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October 8, 2013          Get Retirement News  |  Advertise
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Webcasts and Conferences

ERISA Workshop 2013 - Appleton
November 6, 2013 in WI
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ERISA Workshop 2013 - Chicago
November 7, 2013 in IL
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  LinkedIn   Twitter   Facebook Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
[Official Guidance]

Text of CMS FAQ #2 on Marketplace Subsidy Payment Process for January 2014 (PDF)
6 Questions and Answers, including: What is the cut-off date for issuers to confirm enrollments to the Federally-facilitated Marketplace in order to get paid subsidies for January 2014? What is the regular monthly payment cycle? Is the timeline for January payments the same as for future months? When will I have information about my expected payments for January? [Also issued by CMS: Payment Process Overview in flowchart form.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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[Official Guidance]

Overview of Small Business Health Options Program (SHOP) Marketplace Interactive Voice Response (PDF)
"This diagram outlines the process flow of the Interactive Voice Response (IVR) system and lists the required identifying information users will need when calling the Health Insurance Marketplace for Small Employers." (Centers for Medicare & Medicaid Services)  

[Guidance Overview]

Calculating Income for ACA Premium Tax Credits
"What income counts for premium tax credits? Eligibility for premium tax credits (and for CHIP and for most people in Medicaid) is based on 'Modified Adjusted Gross Income' usually referred to as MAGI. MAGI is adjusted gross income (AGI) determined in the same way as for income taxes plus three types of income that are not included in AGI: excluded foreign income, tax-exempt interest, and the non-taxable portion of Social Security benefits. The reference to the non-taxable portion of Social Security benefits in yesterday's question is confusing. What's the bottom line on how Social Security benefits are counted? The bottom line is that Social Security benefits received by the tax filer and his or her spouse filing jointly are counted. Some Social Security benefits may be in AGI for people who have other income. The modification to AGI to get to MAGI adds in any Social Security benefits that have not already been included in AGI. Stay tuned for more on Social Security benefits received by dependents. What if a child claimed as a dependent receives Social Security benefits? Are those counted as part of MAGI?" (Health Reform: Beyond the Basics)  

[Guidance Overview]

Employer Mandate Toolkit (PDF)
This 11-page "Toolkit" describes the ACA's employer requirements and the penalty for failure to provide health insurance to workers. It includes information about the delay in the mandate to 2015, analysis about its impact on employer-based coverage, and a detailed resource list. (Alliance for Health Reform)  

[Guidance Overview]

The Future of HRAs: Plan Designs and Pragmatic Questions (PDF)
"We want to provide an HRA to employees who have comprehensive group health coverage elsewhere. Is this still allowed? ... [An] 'integrated' health plan can be at the employer or at another employer (such as a spouse's employer's qualifying group health plan). This will likely require a signed certification and/or proof of the other comprehensive coverage ... Can we use our HRA to reimburse individual insurance premiums on the public Exchange/Marketplace? ... the new guidance specifically excludes these arrangements .... What is allowed is a similar approach through a private exchange." (Kushner & Company)  


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[Guidance Overview]

ACA Creates Compliance Challenges for HRAs and Other Arrangements
"Employers that currently offer stand-alone HRAs should consider whether to integrate the HRA with group health plan coverage that satisfies the annual dollar limit prohibition and the preventive services requirement. It may require some drastic changes depending on the nature of the existing plan.... Employers currently offering individual health plan coverage purchased through insurance marketplaces as a qualified benefit under a cafeteria plan will need to amend the plan to drop that option as of the first plan year that begins on or after January 1, 2014." (Perkins Coie LLP)  

[Guidance Overview]

IRS Proposes Reporting Requirements for Plan Sponsors
"Although the proposed regulations allow reporting entities to use a date of birth if a SSN is not available, this alternative should not be used unless the reporting entity has made reasonable efforts to obtain the SSN. According to the preamble, this means that after an initial attempt to collect a SSN, a reporting entity must make two additional (consecutive) annual attempts.... Many employers have been backing away from requiring employees to report social security numbers when enrolling in health coverage. This new reporting requirement may require employers to ... require this information during their next open enrollment." (Seyfarth Shaw LLP)  

[Guidance Overview]

