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[Guidance Overview]
Proposed Regulations Implement 90-day Waiting Period Limit under Health Care Reform
"Under the proposed regulations, eligibility conditions based solely on the lapse of time cannot be more than 90 days. However, other eligibility conditions under governing plan terms are generally allowed unless designed to avoid compliance with the 90-day waiting period limit. For example, according to the Departments, plan provisions are substantive eligibility conditions that do not trigger the 90-day waiting period limit if they base eligibility on whether an employee is: Meeting certain sales goals. Earning a specified level of commission."
(Practical Law Company)
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[Guidance Overview]
Agencies Release Proposed Rule Governing 90-Waiting Period Limit for Health Plans
"The proposed regulations are consistent with -- and no more restrictive on employers than -- guidance previously issued in August 2012. Therefore, plans may follow either the earlier guidance or proposed regulations through at least the end of 2014. The proposed regulations prohibit requiring eligible participants and beneficiaries from having to wait more than 90 days for their coverage to become effective. They do not, however, require a plan sponsor to offer coverage to any particular employee or class of employees, such as part-time employees."
(Littler Mendelson LLC)
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[Guidance Overview]
The Consequences of Losing Grandfathered Health Plan Status (PDF)
This issue: reviews the plan changes that may trigger loss of grandfathered status, outlines the requirements that apply to plans as soon as they lose their grandfathered status, and notes additional requirements that will take effect starting in 2014.
(Segal)
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[Guidance Overview]
Minnesota Health Insurance Exchange Coming Soon
"The 'Minnesota Insurance Marketplace Act' passed the Minnesota legislature and is on its way to Governor Dayton's desk for signature. He is expected to sign the bill. Minnesota is one of only 18 states that have reportedly opted to establish and operate their own health insurance exchange beginning in 2014."
(Faegre Baker Daniels LLP)
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[Guidance Overview]
Implementing Health Reform: Waiting Periods and Enforcement of Market Reforms
"On March 18, 2013, Gary Cohen, the Director of the Office of Consumer Information and Insurance Oversight, stated on a national stakeholder call that most of the final rules needed to implement the Affordable Care Act 2014 insurance reforms are now in place. HHS is now in the final stages of ACA implementation, and it is moving forward."
(Timothy Jost in Health Affairs Blog)
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Critics Say Some Insurers Unfairly Limit Best Breast Pumps
"Dr. Kimberly Luft, a pediatrician with Kaiser Permanente, says the insurer would cover an electric pump if it were deemed a medical necessity. But manual pumps meet the basic needs of most moms, Luft says. She suggests women work with their employers to find enough time to use the devices."
(National Public Radio)
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CVS Pharmacy Wants Workers' Health Information, or They'll Pay a Fine
"A new policy by CVS Pharmacy requires every one of its nearly 200,000 employees who use its health plan to submit their weight, body fat, glucose levels and other vitals ... Employees who agree to this testing will see no change in their health insurance rates, but those who refuse will have to pay an extra $50 per month -- or $600 per year -- for the company's health insurance program.... Critics are calling the policy coercion, and worrying that CVS or any other company might start firing sick workers."
(ABC News)
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Do Workplace Wellness Programs Really Save Employers Money?
"Some studies have shown savings from wellness programs, while others found little change or even higher spending. Gary Claxton of the Kaiser Family Foundation, which produces an annual survey of workplace health plans, says the financial impact is difficult to measure. 'A lot of employers think it's the right thing to do, and they're not so much interested in measuring,' he said."
(The Washington Post)
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Is Safeway Really Good at Controlling Health Care Costs?
"The argument for implementing wellness programs and incentives does inherently make sense. There is significant data to support the fact that unhealthy behaviors do contribute to higher healthcare costs. There's also no question that employees should be held more accountable for their decisions and the impact those decisions have on costs -- not just to themselves, but to the employer. But while financial incentives can be effective in getting people to change behavior in the short term, the challenge is in insuring that employees are consistent."
(MedPage Today)
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Software Developers and Network Engineers: Why You Should Be Working in Health Information Technology
"Health care IT is a field in need of upgrades. Where many of America's businesses -- from retail stores to banks to telecom companies -- depend on interoperable network infrastructure and user-friendly interfaces, many doctors' offices, hospitals, clinics and medical laboratories across the U.S. still rely on legacy software and hardware. Some doctors still store patient files on paper, and write prescriptions by (illegible) hand. In an industry where lives are at stake every day -- and where governmental pressure for providers to adopt electronic record-keeping continues to mount -- outdated practices like these point to a serious need for bright minds with fresh perspectives."
(Tech Republic)
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Employers Exploring Private Health Insurance Exchanges
"[F]or the vast majority of employers that will continue to offer employer-sponsored coverage, public exchanges do not provide a viable solution. Private exchanges offer a new way to provide employer-sponsored benefits that many will find advantageous."
(Mercer)
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Hospital Inpatient Prices Rising Sharply
"Even after adjusting for more numerous or complex procedures performed per admission, prices climbed sharply for most types of hospitalizations. Unadjusted hospital prices per admission rose from $13,016 in 2008 to $15,236 in 2010, an average annual growth rate of 8.2%[.]"
