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November 19, 2013          Get Retirement News  |  Advertise
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Employee Benefits Jobs

Actuary - Remote/Virtual
The Retirement Plan Company, LLC

Data Conversion Specialist
Transamerica Retirement Solutions
in NY

Direct Retirement Sales Specialist
Nationwide Insurance
in KY

Trust & Retirement Services Associate
Westwood Trust
in TX

Member Services Representative
DC Retirement Board
in DC

Retirement Plan Administrator
Warren Averett Staffing & Recruiting
in AL

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Webcasts and Conferences

Health Insurance Marketplaces: The First 8 Weeks
November 22, 2013 in DC
(Alliance for Health Reform)

Employee Benefits Conference
December 3, 2013 in IL
(Illinois CPA Society)

Making Sense of Required Minimum Distributions
December 5, 2013 WEBCAST
(SunGard Relius)

Litigation Risks Related to the Patient Protection and Affordable Care Act (PPACA)
December 11, 2013 WEBCAST

Surviving DOL Investigations of Plans: Part II
December 18, 2013 WEBCAST
(Drinker Biddle & Reath LLP)

View All Webcasts and Conferences

  LinkedIn   Twitter   Facebook Hand-picked links to the web's best news articles,
official guidance, jobs, webcasts and more.
[Official Guidance]

CMS Submission to OMB: Medical Loss Ratio (MLR) Report for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
"MA organizations and Part D sponsors are required to report their MLR to CMS, and are subject to financial and other penalties for a failure to meet a statutory requirement that they have an MLR of at least 85 percent. The Affordable Care Act requires several levels of sanctions for failure to meet the 85 percent minimum MLR requirement, including remittance of funds to CMS, a prohibition on enrolling new members, and ultimately contract termination. Plan sponsors will use the MLR Reporting Tool to provide contract-level MLR information to CMS. The information provided in this MLR Report is the basis for computing the contract's MLR percentage and remittance amount, if any, for a contract year." [Editor's note: Click "All" to see full submission; also available are Supporting statement, along with Response to public comments and Revisions in response to comments.] (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  


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[Guidance Overview]

ACA Subsidy Eligibility for Individuals Over 25
A flow chart with detailed explanation of terms; includes income and other coverage considerations. Also available is a similar chart for individuals under 26 years of age. (Moulder Law)  

[Guidance Overview]

Treasury and IRS Issue Proposed Rules on Reporting Requirements for Employers and Group Health Plans (PDF)
"There is considerable overlap between the two reporting requirements. Although the Treasury indicated that they were attempting to avoid unnecessary reporting and duplication, the provisions in the proposed regulations will create new administrative burdens for plan sponsors (and insurers), and in some cases, appear to go beyond the information needed for enforcement purposes. Originally effective starting in 2014, the Treasury previously delayed the effective date until 2015 (along with the delay in the employer penalty provisions). Thus, the first required reports will occur in early 2016, based on information for 2015." (Alston & Bird, LLP)  

[Guidance Overview]

How the Federal Common Law Rules of Agency Apply to Determine Liability Under the HIPAA Privacy and Security Rules
"Whether a [business associate (BA)] is a [covered entity's (CE's)] agent is a fact-specific analysis that takes into account: The terms of a BA agreement. The full circumstances of the parties' ongoing relationship. The essential factor in determining whether an agency relationship exists between a CE and its BA (or a BA and its subcontractor) is the authority of: A CE to control the BA's conduct in performing services on the CE's behalf. A BA to control the BA-subcontractor's conduct in performing services on the BA's behalf." (Practical Law Company)  

[Guidance Overview]

Changes Coming in 2014 for Small Business Health Care Tax Credit
"Employers will only be eligible for the credit if they purchase health insurance through the new Small Business Health Options Program (SHOP).... Other upcoming changes include: [1] The maximum credit increases to 50 percent (35 percent for tax-exempt organizations); [2] The $50,000 and $25,000 average annual dollar amounts will be indexed for inflation; and [3] The credit is based on the lesser of the employer's actual premium payments or the average premiums in the small group market in its employees' rating area." (McGladrey)  

California Orders Insurers to Cover Speech, Occupational Therapy
"[California's] HMO regulator [has] issued 'cease and desist' orders ... against Health Net, Anthem Blue Cross and Blue Shield of California for denying members medically necessary speech and occupational therapy.... Some of the treatment denials -- but not all -- relate to autism, a contentious issue for health plans. Plans have traditionally considered applied behavioral therapy, which includes intensive speech and occupational therapy, educational rather than medical -- and refused to pay for it. That changed July 1, 2012, when state law mandated coverage." (The Business Journals)  