Correcting Employment Taxes for Same-Sex Spouses: Optional Procedures After Windsor
"Employers must take the applicable Social Security wage base into account. This means that if, after excluding the value of same-sex spouse benefits, the remaining Social Security wages are over the wage base, no adjustment of Social Security tax may be made for that employee." (Ogletree Deakins)  

[Guidance Overview]

IRS Releases Optional Streamlined Procedures for Employer Claims for Refunds or Adjustment of Overpaid Employment Taxes on the Value of Benefits Provided to Employees' Same-Sex Spouses
"Notice 2013-61 addresses claims for refunds or credits for federal tax purposes only. Where income was imputed under state tax law for same-sex spouse benefits, employers and employees will need to look to state tax law procedures to determine how the benefits will be treated for state income tax purposes." (Proskauer's ERISA Practice Center)  

Game On! New Technologies Deliver Much-Needed Excitement to Employee Wellness Initiatives
"Gamification can help provide positive rewards through constant feedback on performance and success. Sixty-two percent of surveyed employers reported using one or more game-like features to promote employee health engagement, and 31 percent said they expected to adopt one or more new elements in the coming year. More than 60 percent reported they sponsor contests such as weight-loss or walking competitions, and 37 percent incorporate game-like features such as raffles or lotteries in employee wellness initiatives." (Communication World, a publication of the International Association of Business Communicators)  

The Future of Domestic Partner Benefits
"Although there is still much more guidance to come on the benefit changes employers must make as a result of the ruling, the decision itself raises a new question: Is there still a need for domestic partner (DP) offerings for unmarried couples in a post-Windsor landscape? ... [A]lthough many employers began offering DP benefits because same-sex couples had no option to marry, DP benefits now are often provided to unmarried opposite-sex couples as well." (Society for Human Resource Management)  

Insurers Getting Faulty Data from U.S. Health Exchanges
"Insurers are getting faulty and incomplete data from the new U.S.-run health exchange, which may mean some Americans won't be covered even after they sign up for an insurance plan. While it's not clear how widespread the problem is, the reports from industry consultants are the first hint that the technical troubles faced by consumers trying to enroll in health plans under the Affordable Care Act may also be hitting the insurers. The companies are receiving electronic files that can't open or have so much missing information on new enrollees they're unusable, the consultants said." (Bloomberg)  

Pennsylvania Blues Plan Offers Consumers Choice of 'Health-Care Tiers'
"With two new HMO plans introduced last week on the federal insurance exchange, Independence Blue Cross (IBC) is offering Philadelphia-area consumers a road map to cut out-of-pocket health-care costs. The trick for consumers who sign up for Blue Cross' HMO Proactive plans is to choose hospitals, primary-care physicians, and specialists in the least expensive of IBC's three price tiers of health-care providers. IBC is the largest health insurer in the Philadelphia area, serving more than two million people." (Kaiser Health News)  

Marketplaces Create New Options and Questions for Employees as Open Enrollment Season Begins
"[B]efore making any choices, ... consumers [should] thoroughly research all options to make sure their new choices meet their health and financial needs.... Remember the Tax Man ... Match Your Plan to Your Profile ... Use Available Research Tools ... Read the Fine Print ... Stay Networked." (HighRoads)  

Health Exchange Delays Tied to Software Crash in Early Rush
"Todd Park, President Obama's top technology adviser, said the failure occurred in the part of the Web site that lets people create user accounts at the beginning of the insurance sign-up process. The crash prevented many people from viewing any of their insurance options or gaining access to information on what federal subsidies might be available. 'At lower volumes, it would work fine,' Mr. Park said of the Web site, healthcare.gov. 'At higher volumes, it has problems.'" (The New York Times; subscription may be required)  

Voters to Consider San Francisco Retiree Health Care Shortfall Solution
"San Francisco voters will be asked next month to approve a measure that seeks to eliminate a projected $4.4 billion shortfall in the city's retiree health care fund over the coming decades, all without increasing employee or taxpayer contributions.... Just one city union opposes the measure, which would tackle the deficit by prohibiting the city from raiding a health care fund established in 2011. Prop. A effectively changes retiree health care from a pay-as-you-go model to a fully funded account by 2045." (San Francisco Chronicle)  

