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[Official Guidance]
Text of DOL ACA FAQ XIII: Expatriate Health Care Plans
"While the Departments gather further information and analyze these challenges to determine what actions may be appropriate regarding the current requirements under the [ACA], ... for plans with plan years ending on or before December 31, 2015, with respect to expatriate health plans, the Departments will consider the requirements of subtitles A and C of Title I of the [ACA] satisfied if the plan and issuer comply with the pre-[ACA] version of Title XXVII of the Public Health Service Act.... Expatriate health plans must, as a condition of this transitional relief, comply with the pre-Affordable Care Act version of Title XXVII of the PHS Act and other applicable law under ERISA and the Internal Revenue Code, including, for example, the mental health parity provisions, the HIPAA nondiscrimination provisions, the ERISA section 503 requirements for claims procedures, and any reporting and disclosure obligations under ERISA Part 1. The Departments note that coverage provided under an expatriate group health plan is a form of minimum essential coverage under section 5000A of the Internal Revenue Code."
(Employee Benefits Security Administration)
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[Guidance Overview]
Expatriate Health Plans: Only Half an Exemption
"[S]elf-insured expatriate health plans are not covered by this exemption. This means that each separate requirement will need to be examined to determine whether it applies to self-insured expatriate health plans (e.g., PCOR fee, transitional reinsurance fee, preventive care requirements, etc.)."
(Kilpatrick Townsend)
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[Guidance Overview]
HITECH and Omnibus HIPAA Final Rule: Due Diligence Required for Business Associates and Subcontractors
"[T]he new rules do NOT require that covered entities enter into any direct contract or other arrangement with Subcontractors of their Business Associates. Instead, covered entities must obtain appropriate assurances from their Business Associates that all of their Subcontractors will be in compliance with the new rules. These assurances must also be obtained by Subcontractors as to those they engage 'no matter how far "down the chain" the information flows'."
(Bond, Schoeneck & King, PLLC)
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[Guidance Overview]
Health Care Reform Brings Research Fees for HRAs (PDF)
"An HRA is not subject to a separate research fee if the plan sponsor also maintains another self-insured plan providing major medical coverage, as long as the HRA and the plan have the same plan year.... However, a plan sponsor may not treat an HRA and a fully-insured group health plan as a single plan for purposes of calculating the PCORI fee."
(The Chelko Consulting Group LLC)
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[Guidance Overview]
Affordable Coverage Under ACA, Theoretically
"IRS and HHS have been issuing guidance and notices, as well as regulations, regarding the definition of affordable coverage. But employers seem to be caught up in household income, 8%, 9.5% and what constitutes affordable coverage to avoid penalties. So breaking down this one issue of 'affordability,' [here's a summary of] where we presently appear to be[.]"
(Fox Rothschild LLP)
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The Cost of ACA Compliance
"[W]ith less than a year until the ACA's controversial 'pay-or-play' mandate kicks in ... the corporate world is still getting its head around what healthcare reform will mean in the long run. But a new survey finds some organizations starting to get a clearer picture of how the ACA will ultimately affect their bottom lines, and responding with a measured approach to rethinking benefit plan design."
(Human Resource Executive Online)
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Don't Count Out CO-OPs Just Yet
"The easy bet was that CO-OPs would meet a swift demise, but as exchanges get close to reality, so do CO-OPs. With only a few months until exchange plan marketing begins, some CO-OPs are coming into the light. The January federal budget deal eliminated future CO-OP funding, so only 24 states will have the nonprofit plans. Some CO-OPs have made moves that could provide long-term prosperity."
(HealthLeaders InterStudy)
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Health Care Employee Decision-Making and Resulting Costs: What Employers Are Missing
"What employers are missing is an understanding of how employees are making health care decisions and how that impacts their health care costs. A large population of health care consumers are starting with a search engine to find health care information online. In the past year, 72% of U.S internet users have gone online specifically for health related information, and 77% of them begin their research at a search engine."
