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April 1, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Webcasts and Conferences

Due Diligence for Alternative Investments
in Arizona on April 18, 2013 presented by fi360

COBRA: From Basics to Healthcare Reform
Nationwide on April 10, 2013 presented by Employers Council on Flexible Compensation (ECFC)

"403(b) Plans: New Pre-approved Plan Procedure and Sample Language" Web Seminar
Nationwide on April 16, 2013 presented by SunGard Relius

403(b) Plans: New Pre-approved Plan Procedure and Sample Language" Web Seminar
Nationwide on May 3, 2013 presented by SunGard Relius

View All Webcasts and Conferences

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[Official Guidance]

CMS FAQs on Medicaid Premium Assistance under the ACA (PDF)
"The Medicaid statute provides several options for states to pay premiums for adults and children to purchase coverage through private group health plans, and in some case[s] individual plans; in most cases, the statute conditions such arrangements on a determination that they are 'cost effective.' ... Under all these arrangements, beneficiaries remain Medicaid beneficiaries and continue to be entitled to all benefits and cost-sharing protections. States must have mechanisms in place to 'wrap around' private coverage to the extent that benefits are less and cost sharing requirements are greater than those in Medicaid." (Centers for Medicare & Medicaid Services)


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[Official Guidance]

CMS FAQs on Use and Reuse of Exchange for Ancillary Insurance Products (PDF)
"Q1: Can stand-alone vision plans and other ancillary insurance products such as disability or life insurance products be offered in or through an Exchange? A1: No.... Q2: Can an Exchange provide any information about vision plans and other ancillary insurance products to the public? Q2: Yes.... Q3: How may State-based Exchange resources be used by other, separate state programs to offer these non-QHP ancillary plans? A3: The Exchange information technology infrastructure can be reused by other, separate non-Exchange state programs to facilitate coverage in ancillary products, provided [certain] conditions are met." (Centers for Medicare & Medicaid Services)

[Official Guidance]

Text of CMS Announcement of Medical Loss Ratio Annual Reporting Procedures for the 2012 MLR Reporting Year (PDF)
"This memorandum outlines the process by which health insurance issuers will submit their medical loss ratio (MLR) data to fulfill reporting obligations under the MLR provisions of the [ACA]. The report for the 2012 MLR reporting year must be filed by June 1, 2013." (Centers for Medicare & Medicaid Services)

[Official Guidance]

Training Information for the 2012 MLR Reporting Year: Submission of Medical Loss Ratio Data to CMS (PDF)
"This notice provides information about upcoming training sessions for the submission process of Medical Loss Ratio (MLR) data for the 2012 MLR reporting year using the MLR Annual Reporting Form.... CMS will host a ... training webinar to review the registration process and changes to the 2012 MLR Form from the prior year. The same webinar will be presented on April 10, 2013 and again on April 16, 2013 ... CMS will host weekly conference calls to answer issuer questions about the 2012 MLR Annual Reporting Form." (Centers for Medicare & Medicaid Services)

[Official Guidance]

Text of GAO Review of the Audit of the PCORI Financial Statements for 2012 and 2011
"GAO did not find any instances in which the Patient-Centered Outcomes Research Institute's (PCORI) independent public accountant (IPA) did not comply, in all material respects, with U.S. generally accepted auditing standards and generally accepted government auditing standards in conducting PCORI's financial statement audit.... [T]he IPA did not identify any new deficiencies in internal control that it considered to be material weaknesses and determined that PCORI resolved the material weakness identified in 2011 regarding a deficiency in its internal control over financial reporting related to its receipt of appropriated funds." (U.S. Government Accountability Office)

[Guidance Overview]

Final FMLA Regs Take Effect (PDF)
"The employer's standard FMLA leave year applies to qualifying exigency leave and other FMLA-qualifying leaves. In the case of military caregiver leave, however, the applicable single 12-month period begins on the first day the eligible employee takes FMLA leave (regardless of the employer's standard FMLA leave year)." (Buck Consultants)

[Guidance Overview]

Federally Facilitated Exchanges Almost Ready
"Although the guidance was issued in draft form, CCIIO and CMS allowed only two weeks for the public to submit comments and ... CMS intends to start accepting issuer applications to the FFEs on April 1, 2013. As such, it seems unlikely that the guidance will be materially revised.... The guidance sets forth the anticipated time frames for the various activities that an issuer will be required to perform in order to obtain certification as a qualified health plan ('QHP'). The tight timeline is [listed in this article]." (Epstein Becker & Green, P.C.)

