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March 4, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Sales Consultant 401k/DB Administration
for Farmer & Betts in ANY STATE

Small Plan Actuary
for National Retirement Services, Inc. in CA

Assistant General Counsel - Retirement Plans
for Nationwide Mutual Insurance Company in OH

Fund Manager
for Verisight, Inc. in CA

Senior Employee Meeting Liaison
for T. Rowe Price in FL, MD

Consultant (concentration in Health Informatics)
for BenRx in GA

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Webcasts and Conferences

New Final Regulations on HIPAA Privacy and Security: HITECH, Breach Notification, Individual Rights, and More
Nationwide on February 28, 2013 presented by Thomson Reuters / EBIA

Putting Your Plans on Auto-Pilot: Automation Options
Nationwide on April 25, 2013 presented by ASC Institute

Forms! Forms! Forms! Administrative and Regulatory Requirements
Nationwide on May 23, 2013 presented by ASC Institute

Challenges Facing Multiemployer Pension Plans: Reviewing the Latest Findings by PBGC and GAO Hearing Webcast
Nationwide on March 5, 2013 presented by U.S. Senate Health, Education, Labor, and Pensions Committee

Health Care Reform Webinar - Coverage Improvements during the Transition Period
Nationwide on March 15, 2013 presented by Davidson Marketing Group -- FutureOffice Network

A Current Update of EPCRS Through Rev. Proc. 2013-12
Nationwide on March 4, 2013 presented by John Marshall Law School, The

Recreating Sustainable Retirement: Resilience, Solvency, and Tail Risk Symposium
in Pennsylvania on April 25, 2013 presented by Pension Research Council

View All Webcasts and Conferences


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[Official Guidance]

Text of Final Regs on Establishment of the Multi-State Plan Program (MSPP) for the Affordable Insurance Exchanges
154 pages. Excerpt: "Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges).... This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.... The purpose of this regulation is to outline the process by which OPM will establish and administer the MSPP, as well as to establish standards and requirements for MSPs and MSPP issuers. " [Editor's note: the document includes 100 pages of OPM's discussion of comments received on the proposed version of the regulations.] (Office of Personnel Management)


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[Guidance Overview]

Implementing Health Reform: The Multi-State Plan Program Final Rule
"OPM received about 350 comments on its proposed rule, of which about 105 were unique comment letters. In the end, the proposed rule was adopted largely unchanged, although some issues were clarified in the final rule, and some technical and a few substantive changes were adopted." (Timothy Jost in HealthAffairs)

[Guidance Overview]

DOL Issues Compliance Self-Tests: PPACA and HIPAA
"Neither checklist predicts the future, and while they do include useful tips about how to comply or what may be required, they do not provide definitive guidance on all issues. Specifically missing from the PPACA tool is an explanation of how to count employees or hours or any explanation of how to determine who will ultimately be eligible for coverage." (Fox Rothschild LLP)

[Guidance Overview]

Implementing Health Reform: The 483-Page Benefit and Payment Parameters Final Rule
"There will presumably be a benefit and payment parameters rule for each future year that the Affordable Care Act remains in place, but this final rule establishes policy not only for 2014 but for the future well beyond 2014.... This is the longest (483 pages) and by far the most complex rule yet issued by HHS for implementing the ACA insurance reforms.... [A]lthough HHS received 420 comments on the proposed rule, most of the changes it made were fairly technical[.]" (Timothy Jost in HealthAffairs)

[Guidance Overview]

Senior Care Employers Should Start Today to Prepare for Health Care Reform (PDF)
"Senior care communities may have special issues under the 'pay or play' rules.... Employers who have a substantial number of part-time employees, low-wage employees, high-turnover employees, seasonal employees, or perhaps 'contractors', will have administrative difficulties in ensuring compliance with the new rules. Each of these types of employee can cause special 'pay or play' issues that must be watched carefully to avoid incurring significant penalties." (Hanson Bridgett LLP for California Assisted Living Association)


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Substantial Excess Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments
"CMS's adjustment to risk scores for 2010 through 2012 to account for diagnostic coding differences was too low, resulting in estimated excess payments to MA plans of at least $3.2 billion.... While CMS did not change its risk score adjustment methodology for 2013, agency officials said they may revisit their methodology for future years. GAO's findings underscore the importance for CMS to implement the recommendation from GAO's January 2012 report that the agency improve the accuracy of its MA risk score adjustments by taking steps such as using the most current data available and incorporating adjustments for additional beneficiary characteristics." (U.S. Government Accountability Office)

