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November 18, 2013          Get Retirement News  |  Advertise
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Defined Contribution Client Manager
Milliman
in OR

Senior Associate, Research, States' Public Sector Retirement Systems
The Pew Charitable Trusts
in DC

Plan Administrator
Benefits of Missouri, Inc.
in MO

Plan Document Specialist
Beneco
in AZ

Defined Benefit Plan Administrator
Boyce & Associates, Inc.
in AZ

Retirement Plan Analyst
Actuarial Consulting Group
in VA

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[Guidance Overview]

Agencies Issue Mental Health Parity Final Regs and Implementation FAQs
"The final regulations and FAQs contain a number of other clarifications, including a procedure and formula for calculating increased costs for purposes of the increased cost exemption and specific disclosure standards for mental health/substance use claims denials. They also eliminate an exception from the interim final regulations that authorized the application of nonquantitative treatment limitations based on 'recognized clinically appropriate standards of care.' Although the regulations are not applicable for many plans until 2015, plan sponsors and service providers will want to begin analyzing the impact of these comprehensive rules on plan design." (Thomson Reuters / EBIA)  


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[Guidance Overview]

Ten Facts About the ACA and Worker Classification
"[T]he ACA focuses new attention on, and further complicates, the already tricky area of law governing the definition of 'employee' and the proper classification of workers as either employees or independent contractors. This list highlights the ACA's requirements, the standards expected to apply in determining the number of employees for that purpose, the broader implications of proper worker classification and the serious risks of misclassification, as well as various existing remedial programs and guidelines for helping ensure workers are properly classified." (Latham & Watkins)  

[Guidance Overview]

HHS Requests Comments on Proposed Health Plan Quality And Enrollee Satisfaction Ratings
"Development of the QRS has not been the highest priority for HHS and implementation and has lagged behind other exchange functions and QHP requirements. The foundation for QRS implementation was laid in the 2012 exchange and QHP rules, however, and QRS implementation takes another step forward with this notice. Rulemaking and guidance to implement the QRS will follow." (Health Affairs Blog)  

Vision Benefit Breaks Out of Its Silo
"[T]he eye-health provider receives the patient's larger medical history and then shares the results of the eye examination back into the system. From there it goes into the member's clinical profile where it is subject to a monthly risk stratification algorithm. This triggers an appropriate response, which can range from something as innocuous as a postcard to the employee to a call from a health coach to an alert to the primary-care physician.... [T]his system is 'leveraging every encounter in healthcare,' which will ultimately lead to a total healthcare-cost model." (Human Resource Executive Online)  

Bigger May Not Be Better: Does Scale Matter for Payors?
"[As] scale increases, the incremental costs driven by greater complexity begin to counteract the economies of scale.... [P]ayors with greater than one million covered lives tend to have more lines of business and to operate in many more states than smaller payors do, and they seem to have higher administrative costs.... [S]maller payors often have much greater standardization of products and processes, and are more likely to outsource IT platforms and core functions. Because their business is less complex, they often appear to be better able to make the most of the efficiencies derived from economies of scale." (Health Affairs Blog)  


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American Hospital Association: Hospitals Can Pay Patients' Health Insurance Premiums
"The federal government has no legal authority to prohibit hospitals from paying their patients' insurance exchange premiums to encourage their enrollment, despite a [CMS] statement implying that it does, according to a sharply worded legal advisory from the American Hospital Association [AHA]. What's more, there is clearly no prohibition against hospital-affiliated charitable foundations, or unrelated charities, paying these premiums on behalf of patients, the AHA said ... The financial assistance may be especially helpful to those would-be enrollees whose federal subsidies aren't enough to make coverage affordable." (HealthLeaders Media)  

Health Insurers Face an Uncertain Future
"The law 'could increase the market size for individual health insurance by more than five-fold by 2020, raising the number of individual policy holders to approximately 72 million in 2020,' according to [a 2012] Deloitte study. That larger individual market could entice banks, smaller insurers and large retailers to enter ... Wendell Potter, a former insurance executive turned industry watchdog and consumer advocate ... predicted the insurance giants will have a hard time competing against smaller players, including nonprofit insurers, in the exchanges.... He contends the new law 'will signify the beginning of the end of the health insurance industry as we know it.'" (Kaiser Health News)  

High-Risk Patients Fuel More ACA Worry
"[S]ome states are taking a second look and considering extending their [high-risk] pools' lives. Such extensions could cost taxpayers money since some states contribute to the cost. In other states, insurers fund a large portion.... While the moves would keep some people with illnesses out of the new insurance exchanges for a short time, they are an example of how insurers' assumptions about the health law keep getting upended." (The Wall Street Journal; subscription may be required)  