(HealthLeaders Media)
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Independent Medical Review of ERISA Claim Is Not Entitled to Arbitration Standard of Review
"[An Oregon] federal district court held that the review of benefit denials by an independent review organization (IRO) is not akin to an arbitration proceeding, and thus did not preclude a plan participant from seeking judicial review under ERISA of an adverse benefit determination.... [This case is significant because] current [ACA] regulations and other guidance provide, without explanation, that IRO determinations are 'binding except to the extent that other remedies may be available under State or Federal law to either the group health plan or to the claimant.'... Exactly how the new ACA rules and the existing ERISA claims rules with judicial review under ERISA section 502 will interact remains to be seen and likely will be the subject of future litigation." [Yox v. Providence Health Plan, No. 12-cv-01348, 2013 WL 865968 (D. Ore., Mar. 8, 2013)]
(Proskauer's ERISA Practice Section Blog)
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California Pregnancy Leave Is Supplemental to General Disability Rights (PDF)
"[W]here an employee has exhausted her leave under the [California Pregnancy Disability Leave Law] but remains disabled, the employer must still meet its obligation ... to accommodate any physical or mental disability of the employee -- including engaging in an interactive process in order to determine the availability and nature of any such accommodations. The employer need not furnish any such accommodation ... that would produce undue hardship to its operation. However, the availability of an undue hardship defense may be limited, since accommodations of pregnancy-related disabilities are likely to be of relatively short duration."
(Schiff Hardin LLP)
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Cash Back on Broccoli: Health Insurers Nudge Shoppers to Be Well
"Some two-thirds of healthcare spending is linked to lifestyle diseases such as obesity, Type-2 diabetes that can be prevented or controlled by healthier diets and lifestyle. So the insurers sponsoring these incentive programs are hoping they'll help curb future healthcare costs."
(National Public Radio)
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Results of a Cash-Back Rebate Program for Healthy Food Purchases (PDF)
"Rebates of 10% and 25% for healthy foods are associated with an increase in the ratio of healthy to total food expenditure by 6.0% (95% CI 5.3, 6.8) and 9.3% (95% CI 8.5, 10.0); an increase in the ratio of fruit and vegetables to total food expenditure by 5.7% (95% CI 4.5, 6.9) and 8.5% (95% CI 7.3, 9.7); and a decrease in the ratio of less desirable to total food expenditure by 5.6% (95% CI 4.7, 6.5) and 7.2%"
(American Journal of Preventive Medicine)
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The Doctor Will See You and a Dozen Strangers Now
"If the idea of sharing your personal medical troubles with your doctor and a bunch of total strangers gives you sweaty palms, you're not alone. Yet, a growing number of people are swallowing hard and doing it. Along the way, they're discovering that they can get more time with the doctor and learn a few things from their fellow patients by forgoing a one-on-one appointment for a group medical visit."
(National Public Radio)
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Money Talks When It Comes to Losing Weight
"Weight loss study participants who received financial incentives were more likely to stick with a weight loss program and lost more weight than study participants who received no incentives ... Previous studies have shown that financial incentives help people lose weight, but this study examined a larger group of participants (100) over a longer period (one year)."
(Mayo Clinic)
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Use of Generics Produces an Unusual Drop in Drug Spending
"The dip was small -- 1 percent, to $325.7 billion -- but it was the first time the research firm IMS Health had recorded a decrease in United States drug sales since the company began tracking such numbers in 1957. And this month, the pharmacy benefit manager Express Scripts reported that spending on commonly used pills -- like those that treat high blood pressure and cholesterol -- dropped by 1.5 percent, the first time that had happened since Express Scripts began following drug trends 20 years ago."
(Associated Press via The New York Times)
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Feds Will Need to Enforce ACA Reforms in 4 States
"At least four states won't enforce new sweeping insurance market reforms rolling out next year with the health law -- leaving federal health officials in Washington to pick up the slack, yet another wrinkle in Obamacare implementation.... [T]he feds will be overseeing the health care law in Missouri, Oklahoma, Texas and Wyoming after those states told HHS they couldn't or wouldn't implement the new rules."
(Politico)
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Some States Balking at Enforcement of Health Law's Insurance Protections
"While federal officials say they will step in if necessary, policy experts note they have little experience enforcing health insurance laws and few resources in states to do it.... The enforcement issue needs to be settled now because health plans are beginning this month to submit insurance products to state regulators that they hope to sell in the new online marketplaces beginning this fall. If states balk at reviewing the plans for compliance with Obamacare rules, insurers could face oversight from both state and federal regulators."
(Kaiser Health News)
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Text of Letter from Congressional Leaders to DOL Requesting Information on ACA's Effect on Hiring and Employment (PDF)
"We are concerned by employer comments recently summarized by the Federal Reserve regarding the potential impact of the [ACA] on hiring.... Section 1513(c) of [the ACA] directs the Secretary of Labor to conduct a study to determine whether employees' wages are reduced due to tax penalties [of the employer mandate].... We respectfully request ... a copy of the completed study no later than April 2, 2013."