Obamacare Requires Employers to Offer Insurance But What If It's Too Expensive?
"Millions of lower-income workers may gain access to employer-sponsored health insurance under the Affordable Care Act -- but they may decide not to purchase that coverage.... [A recent study found that] for workers earning above $50,000, the majority -- 81 percent -- elected to buy into health insurance benefits. Lower-income Americans, by contrast, purchased health benefits at a lower level. Among full-time employees earning $15,000 to $20,000, 37 percent elected to purchase health benefits when they were made available." (Tom Daschle and Bill Frist in The Washington Post)

Our Nation Cannot Control Runaway Medical Spending Without Fundamentally Changing How Physicians Are Paid (PDF)
"Many factors drive the high level of expenditures in our health care system, yet several stand out: Fee-for-service reimbursement.... Reliance on technology and expensive care.... Reliance on a high proportion of specialists.... The commission's recommendations focus on the near-term, calling for drastic changes to the current fee-for-service payment system and a five-year transition to a physician-payment system that rewards quality and value-based care. The recommendations pertain to the way physicians are paid throughout the health care system -- both public and private payers." (National Commission on Physician Payment Reform)

Cost to Workers of the ACA Employer Mandate Penalties Is Greater Than You Think
"[Y]ou might think that the new $2,000 penalty would reduce wages by about $2,000 per employee per year. But ... the employer responsibility levies are not deductible from employer business taxes ... To have the same after-tax profit, an employer ... would have to cut wages by $3,046. An employer paying the $3,000 penalty would have to cut wages by $4,569. That would push someone working full-time at $10 per hour down to minimum wage." (Uwe E. Reinhardt in The New York Times; free registration required)

Lengthy TIME Magazine Cover Story: 'Bitter Pill: Why Medical Bills Are Killing Us'
"[Of] Houston's top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where's all that money coming from? And where is it going? ... When you look behind the bills that ... patients receive, you see nothing rational -- no rhyme or reason -- about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay." (TIME)

Administration to Require Reports on All Health Insurance Price Increases
"Under current rules, the federal government requires insurers to report information on rate increases of 10 percent or more. New rules being issued by the administration will extend this requirement to all rate increases for all health plans sold to individuals, families and small businesses -- a total of 60 million people." (Reuters, via The New York Times; free registration required)

Understanding the Recent Increase in Health Insurance Coverage Among the Nonelderly Population
"This brief examines why the number of nonelderly uninsured people in the U.S. declined by 1.2 million in 2011 [and] finds that the decrease -- a reversal of the rise in the uninsured in previous years stemming from the recent recession -- was the result of an increase in coverage through public programs such as Medicaid and the Children's Health Insurance Program.... The paper includes discussions of trends in coverage by work status, race and ethnicity and region, and of the impact of the [ACA]." (Kaiser Family Foundation)

Private Health Care Exchanges Could Save Money, But Watch HRA Use
"In the FAQ [issued by HHS and IRS in January], employers were cautioned that ... the use of HRA funds to purchase coverage on the individual market or with an employer plan that provides coverage through individual policies, (which is what would happen if employees purchase individual coverage via a private exchange), would violate PHS Act Sec. 2711.... [T]he employer would face penalties under the ACA for not offering coverage through a qualified plan." (Wolters Kluwer Law and Business)

An Average ER Visit Costs More Than an Average Month's Rent
"A team of four researchers looked at medical expenditure bills that represented more than 8,303 emergency room visits. They found, essentially, two things. First, huge variation in prices: Bills sent out for sprained ankles ranged from $4 to $24,110. Second, overall, really high prices: The average emergency room visit now costs 40 percent more than a month's rent." (The Washington Post; free registration required)

Sequester: Medical Researchers Should Panic, Medical Providers Shouldn't
"[T]here is one group that isn't very panicked at all: The health provider community. For years, they've had the finger pointed at them as the main source of our budget woes. Now, the sequestration has provided some shields from its most panic-inducing cuts." (The Washington Post; free registration required)

HSAs and the Coming 'Cadillac' Tax (PDF)
"The 'Cadillac' tax will likely impact many plans at some point as health care costs continue to rise faster than the rate of inflation.... The best way to stay under the threshold is to offer plans that cost less.... Begin phasing in more affordable options now so that change is gradual for your employees, allowing you time to manage expectations." (Fidelity)

DOL Audits Requesting ACA Disclosures
"Recently, the DOL expanded its investigative authority by expanding the scope of its health care audit letter to include new requirements of the [ACA]. The new audit requests can be divided into three categories: (1) requests for all plans; (2) requests for grandfathered plans; and (3) requests for non-grandfathered plans." (Fidelity)