[Guidance Overview]

Final Regs Address Increased Federal Medicaid Matching Funds
"The issue ... is that many Americans who sign up for Medicaid in 2014 will be new Medicaid recipients, but will be eligible under existing state Medicaid program rules -- not in fact 'newly eligible.' These recipients will be covered by the traditional federal match; somewhere between 50 and 73 percent depending on the state. The final regulation tries to sort out which of the new Medicaid recipients will be 'newly eligible,' and thus qualify for the enhanced federal match and which will not be." (Health Affairs)

Is Wellness a Healthy Way to Curb Healthcare Costs?
[I]t seems wellness programs have arrived as a bona fide win-win for employers and their workforces. Not so fast, according to a [recent] research article ... [which] makes the case that cost savings from wellness programs may not be the result of healthier workers, but are more likely the result of cost-shifting to employees who can least afford it. In addition, the article reports that wellness programs actually may run afoul of the ACA by being discriminatory against employees within lower socioeconomic groups." (Human Resource Executive Online)

Vermont First State to Post Health Care Exchange Rates
"The rates, which are subject to review by regulators, range from about $1,700 a month for platinum coverage for a family to an average of $745 a month for catastrophic care, but those figures don't take into account health care subsidies that would reduce the rates significantly." (FoxNews)

Can Mass Marketing Heal the Splits over Obamacare?
"America's more than 48 million uninsured people are no monolithic mass. A marketing analysis posted online by the federal Health and Human Services Department reveals six distinct groups, three of which appear critical to the success or failure of the program. They're the 'Healthy & Young,' comprising 48 percent of the uninsured, the 'Sick, Active & Worried,' (29 percent of the uninsured), and the 'Passive & Unengaged' (15 percent)." (Associated Press)

Five Keys to Writing a Successful Qualified Health Plan Application
"Applications to join healthcare exchanges vary by market and type of exchange in a state.... [T]hese top five application response principles and project management practices can be applied. 1. Understand requirements.... 2. Develop a work group.... 3. Determine accountability by requirement.... 4. Set rigorous draft response timelines.... 5. Provide guidelines for response content." (Healthcare Town Hall)

CMS to Review Gender Change Surgery
"CMS's decision to reconsider coverage of surgical treatment triggers an initial 30-day public comment period, which will end April 27. In announcing the review, the agency said it was 'particular interested in clinical studies and other scientific information relevant to the topic under review.'" (MedPage Today)

Americans Pay Way More for Health Care Than Anyone Else
"One day in the hospital costs Americans $4,287 on average. In Australia, that stay costs an average of $1,472, and in France -- $853. A routine office visit in costs U.S. patients an average of $95 -- two and a half times more than in Chile, which had the second-highest cost for routine office visits.... The price for every service evaluated in the report costs more in the United States than anywhere else in the world. The only exception was for cataract surgery, which costs patients $922 in the United States, $1,311 in Australia and $1,048 in Chile." (Milwaukee Business Journal)

Wellness Programs Aren't Working? These Three Ideas Might Help
"Drawing on behavioral economics and networking theory, the following components hold promise: [1] Turn Wellness Into a Game: Provide Feedback Instantly.... [2] Take Advantage of Automated Hovering.... [3] Emphasize Social Connection." (The Health Care Blog)

Why Uninsured Might Not Flock To Health Law's Marketplaces
"With almost one in five of its residents lacking health insurance, officials in Palm Beach County ... launched a program that offered subsidized coverage to residents who couldn't afford private insurance, but made too much to qualify for Medicaid ... Enrollees would be able to buy policies for about $52 a month -- far cheaper than what private insurers were offering. But a year after the program began, fewer than 500 people had signed up -- less than a third of the number expected." (Kaiser Health News)