Paving a Way to Greater Flexibility
"On Oct. 9, San Francisco became the first municipality to pass an ordinance that gives employees working in the city the right to request changes in their working arrangements in order to meet their caregiving responsibilities. The legislation also prohibits employment discrimination based on a person's status as a caregiver or parent. Coming on the heels of a similar bill enacted in Vermont this past May, some experts predict other cities and states could soon follow Vermont and San Francisco's lead." (Human Resource Executive Online)  

Healthcare Plan Enrollment Surges in Some States After Rocky Rollout
"A number of states that use their own systems, including California, are on track to hit enrollment targets for 2014 because of a sharp increase in November, according to state officials.... Several other states, including Connecticut and Kentucky, are outpacing their enrollment estimates, even as states that depend on the federal website lag far behind." (Los Angeles Times)  

Majority in U.S. Say Healthcare Is Not a Government Responsibility
"The 56% of U.S. adults who now say it is not the federal government's responsibility to make sure all Americans have healthcare coverage continues to reflect a record high. Prior to 2009, a clear majority of Americans consistently had said the government should take responsibility for ensuring that all Americans have healthcare." (Gallup)  

Stabilizing Premiums Under the ACA: State Efforts to Reduce Adverse Selection
"Several states are going beyond [ACA] provisions to protect consumers from health insurance premium increases caused by 'rate shock.' This report analyzes 11 states and finds that officials are taking different approaches to protecting consumers." (Robert Wood Johnson Foundation)  

Obamacare Failure May Shave 30% From U.S. Drug Sales
"Potential shortfalls in enrollment for President Barack Obama's health-care overhaul would put a 30 percent dent in projections for U.S. prescription-drug sales in 2017 ... That worst-case scenario would translate to $320 billion in drug spending, according to the report. The best case is supposed to be $460 billion, boosted by demand from the health law's expansion of insurance coverage and medical screenings, and removal of restrictions on pre-existing conditions." (Bloomberg)  

Text of Amicus Brief of 40 Congressmen Challenging Origination of the ACA in the U.S. Senate (PDF)
57 pages. Excerpt: "In every plain English language sense of the word both today and in 1789, ACA 'originated' in the Senate as Senator Reid's self-described 'Senate Health Care Bill.' The only part of ACA that originated in the House was the bill number -- and chamber-specific bill designators did not even exist in the early Congresses." [Sissel v. HHS, No. 13-5202 (D.C. Cir.), brief dated Nov. 8, 2013] (U.S. House Judiciary Committee Chairman Rep. Trent Franks and 39 other Members of the House of Representatives)  

Pros and Cons of the President's Policy Fix for Health Plan Cancellations
"While the president's proposal could help provide temporary relief to people whose plans no longer meet the law's consumer protections, the policy also carries risk, foremost of which is higher premiums for the millions of people expected to gain coverage in the marketplaces in the coming years.... But these risks will likely be mitigated by at least three factors: [1] the law's transitional risk corridor program; [2] the comparatively small number of people who are affected and will maintain their old plans; and [3] improvement in the performance of the marketplace websites." (The Commonwealth Fund)  

ML Strategies Health Care Reform Memo, November 18, 2013 (PDF)
Items include: Cancellation Plan Fix; Will cholesterol-fighting medicines become even more widely prescribed; Initial Enrollment Numbers Released; Oversight Hearing on Website Rollout; Request for QHP Comments; and Hearings and Mark-Ups Scheduled. (ML Strategies, LLC)  

Reference Pricing: Will Price Caps Help Contain Healthcare Costs?
"Reference pricing can help raise awareness among patients about price differences across service providers, and exert competitive pressure on high-cost providers to bring down their prices. But questions remain about this benefit design and the problems it aims to solve." [Briefing held November 18; speakers include: Andr?a Caballero, program director at Catalyst for Payment Reform; Theresa Monti, vice president at Total Rewards at Kroger; David Cowling, chief of the Center for Innovation at CalPERS; and Michael Belman, medical director at California WellPoint. Available are: full video of briefing, text of speaker presentations, additional source materials, and offsite reference materials.] (Alliance for Health Reform)  

New York State Plans Say 'No Thanks' to Obamacare Fix
"'Just trying to go back and recreate a product that you've eliminated is not something that plans are looking forward to with great enjoyment,' Leslie Moran, vice president of the New York Health Plan Association said. Besides, nobody is really sure New Yorkers want their old plans back anyway. Premium increases on New York plans have been among the most modest in the country[.]" (The Health Care Blog)  