In Medicare Advantage MLR Rule, CMS Giveth and CMS Taketh Away
"Compared with what happened in the preliminary 2014 pay-rates notice issued Feb. 15, Medicare Advantage plans may have gotten away relatively easy in the proposed Medicare minimum medical loss ratio (MLR) rule released the same day. But this doesn't mean they won't face significant problems, especially since the rule would make Medicare Part D an integral part of the MLR calculation that begins being applied to MA next year." (AISHealth.com; free registration required)

[Opinion]

Understand the Costs of Mandatory Paid Sick Leave
"The ultimate goal ... is not a city or state sick day requirement but a federal one in the form of the Healthy Families Act. But before Congress follows Seattle, San Francisco, and Connecticut in search of a universal benefit from a new mandate, they'd do well to examine the evidence and see if one actually exists.... The estimated employer savings were based on a single study of data from 1987, years before any city or state had a sick leave law." (U.S.News & World Report)

[Opinion]

The Health Care Leader We Need
"Imagine a large company operating for seven years without a CEO. A company with a product that accounts for more than 15 percent of our nation's gross domestic product. A company implementing the largest national effort at reform since its creation. A company set to gain an additional 30 million customers in the next year. Unfathomable. Yet that is exactly the situation at one of the largest federal 'companies.' The Centers for Medicare & Medicaid Services (CMS) has not had a Senate-confirmed administrator since 2006." (Tom Daschle and Bill Frist in The Washington Post)

[Opinion]

To Contain Health Care Costs, Pay Doctors Differently
"Lawmakers have spent decades dancing around how to stop health care costs from eating up greater and greater portions of our overall budget.... These proposals, at best, address the problem of health spending at the margins. The real culprit here is fee-for-service payment to doctors." (Politico)

[Opinion]

Obamacare In Pictures
"This picture captures the 10,000 words it would require to explain with technical precision where President Obama's Affordable Care Act fits relative to all health reform plans. It places 'ObamaCare' along an ideologically scaled continuum of all serious reform options developed, debated and discarded or ignored since the 1980s." (The Health Care Blog)

[Opinion]

GAO Report Underscores ACA's Inability to Reduce Health Care Costs
"Several factors beyond the reach of the ACA's cost control provisions underpin the increase in health care spending, including: technological advancements, growth in personal income, expanded insurance coverage, and demographic changes. In fact, much of the ACA's ability to control costs relies on reducing provider payments, a feature that is likely to increase cost-shifting to employers." (HR Policy Association)

[Opinion]

A Health Care Entitlement Worth Ending
"It will be difficult, if not impossible to meet a reasonable fiscal target without addressing federal health care spending. However, the current fight is misplaced. The health care 'entitlement' we need to reform is the notion that America's health care system is entitled to an ever-growing share of America's wealth." (HealthAffairs)

[Opinion]

The Contrarian Approach to Health Care Reform and Group Benefit Planning
"Not since the passage of ERISA (1974), and later HIPAA (1996), has there been a more compelling piece of federal legislation that will change the landscape for such a wide audience ... [E]mployers, employees, HR professionals, insurance companies, providers and agents are all affected simultaneously. Questions have been raised about the survival of the employer sponsored marketplace. Should a defined contribution approach take its place? If [ACOs] grow and thrive, are there still a need and a market for insurance companies and agents? [The authors] believe there is." (Healthcare Reform Magazine)

[Opinion]

New Regs Released on ACA's $100 Billion Health Insurance Tax; Premiums to Rise
"A 2011 report by Oliver Wyman found that nationally the health insurance tax alone 'will increase premiums in the insured market on average by 1.9% to 2.3% in 2014,' and by 2023 'will increase premiums 2.8% to 3.7%.'" (America's Health Insurance Plans)

Benefits in General; Executive Compensation

Deferred Compensation Reminder: Beware Reimbursement Offset Provisions
"Section 409A of the Internal Revenue Code, regulating deferred compensation arrangements, can create traps for employers in situations where the employer wants to offset against amounts owed to the employer, unpaid amounts owed by the employee. [If] an employee has an obligation to reimburse an employer for certain expenses, that obligation cannot provide that the employer can offset that obligation against amounts of deferred compensation the employee is entitled to receive in the future. These types of offsets are considered prohibited accelerations of the deferred compensation payments, in violation of Section 409A." (Haynes and Boone, LLP)

Press Releases

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