Court May Not Substitute Legal Separation for Divorce Solely to Provide Health Coverage
"With costly health benefits on the line, divorcing participants may do their best to manipulate the system in order to maintain coverage by recharacterizing a divorce as a legal separation.... [U]nless a plan's terms specify that legal separation causes a loss of plan coverage, legal separation will not be a qualifying event for COBRA purposes; nor will it justify an election change under the cafeteria plan rules." [Leverett v. Leverett, 2013 WL 1165375 (Ala. App. 2013)] (Thomson Reuters / EBIA)

Fifth Circuit Joins Fourth in Concluding Surcharge Is Available Fiduciary Breach Remedy Under Amara
"The employer's misrepresentation about the retiree's eligibility for medical coverage resulted from miscalculating his total service. The miscalculation also led to an error in his monthly retirement benefit -- the correct amount was less than half of what he had been receiving under the mistaken calculation.... This case serves as yet another reminder to employers to ensure the accuracy of information communicated to plan participants and beneficiaries[.]" [Gearlds v. Entergy Services, Inc., 2013 WL 610543 (5th Cir. 2013)] (Thomson Reuters / EBIA)

OIG Issues Updated Guidelines for Evaluating State False Claims Acts: More State Litigation on the Horizon?
"[The] Updated OIG Guidelines for Evaluating State False Claims Acts ... describe OIG's methodology for determining whether a state's Medicaid false claims law satisfies the four requirements in Section 1909(b) of the Social Security Act that are necessary to qualify for a 10-percentage-point increase in the state share of Medicaid-related false claims recoveries." (Epstein Becker & Green, P.C.)

FMLA Amendments May Impact Company Policies
"Qualifying exigency leave is easily the most complex type of leave.... The amendments specify that National Guard, Reserves and Regular Armed Forces are all included in this policy.... Additionally, the rules clarify that active duty requires deployment to a foreign country. The regulations also expand the situations that may be considered a 'qualifying exigency.'" (Snell & Wilmer L.L.P.)

ACLJ Gets 5th Injunction Against HHS Mandate
"[T]he United States Court of Appeals for the District of Columbia Circuit [has] granted an injunction in favor of ... Frank and Phil Gilardi and their two companies, preventing application of the HHS Mandate against them until their appeal is fully resolved. The Mandate was set to apply on April 1st, when the companies' health plans were to be renewed." (American Center for Law and Justice)

Legislative Panel Proposes Health Coverage for Part-Time Florida Public Employees
"A Florida House panel approved a measure ... to offer health insurance to 8,737 of the state's part-time employees and their family members instead of paying a hefty fine under the federal health overhaul. The panel could have decided to cap part-time employees to working 30 hours per week or chosen not to provide any health coverage, which would result in a $318 million fine under the [ACA]." (TimesUnion.com)

For Health Insurance Companies, Unhappy Customers Don't Mean Lower Revenue
"The number of confirmed consumer complaints made against an insurer doesn't affect that insurer's market share, according to a multiyear analysis of complaints registered with the Oregon Insurance Division." (The Lund Report)


Individuals on Disability Are Enmeshed in the Safety Net
"Disability is like Hotel California: You can sign up anytime you like (if you have a qualifying condition), but you can (almost) never leave. One economist, cited in the story, points out that fewer than 1 percent of the disabled have returned to the workforce in the past two years." (The Heritage Foundation)


Disability Benefits: America's $124 Billion Secret Welfare Program
"Imagine for a moment that Congress woke up one morning, realized that the United States was suffering from a paralyzing long-term unemployment crisis, and, in a moment of progressive pique, decided to create a welfare program aimed at middle-aged, blue-collar workers.... [It] turns out there already is a 'de facto welfare program' for those struggling Americans. The problem is, instead of getting the unemployed back on their feet, it pays them to give up work for good." (The Atlantic)


