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April 15, 2013          Get Retirement News  |  Advertise  |  Unsubscribe
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Employee Benefits Jobs

Client Service Representative
for Associated Pension Consultants in CA

Account Services Representative
for Verisight, Inc. in CA

Reviewing Actuary
for Hooker & Holcombe, Inc. in CT

Litigation Associate
for Boutique Employee Benefits Firm in DC

Enrolled Actuary
for Third Party Administration Firm in NC

Participant Service Center - Defined Benefit Pension Plan Administrative Outsourcing
for Savitz Organization in PA

Defined Benefit Analyst, Data Specialist
for The Savitz Organization in PA

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Webcasts and Conferences

Ethics Case Studies One
Nationwide on April 25, 2013 presented by McKay Hochman Co., Inc.

Kitchen Table Economics Forum With Panelist EBRIís Dallas Salisbury
in District of Columbia on April 16, 2013 presented by Washington Post

View All Webcasts and Conferences


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[Guidance Overview]

HIPAA Compliance for Group Health Plans: Next Steps for Employers
"While these steps are most relevant for employers that sponsor self-funded group health plans... employers who provide health benefits to employees through fully insured arrangements must also be mindful of HIPAA requirements. [1] Review and Update Policies and Procedures.... [2] Inventory Business Associates and Prepare for New BAAs.... [3] Update and Distribute the Notice of Privacy Practices.... [4] (Re)Train Your Workforce." (Verrill Dana LLP)


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[Guidance Overview]

HIPAA/HITECH Comprehensive Final Rule Issued
"Plans need to: Update their HIPAA Policies and Procedures to reflect the final rule.... For breach notification, be prepared to conduct a risk assessment ... Confirm that genetic information is not used to set eligibility or cost-sharing rules, to set premium or contribution rates or for other underwriting purposes.... Update notices of privacy practices ... Review existing business associate agreements ... Determine whether certain vendors have now become business associates ... Review liability insurance policies." (Segal)

Doctors Win First Legislative Immunity Against ACA Use in Liability Suits
"Physician leaders hope a first-of-its-kind bill approved in Georgia protecting doctors from civil liability for breaching federal health system reform requirements will be replicated in other states. Medical associations long have been concerned that federal quality-of-care and payment reform measures, such as those authorized by the Affordable Care Act, could be used to fuel negligence accusations against individual physicians." (American Medical News)

Sebelius: Federally-run Exchanges Will Be Ready on Time, So No Need for Backup Plan
"Although many states have refused to set up their own exchanges, several states are willing to take over the marketplaces after the federal government builds them, Sebelius said. 'We are actually in conversations with lots of states' that could see themselves taking over their exchanges down the road, she said." (The Hill)

Obama and Insurance Executives Discuss Health Insurance Exchanges
"Mr. Obama had not been scheduled to attend the meeting, but he presided over the entire hourlong session, which included his chief of staff, Denis R. McDonough, and his health and human services secretary, Kathleen Sebelius. One official called it 'productive,' adding that 'the president discussed our shared goal of educating Americans about the value of health insurance and the new health insurance marketplaces.'" (The New York Times)

How the President's Budget Would Change Medicare
"Higher Cost Sharing for New Medicare Beneficiaries ... Wealthier Beneficiaries Pay More ... Doughnut Hole Closing Faster, Higher Drug Rebates for Low-Income Beneficiaries ... Provider Cuts ... What Obama Left Out." (Kaiser Health News)

Some Insurers, Consumer Advocates Want Go-Ahead for Alternative Payment Methods
"Instead of fee-for-service medicine, in which a provider receives a payment for every test, procedure and visit, providers want the government -- or states or private payers -- to pay for treatment as a whole. In theory, physicians would provide treatments that have been proven to work but are also cost-effective." (USA TODAY)

In Arkansas, It's a Huge Day for Obamacare
"If the Arkansas legislation fails, that does not preclude other states from pursuing the same Medicaid expansion framework. Any state can ask [HHS] for this type of flexibility and work out an agreement. Still, not having Arkansas on board would likely prove a pretty big setback. State legislators and health policy experts ... were waiting on Arkansas as the litmus test." (The Washington Post)

Programs Help Independent Artists Access Health Care
"Freelance artists are part of the estimated 15 million people who are currently self-employed ... They make up 42 percent of the membership at the Freelancers Union, a fast-growing national organization that provides insurance and benefits for its more than 200,000 members. In 2014, the union will also offer three consumer-operated and oriented plans (co-ops) in New York, New Jersey and Oregon, using funding from [CMS] that was authorized in the health law." (Kaiser Health News)

Failings of the ACA High-Risk Pool May Offer Cautionary Tale
"A program created by the Affordable Care Act to provide a bridge health coverage option for people with preexisting conditions fell far short of expectations on access and enrollment, witnesses testified before the House Energy and Commerce health subcommittee." (American Medical News)

ACA Data 'Dashboard' Will Track Chronic Conditions
"CMS said the new 'dashboard' would make it easy for physicians and others in the health system to find current information on where these types of conditions take place, what services these beneficiaries need, and what Medicare spends on them. In 2011, the program spent about 93% of its funding, or $276 billion, on beneficiaries with two or more chronic health issues." (American Medical News)

Employer-Based Health Insurance Continues Rapid Decline
"The rapid decline of employer-based health insurance in the U.S. continues. The ACA may slow or accelerate the trend, but it's a trend far older than the ACA. Instead, the ACA is providing an option for workers in those firms without other ways to find health insurance coverage. This time, Massachusetts is a national laggard -- in a good way." (Boston.com)