(The Institute for HealthCare Consumerism)
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Can H&R Block Make Health Reform Work for Its Customers?
"[W]ithholding tax refunds is about the only way the IRS can enforce ObamaCare's mandate. So the company is now considering how to help its clients enroll in Medicaid or in a plan sold on a health insurance exchange to avoid those withholds."
(John Goodman's Health Policy Blog)
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Get Ready for the SHOP(ping) Spree
"[S]even things that a small business owner can do now to get ready for the health insurance marketplace and possible participation in a SHOP.... 1. Make sure you understand how insurance works.... 2. Learn about different types of health insurance.... 3. Start thinking about when to begin coverage.... 4. Set your budget.... 5. Get organized.... 6. Make a list of questions you have before it's time to choose which health plans you'll offer.... 7. Look for help."
(Wolters Kluwer Law and Business)
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Few Existing Health Plans Meet New ACA 'Essential Health Benefit' Standards
"The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the [ACA]. On average, the health plans provided 76% of the ACA's Essential Health Benefits."
(HealthPocket)
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Using FMLA to Understand and Manage Disability Absence
"Findings include: [1]A substantial minority of employees takes FMLA leave (24% over a five-year period); [2] Employees who use FMLA are more likely to use [short-term disability (STD)] the following year; [3] When preceded by FMLA claims, STD durations are longer, and later [long-term disability] claims are more likely."
(Integrated Benefits Institute)
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States Balk at $15 Billion Health Care Reform 'Tax'
"In Wisconsin alone, the fee would hit the state's coffers to the tune of $23 million in 2014, and will likely total more than that in subsequent years ... The blow to Wisconsin's private insurance market would be far higher -- $3 billion over the next 10 years[.]"
(The Hill)
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Watch for Emergence of Health Insurance Stores
"Here's what the blueprint of health insurance selling can look like soon and in the years to come. It is nonpartisan and reflects the interests of many publics with a stake in the outcome, most importantly the millions of consumers who will purchase health care through this system. Most of all it is clear thought and something that will work to strengthen purchasing and access in our country's health care system."
(Davidson Marketing)
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[Opinion]
Company Wellness Programs Don't Really Save Money
"If you run a large organization or its human resources department, you are probably starting to wonder if your financial commitment to wellness programs makes sense. Your consultants and vendors assure you that they save lots of money. Yet you still have plenty of obese workers, and recent academic literature overwhelmingly reports no savings from the programs.... Just asking your benefits consultants three simple questions will solve this conundrum."
(Harvard Business Review)
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[Opinion]
Trillion-Dollar Obamacare Taxes Will Affect Us All
"The total tax burden of ObamaCare is now estimated at $1.058 trillion -- a steep increase from the initial $569 billion estimate produced at the time of the passing of the law. Owners of small businesses will be hit the hardest, facing both a tax increase on self-employment income and the employer mandate. The tax increase may force some small businesses to shut down or fire workers and raise prices."
(National Center for Policy Analysis)
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[Opinion]
Impact of the ACA on the Labor Supply
"While substantial attention has been given to the employer side, the employee side also experiences many distortionary effects. Some of these distortions include incentives to reduce hours, not seek work, drop insurance coverage, drop dependent coverage, become divorced, or avoid marriage. It is apparent that Obamacare's effects extend far past the number of employees a business will employ, or how many hours a week an employee will be allowed to work."
(The Heritage Foundation)
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[Opinion]
10 Stories of Job Loss As Consequences of Obamacare
"As employers and businesses prepare for Obamacare's sweeping changes and mandates to begin in 2014, many are already laying off some of their employees. An event at Heritage today will discuss the burdens of the law both for small businesses? ability to hire and grow and individuals? ability to find jobs. Here are 10 examples of job loss due in whole or part to Obamacare and its consequences ..."