Obamacare Gives States Innovation Grants to Cut Costs, Improve Quality
"Out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs.... Under the innovation grant program, states must convince private insurers, major employers and Medicare to join their experiments, in the hope that their combined market power will force even the most prestigious health care providers to pay attention ... [The linked article includes] a rundown of what each state plans to do with its ACA grant:" (Pew Center on the States)  

Healthcare.gov Goal Is for 80% of Users to Be Able to Enroll for Insurance
"The goal for how many people should be able to make it through the insurance exchange is an internal target that administration officials have not made public. It acknowledges that as many as one in five Americans who try to use the Web site to buy insurance will be unable to do so. The measure is the first concrete performance standard in the 3-1/2 years since the government began to design the health exchange, and was defined by a group of federal officials and technical experts in late October." (The Washington Post; subscription may be required)  

One in Three Exchange Enrollees Is in California
"The majority of those enrolled through California's insurance marketplace so far tend to be older than average and not eligible for financial subsidies, [Covered California Executive Director Peter] Lee said. 'These are people who have been waiting for a long time to get coverage,' he said. Lee said he expected that, over time, more young people would sign up." (MedPage Today)  

Florida Regulator, Blues Plan Agree to Insurance Fix
"Most carriers will be unaffected because the state had already allowed Aetna, Humana, Coventry and Cigna to offer members the option of renewing their 2013 policies before the end of this year ... [T]he state's Blue Cross and Blue Shield affiliate said it planned to follow the president's suggestion to extend policies ... Eventually, all of its 300,000 policyholders could be given the same option when their policies expire next year. [Florida Insurance Commissioner Kevin] McCarty said Florida Blue would not raise rates on policyholders whose coverage was slated to end in December because it's too late for the insurer to meet the state's 45 days notice requirement to consumers." (Kaiser Health News)  

[Opinion]

ERIC Asks IRS to Further Simplify ACA Employer Information-Reporting Requirements
"'We suggest that instead of this elaborate, expensive, and cumbersome reporting structure, that the government shift its focus from individualized reporting to one that will permit large employers merely to certify that they have covered 95% of their full-time employees, thus satisfying their obligations under Code section 6056,' [Richard Stover, Principal and Consulting Actuary of Buck Consultants] said. ERIC further recommended that an employer be given the option to satisfy the requirement for the section 6055 reporting by posting a notice on the company's website that employees may obtain specific coverage information upon request." (The ERISA Industry Committee [ERIC])  

[Opinion]

A Conservative Cure for Obamacare
"What strategy, then, would move us closer to the patient-and consumer-focused health-care system that conservatives desire while also recognizing the facts on the ground? ... Propose changes that will make plans more affordable and drive enhanced competition among insurers and providers ... [H]igh-deductible, HSA-eligible plans have an opportunity to capture significant new market share on the exchanges.... [E]ncourage more competition between insurance plans by repealing Obamacare's community rating provisions ... [O]ffer true consumer choice in terms of benefits and coverage... [C]atastrophic plans should also be eligible for subsidies." (Bloomberg)  

[Opinion]

Healthcare Reform: Stop Digging and Start Over
"[W]hat Obama presented Thursday as a favor looks like one more mess for state governments, insurers and ... American citizens. Under the policy Obama articulated, the states and insurers aren't required to do anything. The American citizens? Under Obamacare, they're still required to have health insurance. Or pay a government fine.... Obama doesn't want to reopen this law for fear that Republicans and some Democrats will substantially rewrite it. But that's what has to happen." (Chicago Tribune; subscription may be required)  

[Opinion]

The Only Obamacare Fix Is to Legalize Real Health Insurance
"What most people consider health 'insurance' is actually genuine insurance combined with inefficient pre-paid medical care.... [We] don't use car insurance to cover routine predictable expenses such as oil changes.... Three concrete steps that would allow Americans to buy real health insurance: [1] Eliminate the tax disparity between employer-provided health insurance and individually-purchased health insurance.... [2] Eliminate all mandated benefits. Insurers should be free to offer to willing consumers inexpensive policies covering only catastrophic accidents and illnesses.... [3] Allow insurers to sell policies across state lines." (Paul Hsieh in Forbes)  

[Opinion]

Insurance Industry Ready While Healthcare.gov Struggles
"It took the insurance industry months to get ready for Obamacare's rollout. They had to create entirely new insurance plans to comply with the new rules. They had to create new rate tables, reformat their provider networks in order to make these government mandate-rich products more affordable and completely reprogram their computer systems to handle it all.... But the President is now telling the insurers to turn their product offerings and computer system on a dime in less than a month?" (Robert Laszewski in USA TODAY)  

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