Unhealthy Habits Have Growing Effect On Insurance Premiums
"Already, 20 percent of firms surveyed impose consequences on employees if they 'don't utilize the health-awareness tools the company provides,' according to a recent report ... And roughly 60 percent of employers said they plan to impose penalties in the next three to five years for workers who don't take action to improve their health. The shift is drawing fire from patients' rights groups, which consider the policies coercive and a violation of privacy." (InsuranceNewsNet.com)

It's Ok to Grant a Benefit Claim That Was Denied on Appeal Without Saying Why
"[I]nformation only has to be produced that existed prior to the filing of the appeal, but not information received during the appeal process unless the appeal is also denied. If the plan administrator receives subsequent information that makes it want to rescind the original denial, it appears that there would not be an obligation to explain why the reversal occurred. A plan administrator can simply grant the appeal without ever specifying it relied on something other than the participants appeal submission." (Fox Rothschild LLP)

Seven Best Practices in FMLA Intermittent Leave Administration
"While small increments of leave time under the Family and Medical Leave Act may cause administrative headaches, there are various tips and strategies on how to contend with time tracking issues and employee abuse of intermittent FMLA leave." (Thompson SmartHR Manager)

Does the Obama Administration Have the Money to Set Up Obamacare?
"How does HHS handle the country's largest insurance expansion decade -- one that's supposed to come with at least a $5 billion price tag -- on a $1 billion budget? The short answer ... seems to be: By piecing together a patchwork of obscure funding sources ... While HHS has authority to spend any amount on exchange grants to states, it's much more limited on what the agency itself can finance." (The Washington Post)

Examining the President's 2014 Budget Proposal for the Department of Health and Human Services
"The FY 2014 Budget requests $634 million to employ an additional 280 full-time CMS employees to 'oversee expanded responsibilities resulting from the [ACA] and other legislation passed in recent years'.... In addition the Budget requests $350 million in additional funding for approximately 1,000 new employees at the IRS to oversee implementation of the ACA." (Mintz Levin)

Since the Recession, More People Have Gone on Disability Than Have Joined the Labor Force
"[T]he flight to the Social Security Disability Insurance program accounts for one quarter of the drop in labor force participation since the recession ended. In fact, since January 2010, 8.8 million former workers have been awarded SSDI benefits compared to an increase in employment of 5.8 million. According to the latest report, in 2011, less than 0.5 percent of SSDI beneficiaries left the program to work again." (HR Policy Association)

Doctor-Owned Hospitals Prosper Under ACA
"[P]hysician-owned hospitals have emerged as among the biggest winners under two programs in the health law. One rewards or penalizes hospitals based on how well they score on quality measures. The other penalizes hospitals where too many patients are readmitted after they leave.... Of 161 physician-owned hospitals eligible to participate in the [ACA's] quality programs, 122 are getting extra money and 39 are losing funds ... That's a stark contrast with other hospitals -- 74 percent of which are being penalized." (Kaiser Health News)

[Opinion]

The 50-Employee Rule: A Health Care Mandate or Hiring Barrier?
"Under the old calculus, [the decision to hire the 50th employee] would be driven by the typical cost-benefit analysis that rules so many small business decisions. Namely, would this new worker bring with him or her enough productivity to justify the costs of their salary and benefits? And do the firm's -- and the economy's -- future prospects appear rosy enough to warrant this act of faith and bid for future growth? It seems so cut-and-dried. Quaint, somehow. And now wholly outdated by the new regulatory strictures of Obamacare." (PennLive)

[Opinion]

Is Patient Engagement by the Chronically Ill a Solution ... or a Healthcare Urban Legend?
"[This] statistic from the Centers for Disease Control and Prevention never fails to shock: the 133-million adults -- or 'nearly 1 in 2' -- with chronic disease account for 75% of spending. Engaging those high utilizers, the story continues, will help bring healthcare spending under control. This storyline is a classic healthcare urban legend." (The Health Care Blog)

[Opinion]

Michael Novak Anticipated Obamacare 30 Years Ago
"It is easy enough for the planners to tell others what to do. Insurance companies are required cover adult 'children' to age 26, pay for preventive care with no cost sharing, and so on, and they do it. But everything -- everything -- the federal government itself was supposed to do has failed[.]" (John Goodman's Health Policy Blog)

[Opinion]

Health Insurance Exchanges Should Incorporate Lessons Learned from Abroad
"Although it's a radical idea for us Americans to think of shopping for our health insurance coverage through an online marketplace, it's commonplace in other countries ... Those countries have been regulating exchanges since the 1990s, successfully leveling competition throughout the insurance markets and enrolling thousands of people in health plans." (FierceHealthPayer)

Benefits in General; Executive Compensation

ERISA Reporting and Disclosure Guide for Retirement, Health and Welfare Plans (2013 Edition)
"The Guide is useful in: [1] Identifying forms to be filed and distributed annually. [2] Developing controls for compliance, including an internal calendar for reporting and disclosure. [3] Determining and coordinating reporting and disclosure items for actuaries, attorneys and accountants to prepare. [4] Identifying special reporting and disclosure requirements for plan installation, amendment, termination, etc. [5] Evaluating administrative considerations in establishing a new or supplemental plan. [6] Advising on responsibility for compliance with the reporting and disclosure rules." (PricewaterhouseCoopers)

Workers Want Better Benefits Communication
"Individuals whose employers offer benefits are nearly unanimous (98%) in saying it's at least somewhat important to understand the benefits provided to them by their employer, and a strong majority -- 73% -- say it's very important.... Only 60% of those surveyed said [their employer's communication is] fairly or very effective, and 9% said it's not at all effective." (Wolters Kluwer Law & Business)

Press Releases

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