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February 20, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Webcasts and Conferences

COBRA for Rookies: Understanding the Basics to Avoid Liability
Nationwide on March 14, 2013 presented by Thomson Reuters / EBIA

Health Care Reform: Employer Compliance and Strategies - Webinar Recording
Nationwide on March 20, 2013 presented by Nixon Peabody LLP

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[Guidance Overview]

Key Compliance Actions for the New HIPAA Privacy Regulations
"[I]n analyzing relationships with vendors to determine whether business associate covenants must be obtained, covered entities and 'intermediate' business associates should look beyond mere naming conventions and make determinations regarding whether the data transmission organization has more than 'random or infrequent' access to PHI. Conversely, the Omnibus Rule provides clarification on entities that do not qualify as business associates[.]" (Epstein Becker & Green, P.C.)


[Advert.]

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[Guidance Overview]

Final HIPAA Regs Released: Time to Review Your HIPAA Policies?
"Notably, the new regulations provide for a new Breach Notification Rule. That new rule provides that an impermissible acquisition, access, or use or disclosure of PHI is presumed to be a breach unless the covered entity or business associate demonstrates that there is a low probability that the PHI has been compromised based on a risk assessment using four factors[.]" (Ford & Harrison LLP)

[Guidance Overview]

DOL Audit Letters Requesting Proof of Compliance with Health Care Reform Requirements
"The [DOL] recently expanded its health plan audit letter to request documents demonstrating compliance with the [ACA]. [Items requested include:] [S]amples of the written notice describing enrollment opportunities related to dependent coverage of children up to age 26; A list of any individuals whose coverage has been rescinded, the reasons for the rescissions and copies of the written notices of rescission that were provided.... Records documenting the terms of the plan in effect on March 23, 2010, and any other documents necessary to verify, explain or clarify status as a grandfathered health plan ... Samples of adverse benefit determinations and external review decision notices utilized by the plan on or after September 23, 2010 [in the case of non-grandfathered plans]." (McDermott Will & Emery)

Wellness Program 'Best Practices' Foster Success
"In an analysis of data collected from more than 700 U.S. employers, researchers found that the best practices most strongly associated with positive wellness program outcomes were: [1] Including spouses in key components of the program. [2] Promoting all wellness activities under a single brand name. [3] Having a formal, written strategic plan with financial objectives. [4] Active participation by senior leadership in wellness programs." (Society for Human Resource Management)

Empowering Individuals to Be Better Health Care Consumers
"Today, [consumer-directed healthcare] is one important part of the consumer equation, but evolving market forces, including the blurring of lines between payers and providers (e.g., payers vertically integrating with providers; and providers taking on risk and becoming more like payers), are further complicating the landscape by redefining who the consumer engages with as he or she navigates the healthcare system." (Triple Tree; free registration required to download full report)


[Advert.]

March 17-20, 2013: What's in Store for Your Healthcare and Retirement Plans?

Sponsored by University Conference Services

An educational conference focused on key retirement plan and
healthcare benefits issues for mid-sized employers.
800-864-2063 www.ucs-edu.net


Big Firms Win Multimillion Dollar Contracts to Build Insurance Marketplaces
"[P]rivate companies are building the underpinnings of the online health insurance marketplaces that are a key element of the law -- and winning contracts worth hundreds of millions to do so.... The dollar value of the deals varies widely because some contracts included updating states' Medicaid information technology systems. The insurance websites will be tied to Medicaid information systems to help connect people to insurance coverage." (Kaiser Health News)

Nurse Practitioners Push to Help Care for Health Law's Newly Insured
"More than 27 million Americans will soon gain health coverage under the health law. But who will treat them all? David Hebert With such a large coverage expansion, and with an anticipated shortage of primary care physicians available to serve them, some states have or are considering allowing so-called advanced practice nurses -- those with advanced degrees -- to treat more patients." (Kaiser Health News)

How the ACA Has Expanded Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans
"While almost all large group plans and most small group plans include coverage for some mental health and substance use disorder services, there are gaps in coverage and many people with some coverage of these services do not currently receive the benefit of federal parity protections. The final rule implementing the Essential Health Benefits directs non-grandfathered health plans in the individual and small group markets to cover mental health and substance use disorder services as well as to comply with the federal parity law requirements beginning in 2014." (Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services)

Health Insurance Rate-Setting Map in California Would Raise Costs
"A proposal to split California into six zones for setting health insurance rates would drive premiums up as much as 23% for some policyholders next year as part of the federal healthcare overhaul, the state insurance commissioner is warning.... Insurance Commissioner Dave Jones said he's pushing for an 18-region plan that would cap increases at 8%." (Los Angeles Times)

2013 Midwinter ABA Meeting Report of 2012 FMLA Cases (PDF)
Annual comprehensive report of most of the significant cases arising under FMLA from 2012. (American Bar Association, Section of Labor and Employment Law, Subcommittee on FMLA)

Employers Still in Shock Mode with ACA
"More than half of employers have not calculated their costs under the [ACA\], but of those that have, 61% say PPACA has increased their expenses. According to a [recent] survey ... a majority, or 60%, of employers would like to avoid increases in spending on their group plans. Only 20% of respondents plan to adjust benefits outside of health care, such as retirement, dental, vision, salaries and vacation." (Employee Benefit News)