Is the Social Security Disability Insurance Program Essentially a Welfare Program?
"The surge in the numbers of Americans who are now living off of Social Security's disability insurance program is troublesome. But it reflects the harsh reality of an ongoing jobs crisis that is leaving millions of people unemployed or under-employed, barely scraping by, desperate to find work or better jobs.... But what really worries [the author] is that even those Americans who are working and managing to save something on the side, their retirement dreams are evaporating, and many of them will likely have to enroll in this 'de facto welfare program' before they reach retirement age." (Pension Pulse)


A Reason to Be Encouraged about Health Care Debates
"The media is at last finally taking a hard look at what drives healthcare costs, namely overpriced care, money driven medicine, a systemic failure to follow evidence based medicine, and misguided efforts to control health costs by the corporations. Why is this good news? Well, for decades the high cost of healthcare was blamed on the accountants, i.e., insurance companies to be precise." (Cracking Health Costs)


AMA Pushes for Better Insurance Exchange Networks
"Standards ensuring that consumers have access to sufficient networks of health care professionals on federally operated health insurance exchanges need to be tightened ... AMA Executive Vice President and CEO James L. Madara, MD, specified what information qualified health plans on these marketplaces should be providing. Insurance regulators and consumers need to be able to make informed decisions on whether a plan's network has an adequate supply of primary care and specialty physicians, he stated." (American Medical News)


Obamacare Opens Pandora's Pillbox
"When President Obama set out to fix a broken health insurance system and find a pathway to coverage for all Americans, he could not help but open Pandora's Pillbox -- focusing and intensifying nearly every one of our culture wars. This has less to do with the actual details of Obamacare than with the hard realities of how the health insurance system invades, pervades, and connects us all -- as almost anyone involved in prior health reform debates, or in trying to manage health care for an insured population, would attest." (The Health Care Blog)

Benefits in General; Executive Compensation

[Official Guidance]

Text of Proposed Regs on the $500,000 Deduction Limitation for Remuneration Provided by Certain Health Insurance Providers
"[I]f applicable individual remuneration, deferred deduction remuneration, or a combination of applicable individual remuneration and deferred deduction remuneration that is attributable to services performed by an applicable individual for a covered health insurance provider in a disqualified taxable year exceeds $500,000, the amount of the remuneration that exceeds $500,000 is not allowable as a deduction in any taxable year. To the extent that the aggregate applicable individual remuneration and deferred deduction remuneration attributable to services performed by an applicable individual for a covered health insurance provider in a disqualified taxable year is less than $500,000, the remuneration generally may be deducted by the covered health insurance provider in the taxable year or years in which the amount is otherwise deductible." (Internal Revenue Service)

[Guidance Overview]

Changes in the IRS Independent Contractor Classification Program
"There are two primary benefits to the [voluntary classification settlement program]. First, there are no penalties and no interest, and the payment involved is very nominal.... The second benefit is that the employer and the IRS enter into related to these workers for past years. Therefore participants in the program will relinquish the independent contractor classification prospectively without implicating the past." (Pepper Hamilton LLP)

Hodgson Russ Employee Benefits Developments, March 2013
Articles include: [1] Department of Health and Human Services Issues Final HIPAA Privacy and Security Regulations; [2] IRS Updates EPCRS Process; [3] DOL Updates Delinquent Filer Voluntary Compliance Program; [4] Employee Not Entitled to COBRA Penalties; [5] Court Denies ERISA Claims Involving a Plan Sponsor's Imprudent Investment Decisions; [6] PBGC Properly Denied Shutdown Benefits; and [7] ERISA Does Not Preempt Shareholder Derivative Action for ESOP Participants. (Hodgson Russ LLP)

Trucker Huss Benefits Report, March 2013 (PDF)
Articles include: [1] New HIPAA Privacy and Security Rules -- What Plan Sponsors and Their Business Associates Need to Know to Comply by the September 23, 2013 Deadline; [2] HHS Issues Final Rules on Essential Health Benefits, Actuarial Value, and Accreditation; [3] Target Date Retirement Funds: New Fiduciary Tips; and [4] DOL Extends Transition Period for Temporary NAIC-similar State External Review Process under the ACA. (Trucker Huss)

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David Rhett Baker, J.D., Editor and Publisher
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