoming sick. It is a groundbreaking time for health care in our country.... [S]ix states who applied early have made enough progress setting up their own marketplaces or Exchanges that [HHS] ready to conditionally approve their plans -- meaning they are on track to meet all Exchange deadlines. These early applicant, early approval states include: Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington."
(Healthcare.gov)
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[Opinion]
An Easy Way to Rein in Health Costs: Cut Back the Tax Benefits
"Each year, the federal government gives away $250 billion in tax exemptions for employer healthcare insurance premiums. This is bigger than the amount of money that is at stake on the fiscal cliff.... The largest share of these federal giveaways goes to the highest income Americans, since they are able to deduct more dollars for the same health insurance premiums with their higher tax brackets. If this one tax exemption was removed or reduced, we could solve the entire fiscal cliff problem without raising tax rates or changing exemptions for charity, home mortgages, state and local taxes, or any of the other federal tax deductions."
(Orange County Register)
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[Opinion]
Four Bad Arguments for Raising the Medicare Age
"It's tempting to read [two recent articles] and decide that, all things considered, liberals should at least consider raising the Medicare age to 67 as part of a budget compromise. They shouldn't.... Here are four arguments for compromising on the Medicare age -- and why they're wrong."
(The Huffington Post)
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[Opinion]
Here's a Better Way to Raise the Eligibility Age for Medicare Benefits
"Raising the Medicare eligibility age makes no sense. It cuts federal health-care spending but raises national health spending, which is what really matters. It doesn't modernize the system or bend the cost curve. It doesn't connect to any coherent theory of health reform, like increasing Medicare's bargaining power, increasing competition in Medicare, ending fee-for-service medicine, or learning which treatments work and which don't."
(The Washington Post; free registration required)
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[Opinion]
Deloitte Health Care Reform Memo, December 10, 2012
"Those without health insurance are quite supportive of universal coverage. And those with employer-sponsored coverage featuring high deductibles and narrower networks of providers favor lower costs and improved service. We all look through the lens of our own circumstances, especially when it comes to health care. And what we pay out-of-pocket seems a key factor in how we view health care."
(Deloitte)
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[Opinion]
Text of Comments to HHS Requesting Extension of 'Impossibly Abbreviated' Comment Period for Proposed Regs on Health Insurance Market Rules and Rate Review
"The Federal Register ... shows that the proposed rule was signed on May 15, 2012, by Marilyn Tavenner, Acting Administrator for [CMS] ... but not approved by Secretary Sebelius until August 6, 2012 -- over two months later -- and, even more perplexing, not subsequently published in the Federal Register until November 26, 2012. This is a delay of over three months in publishing an approved regulation which then includes an impossibly abbreviated comment period. Certainly the public is entitled to at least the same length of time to review the proposed rule as apparently taken by the Secretary's Office. Interested parties should not be shortchanged in their ability to develop comprehensive comments."
(U.S. Chamber of Commerce)
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[Opinion]
Text of U.S. Chamber of Commerce Request for Extension of Comment Period for Proposed Regs on Essential Health Benefits, Actuarial Value, and Accreditation (PDF)
"The U.S. Chamber of Commerce requests that the Department of Health and Human Services (HHS) extend the comment deadline for the proposed regulation on Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation by 60 days to February 26, 2013. This would provide an appropriate 90 day comment period which is necessary to appropriately analyze and thoughtfully comment on this complex proposed regulation.... A close reading of the NPRM ... reveals that the department withheld this proposed regulation until after the election, even though it was signed on August 1, 2012, over three whole months before the election.... The almost four months of delay and review in the Secretary's office, between August 1st and November 14th, in and of itself indicates the complexity of this regulation and highlights the absurdity of a 30-day review period for the regulated public."
(U.S. Chamber of Commerce)
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[Opinion]
Text of U.S. Chamber of Commerce Request for Extension of Comment Period for HHS Notice of Benefit and Payment Parameters (PDF)
"The 30 day comment period provided in the NPRM is wholly inadequate for the Chamber to conduct a thorough analysis and develop meaningful comments. This proposed regulation is one of the most critical flowing from the [ACA] and the administration must make every effort to craft clear regulatory language and provide flexibility as employers work diligently to comply with the law.... HHS has provided no justification for such a compressed comment period and departure from the administration's own recommendations [that comment periods should generally be no less than 60 days]. Even if the goal is to conclude this rulemaking in time for insurers and employers to meet 2014 statutory requirements, the expected duration of this rulemaking with a 30 day comment period will not permit adequate time for such plan development and implementation before 2014."
(U.S. Chamber of Commerce)
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Benefits in General; Executive Compensation
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[Guidance Overview]
ISS Clarifies 2013 Policy Updates (PDF)
"ISS' peer group selection methodology will use a company's disclosed self-selected peer group as a key input for selecting ISS peers. In an effort to ensure current groups for 2012 pay determinations are used, a web-based tool is available for companies to submit changes to their peer groups so long as the updated peer groups will be disclosed in the 2013 proxies. This tool will be available for use until December 21[.]"
(Frederic W. Cook & Co., Inc.)
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Many Corporations Announcing Special Year-End Dividends; Consider Impact on Stock Compensation Accounting
"Over the last few weeks there have been some high-profile reports of companies announcing special one-time cash dividends that will be made before the end of the year. The main motivation is anticipation of higher dividend tax rates come 2013.... In connection with a special dividend, companies commonly make adjustments to employee stock awards to keep the holder whole. This [article] discusses potential accounting issues to consider when modifying stock compensation awards due to a special one-time dividend."
(PricewaterhouseCoopers)
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Employer Costs for Employee Compensation, September 2012 (PDF)
"Employer costs for employee compensation averaged $30.80 per hour worked in September 2012, the U.S. Bureau of Labor Statistics reported ... Wages and salaries averaged $21.32 per hour worked and accounted for 69.2 percent of these costs, while benefits averaged $9.48 and accounted for the remaining 30.8 percent. Total employer compensation costs for private industry workers averaged $28.95 per hour worked in September 2012."
(U.S. Bureau of Labor Statistics)
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Press Releases
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