Costliest One Percent of Patients Account for 21 Percent of U.S. Health Spending
"These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person.... Nearly all wind up in emergency rooms because they have enormous difficulty navigating the increasingly fragmented, complicated and inflexible health-care system." (Kaiser Health News)  

Factors Linked to Creation of Accountable Care Organizations
"Researchers found wide variation in the geographic distribution of accountable care organizations, with large areas such as the Northwest essentially empty of the organizations. Meanwhile other regions, including the Northeast and the Midwest, are dense with the groups. Factors associated with formation of accountable care organizations include a greater occurrence of payment risk sharing at hospitals, larger integrated hospital systems and primary care physicians practicing in large groups." (RAND Corporation)  

Access and Cost Barriers to Mental Health Care, by Insurance Status, 1999-2010
"Although access to specialty care remained relatively stable for people with mental illnesses, cost barriers to care increased among the uninsured and the privately insured who had serious mental illnesses. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the [ACA]." (Health Affairs)  

Physicians Skeptical of ACA Exchanges
"A majority of physician practices (55.5%) hold an 'unfavorable' or 'very unfavorable' view of the impact the [ACA] health insurance exchanges will have on them ... Almost as many (40.2%) said they were still evaluating their options or planning not to participate with insurance products sold on the exchanges,... Those still weighing their options cited the risk of low reimbursement rates (85%), financial liability during a 90-day grace period for exchange plan enrollees (83%), and concerns about the financial burden of patient collections (82.5%) as barriers to participation." (MedPage Today)  

ML Strategies Health Care Reform Update, October 7, 2013 (PDF)
Update on developments in federal and state health care reform legislation and regulations, including summaries of recent announcements and regulatory activity by HHS, CCIIO, IRS and CMS. (ML Strategies, LLC)  

Trends Underlying Employer-Sponsored Health Insurance Growth for Americans Younger Than Age 65
"Total per capita spending for employer-sponsored insurance grew at an average annual rate of 4.9 percent [between 2007 and 2011], with prescription spending growing at 3.3 percent and medical spending growing at 5.3 percent. Out-of-pocket medical spending increased at an average annual rate of 8.0 percent, whereas out-of-pocket prescription drug spending growth was flat.... [C]hanges in utilization contributed less than changes in price did to overall spending growth for those with employer-sponsored insurance." (Health Affairs)  

[Opinion]

Measuring Obamacare Enrollment Is Actually Kind of Tricky
"The White House will not be releasing data on enrollment in the federal marketplace until November ... We do have some data trickling out from the states right now though -- but even with those initial numbers, deciding who counts as an Obamacare enrollee can be tricky business. That's because there are a number of steps in the application process for health insurance under the [ACA]. And states are using lots of different metrics to determine how well their new insurance marketplaces are going." (The Washington Post; subscription may be required)  

[Opinion]

Obamacare Is a Continuation of the Business Model for Insurance
"Rather than taking us halfway to single payer, Obamacare is a continuation of many decades of government preference for the most wasteful health care financing scheme ever invented: the private, for-profit health insurance business model.... Federal tax policies and state regulations with bipartisan support over many decades have locked Americans into buying health insurance, despite the well documented fact that the health insurance business model features $400 billion per year excess administrative costs and still fails to hold down health care price inflation." (Deseret News)  

Benefits in General; Executive Compensation

2013 Talent Management and Rewards Study -- North America
"With health care reform underway, nearly half of U.S. employers (45%) are considering making changes to their total rewards programs or talent management strategies. Employers continue to take a conservative approach to funding their bonus pools and the average projected bonus funding for current-year performance is 87% of target." (Towers Watson)  

Substantial Health and Economic Returns from Delayed Aging May Warrant a New Focus for Medical Research
"The economic value of delayed aging is estimated to be $7.1 trillion over fifty years. In contrast, addressing heart disease and cancer separately would yield diminishing improvements in health and longevity by 2060 -- mainly due to competing risks. Delayed aging would greatly increase entitlement outlays, especially for Social Security. However, these changes could be offset by increasing the Medicare eligibility age and the normal retirement age for Social Security." (Health Affairs)  

Press Releases

Postponed: Hearing on Proposed Multiemployer Pension Reforms
U.S. House Education and the Workforce Committee

Head of IRS ObamaCare Implementation to Testify Before Oversight Committee
U.S. House Committee on Oversight & Government Reform

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