(The Heritage Foundation)
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[Opinion]
Refuting, Once Again, the Medicare Part D Myth
"The Medicare Part D drug benefit, which private insurers deliver, did indeed cost much less over its first five years (2006-2010) than the Medicare trustees and the Congressional Budget Office (CBO) originally expected. But, as a Kaiser Family Foundation analysis states, there 'is compelling evidence that factors other than competition offer the best explanations for the lower-than-expected spending trend' in Part D."
(Center on Budget and Policy Priorities)
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[Opinion]
Paying for Health Care: Key to Reform Is Not How Providers Charge, But How Much They Charge
"If you were eating in a Chinese restaurant, would you have the temerity to tell the manager how to repackage and re-price the items on the menu? ... The medical marketplace must be one thousand times more complex than the market for Chinese food. Yet there are all kinds of outsiders who think they know how health care should be packaged and priced."
(John Goodman's Health Policy Blog)
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[Opinion]
'Pro-Choice' Obama Administration's HHS Mandate Offers No Choice For Religious Objectors
"What one must understand about these lawsuits is that the employers challenging the Mandate are not seeking to stop anyone's access to contraceptive methods, abortion, or sterilization procedures or to impose their religious views on others. Rather, these employers simply do not want to be forced to pay for goods and services in violation of their faith. This is true whether or not their employees ever use those goods and services."
(American Center for Law and Justice)
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[Opinion]
The Republican Case for Waste in Health Care
"Though we spend more per person on health care than any other people on earth, and with results that are no better and often worse than all other advanced nations, we have allowed conservatives and corporate interests to bind us with laws that explicitly forbid the use of formal cost-benefit analysis to determine how health care dollars are spent. Until we get our heads around this contradiction, we are in big trouble."
(The Health Care Blog)
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[Opinion]
Text of Comments to CCIIO on Revised Unified Rate Review Template and Instructions (PDF)
Specific recommendations include: clarifying language to be added several points in the description of entries for index rate; a change to the description of the entry for projected risk adjustments; adjustments to the description of the entry for reinsurance recoveries and taxes and fees; and changes to the description of AV pricing value.
(The Health Practice Council Rate Review Practice Note Work Group of the American Academy of Actuaries)
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[Opinion]
Text of Testimony before Ways and Means Committee on Revising Medicare's Fee-For-Service Plan Design (PDF)
"To address the problems with the current [fee for service (FFS)] benefit design, proposals have been developed that would combine a new cost-sharing limit with a unified Part A and Part B deductible.... These changes would result in more coordinated Part A and B cost-sharing requirements and would bring the FFS benefit design more in line with the structure of private health insurance programs."
(American Academy of Actuaries)
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Benefits in General; Executive Compensation
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Section 409A Tax Assessed on Discounted Stock Options -- Taxpayer Sues for Refund
"[The IRS] has begun to enforce the Section 409A Rules in examination of employers sponsoring [non-compliant deferred compensation] arrangements. In a recent court case, ... the Plaintiff, Dr. Sutardja, appealed an IRS assessment of the 20% Section 409A surtax in the amount of $3,172,832 plus another $304,456 in interest ... The assessment resulted from the exercise of a stock option which was found by the IRS to have been issued at a discount below the fair market value on the date of grant. Under the Treasury Regulations, discounted stock options are subject to Code Section 409A and must have fixed dates for exercise and payment and may not contain any discretionary provisions for the time or form of payment."
(Leonard, Street and Deinard)
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Annual Incentives Plans: Design Under the Microscope
"Based on [a] review of company disclosures ... [1] Target [annual incentive plan (AIP)] levels have increased modestly over the past five years as companies have curtailed salary increases and reduced retirement benefits and perks in the quest for enhanced pay-for-performance alignment. [2] More companies are measuring AIP performance using multiple financial performance metrics.... [3] In order to provide more differentiated payouts among participants, companies have increased the use of individual performance evaluation and discretion in determining AIP payouts. [4] Payout levels overall seem generally aligned with performance, although some pay-for-performance outliers remain."
(Towers Watson)
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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