Medicare Payment Does Not Trump Out-Of-Network Exclusion
"A federal district court blocked an effort to force an ERISA health plan to pay secondary for an expensive specialty drug that was excluded from coverage because it wasn't filled at an in-network provider as required by plan terms. The U.S. District Court for Northern Illinois rejected the plaintiff's argument that whenever Medicare covered a claim excluded by the plan, plan exclusions were wiped out and the plan had to pay secondary." [American Service and Product v. Aetna Health, 2013 WL 182812 (N.D. Ill., Jan. 17, 2013)] (Thompson SmartHR Manager)

Expressing Intent to Appeal in the Future Does Not Constitute an 'Appeal'
"Can a mere request for medical records, and a reference to an 'appeal in the future tense,' trigger the appeal? No.... [According to the court, a] timely appeal is a prerequisite to filing an action in federal court; ... It was reasonable for Hartford to conclude [the plaintiff's] December 2008 letter was not an appeal because it merely made 'reference to an appeal [in] the future tense'." [Reindl v. Hartford Life and Accident Insurance Co., 2013 WL 425356 (8th Cir. Feb. 5, 2013)] (Lane Powell PC)

Projected Medicare Spending Has Fallen by More than $500 Billion
"[P]rojected Medicare spending over the 2011-2020 period has fallen by more than $500 billion since late 2010 -- based on a comparison of the latest [CBO] projections with those of August 2010. That's important to remember because it was in late 2010 -- and based on CBO's August 2010 projections -- when Fiscal Commission co-chairs Erskine Bowles and Alan Simpson issued their original budget proposal, calling for slightly more than $300 billion in Medicare spending cuts through 2020." (Center on Budget and Policy Priorities)

Continued Growth of Public and Private Accountable Care Organizations
"The continued growth of the accountable care movement is apparent, as ACOs have spread to 49 states, Washington DC and Puerto Rico. The only state without an ACO is Delaware, though there have been discussions about forming an ACO in the state and ACOs in neighboring states may cover some Medicare patients there. California, Florida and Texas lead the nation with 46, 42 and 33 ACOs respectively." (Health Affairs Blog)

Ways and Means Committee to Examine Traditional Medicare's Benefit Design
"House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) today announced that the Subcommittee on Health will hold a hearing to review the current benefit design of the Medicare Fee-For-Service program and consider ideas to update and improve the benefit structure to better meet the needs of current and future beneficiaries. The hearing will take place on Tuesday, February 26, 2013 in 1100 Longworth House Office Building, beginning at 10:30 A.M." (U.S. House Ways and Means Committee)

80% of Health Insurers Charge Consumers Higher Premiums Than Quoted
"When shopping for insurance, consumers are quoted the best rate given to the healthiest applicants.... Nationally 80% of health plans increased premium amounts after the consumer applied. Plans on average increased the premiums for 18% of applicants." (HealthPocket)

[Opinion]

"... A Menace to the State"
"The full quotation, of which the above title is a segment, goes 'Every law not based on wisdom is a menace to the State.' ... The decision of the Supreme Court upholding the constitutionality of the Affordable Care Act, resting on Congress' Taxing power under the Constitution, is largely the act of one man, its Chief Justice.... Historians must search more deeply for the reason that Justice Roberts, who knows constitutional law as well as any legal scholar today, was moved to rest the most major social legislation of our time on a foundation so vulnerable to challenge." (Alvin D. Lurie, Esq. on BenefitsLink.com)

[Opinion]

Why Premiums Will Change for People Who Now Have Nongroup Insurance
"Overall, ... average, unsubsidized premiums for nongroup coverage will be somewhat higher under reform than they are today (as does the [CBO]). This is because many people will be getting better insurance. The law requires that all nongroup insurance provide a package of essential benefits, which includes items like maternity care and mental health that often are not covered in nongroup policies now. And, while patient cost sharing will still be quite high, everyone's out-of-pocket costs will be capped, which is not always the case today." (Kaiser Family Foundation)

[Opinion]

Why Did Health Insurance Stocks Tank the Morning After President's Day?
"Late Friday afternoon, right after the market closed, the federal government cut Medicare Advantage reimbursement rates way more than anyone expected. The change amounts, according to Wall Street analysts, to a pay cut of about 7 to 8 percent in 2014.... One easy way for plans to deal with the rate cut would be to cut benefits, spending their reduced funds on a reduced set of benefits. The federal government, however, largely blocked this option, as health plans cannot increase monthly member cost sharing by more than $30." (The Washington Post; free registration required)

[Opinion]

Under Obamacare, Who Even Counts As a Tobacco User?
"[W]ho counts as a tobacco user in the first place[?] A smoker who goes through a pack a day likely fits the bill, but what about one who only smokes the occasional cigarette in the bar? The person making a quit attempt? The user of e-cigarettes? These are questions that, 10 months before this provision goes into effect, are still wide open. They are also a great example of why a 900-page law requires thousands more pages of regulation, as the federal government tries to turn relatively vague provisions into concrete law." (The Washington Post; free registration required)

[Opinion]

Miners Arrested in Fight to End Peabody's Termination of Retiree Health Benefits
"In 2007, Peabody Energy and Arch Coal spun off a large chunk of their health care and retirement obligations to a new entity called Patriot Coal. In a financial and bankruptcy transaction that UMWA Vice President from Alabama, Daryl Dewberry, described as 'nickel slick', Peabody Energy and Arch Coal are trying to wash their hands of responsibility for the health benefits for which they had signed contracts." (My FDL)

Press Releases

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