(Subcommittee on Heath, Employment, Labor and Pensions, Committee on Education & the Workforce, U.S. Senate)
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Third Party Administrators Can Be Held Liable for FMLA-Related Violations
"Because the TPA accepted complete and sufficient certification supporting the need for eight weeks of leave, but only provided four weeks, the court held that these facts 'are sufficient to suggest, though they do not conclusively prove, that defendant intentionally denied meritorious FMLA leave requests to enhance its reputation as a benefits administrator and increase its book of business.'" [Arango v. Work & Well, No. 11C525 (N.D. Ill., Mar. 15, 2013)]
(FMLA Insights)
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[Opinion]
Obamacare Is Failing Small Businesses
"One of Obamacare's many failures is the temporary small business tax credit, which is intended to encourage small employers to offer health insurance to their employees by partially offsetting the cost... But even after spending $1 million to advertise the credit, only 7 percent of potentially eligible employers claimed it."
(The Heritage Foundation)
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[Opinion]
Statement by AHIP President About Senate Bill to Repeal the ACA's Health Insurance Tax
"Taxing health insurance makes it more expensive, and that is the opposite of what health care reform was supposed to accomplish.... Families and small businesses simply cannot afford to pay an additional $100 billion sales tax on their health insurance at a time when they are already struggling to keep up with rising medical costs."
(America's Health Insurance Plans)
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[Opinion]
Health Care Prices Are 'Fiction, Fantasy'
"The important thing is, when looking at prices in health care, remember you are looking at nothing. Fiction. Fantasy. Administered numbers. And the fact that we make decisions and that hospitals themselves often allocate resources on these prices is one of the ways the system is massively broken."
(Boston.com)
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[Opinion]
Steven Brill's Big Breakthrough
"High healthcare costs are spawned by a powerful ethic in American medicine that is too often nurtured by the press, an ethic that dictates that the medicine men -- doctors, hospitals, and drug companies -- sit at the right hand of God and deserve all they can get. Brill's article crashes right through that fence, in fact, and provides the stuff for further productive reporting."
(Physicians for a National Health Program)
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[Opinion]
ACLJ Continues Its Efforts Against the HHS Mandate In the Gilardi and Korte Appeals
"[The ACLJ represents] Frank and Phil Gilardi and their family-owned companies, Freshway Foods and Freshway Logistics. These Ohio-based companies process, pack, and deliver fresh produce to twenty-three states and have about 400 full-time employees. The Gilardi brothers are Catholic, and they run their companies pursuant to their faith. On April 1, 2013, however, when their employee health insurance is up for renewal, the Mandate will require the Gilardis, contrary to their Catholic faith, to provide coverage for all contraceptive methods, including abortion-inducing drugs, and sterilization procedures. If they do not comply, the federal government will impose annual penalties of more than $14 million dollars."
(American Center for Law and Justice)
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[Opinion]
A Disaster in the Making: Private Health Insurance Exchanges
"While the CDHP advocates spread the word that giving consumers control of their health insurance dollars will lower health care spending by allowing employees to 'buy only the insurance that they need,' they will remain silent on what really happened. They shifted risk from the employers and their insurers onto the backs of the employees."
(Physicians for a National Health Program)
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[Opinion]
Unifying the District of Columbia's Health Insurance Marketplace
"The Exchange holds the promise of enabling small employers to offer employees a number of plan options, which would increase choice for both employers and their workers. 'Combining the new exchange and existing health insurance markets into a larger, single market would make it far likelier that the DC Exchange achieves this critical goal' [said Robert Greenstein, President of the Center on Budget and Policy Priorities]."
(Center on Budget and Policy Priorities)
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[Opinion]
ACA at 3: Holding Insurance Companies Accountable
"[S]ince the rule on rate increases was implemented, the number of requests for insurance premium increases of 10% or more plummeted from 75% to an estimated 14% since the passage of the health care law. The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggests that this slowdown in rate increases is continuing into 2013."
(The White House)
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Benefits in General; Executive Compensation
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[Guidance Overview]
IRS Issues Favorable Guidance on Recently Modified Voluntary Classification Settlement Program
"The guidance clarifies how employers can reclassify some or all of their workers and how, once reclassified, all workers in the same class must be treated as employees for employment tax purposes. The guidance also provides instructions for filing the application using Form 8952 and explains how the VCSP payment is calculated."
(McDermott Will & Emery)
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Banning Work-from-Home Programs Not a One-Size-Fits-All Decision
"[F]ive questions employers should consider when evaluating their virtual work programs: [1] To what extent does the organization's strategy emphasize collaboration and innovation, and what tools does it have to encourage and enhance collaboration for those working virtually? ... [2] Are formal guidelines in place to help managers and employees evaluate whether a virtual work arrangement is appropriate for the role/employee, or are arrangements offered on an ad hoc basis? [3] How does offering a virtual work program impact employee attraction, engagement and retention, especially with high performing employees? What effect would eliminating this policy have? [4] Does the organization have managers who can successfully manage their teams, whether employees are working in or out of the office? [5] Are there tools in place to assess the effectiveness of virtual work, such as performance, engagement, retention, teamwork and cost/savings impact?"
(Aon Hewitt)
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Press Releases
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