White House Considers Allowing Insurers to Bypass Healthcare.gov for Enrollments
"Giving big insurers a prominent role in signing up customers 'undermines the very essence of the [health law] and would not be in the interest of the consumer,' [said Cliff Gold, chief operating officer at CoOportunity Health]. 'In the rush to get people enrolled, we hope that mistakes won't be made that will reinforce the existing insurance model.' While some insurers are enthusiastic about being involved more directly with customers, they have technical concerns. In particular, they say any new tool to calculate enrollees' eligibility for tax credits needs to be accurate and binding." (The Wall Street Journal; subscription may be required)  


Justice Department Brief Admits Group Health Plans Will Be the Next Casualty
"On October 17, the Obama Department of Health and Human Services, represented by the Obama Justice Department, submitted a brief to the federal district court in Washington, opposing Priests for Life's summary judgment motion. On page 27 of its brief, the Justice Department makes the following remarkable assertion: ... Even under the grandfathering provision, it is projected that more group health plans will transition to the requirements under the regulations as time goes on. Defendants have estimated that a majority of group health plans will have lost their grandfather status by the end of 2013." (National Review)  


How Obamacare's Fear of Further Failure Is Becoming an Impediment to Success
"Forcing the system to do the heavy lifting of registration and verification before people could even read the site crashed the servers. So the Obama administration decided to open up window shopping.... It might be working fine. But it's a horrible user experience.... Fight through it, and, finally, after all that, you can browse some plans. There's no estimate of subsidies, or of the way your age will affect your premiums. And this simple, not-particularly-helpful information is only accessible after navigating, by my count, eight separate pages, each covered in intimidating explanatory text and discouraging warnings. It's a mess. And it doesn't need to be." (Ezra Klein and Evan Soltas in The Washington Post; subscription may be required)  


This Is Pretty Amazing: Insurance Commissioners Suddenly in the Limelight
"Overnight, the insurance commissioners became gatekeepers for a crucial White House priority -- and a target of massive media attention. The regulators who spend most their days pouring over insurance filings are, all of a sudden, turning up in prime-time television[.]" (John Goodman's Health Policy Blog)  


Twenty-Seven Significant Changes to Obamacare
"[E]ven this large number of changes hasn't stopped the cascade of failures we are seeing today.... [A list] shows those made by the Obama administration before the president's most recent announcement; those made by the 111th Congress (with Democratic control of the House) and signed by President Obama; changes made by the 112th and 113th Congresses (with Republican control of the House) and signed by the president; and those made by the U.S. Supreme Court." (Galen Institute)  


UnitedHealthcare Drops Doctors; Medicare Advantage Patients Left in Lurch
"Last month, just as Medicare's open enrollment period was set to begin, UnitedHealthcare dropped thousands of physicians nation-wide ... from its Medicare Advantage programs without an explanation. Who are these physicians and why were they dismissed from United's Medicare Advantage plans en masse without being dropped from any of United's commercial programs? Company executives remain notably tight-lipped despite public inquiries from physicians, newspapers and lawmakers.... Based on the information available, it is clear that the company's end goal is to unload its sickest, costliest patients." (Hartford Courant)  


The Exchanges Aren't Working, and Here's Why
"In many ways, the first dollar coverage for preventive care and the wide ranging number of services covered by the ACA aren't truly insurance ... Instead, these features amount to a very generous pre-payment plan for medical services supported by the United States treasury.... [T]he President should have used the recent attention on the individual market as an excuse to pause, and carefully reconsider whether the [Essential Health Benefit] has actually been set far too high. Doing so would allow insurers to develop innovative benefit designs to create health insurance plans that provide quality coverage without exacerbating the growth of medical spending." (The Health Care Blog)  

Benefits in General; Executive Compensation

BLS Employment Cost Index, September 2013 (PDF)
"Compensation costs for civilian workers increased 0.4 percent, seasonally adjusted, for the 3-month period ending September 2013 ... Benefits (which make up ... 30 percent of compensation) increased 0.7 percent ... Benefit costs increased 2.2 percent for the 12-month period ending September 2013, compared with the 2.4 percent increase for the 12-month period ending September 2012.... The increase in the cost of benefits [for private-industry workers] was 2.0 percent for the 12-month period ending September 2013, compared with a 2.2 percent increase in the period ending in September 2012. Health benefit costs increased 2.7 percent. In September 2012, the increase was 2.3 percent." (U.S. Bureau of Labor Statistics)  

ISS Accepting Peer Group Updates Starting November 20, 2013
"ISS will be accepting updates to Russell 3000 companies' self-selected peer groups from November 20, 2013 [through] December 9th.... If your company revised its peer group since last year's proxy and used this revised peer group for compensation decisions that were made for the year that will be required to be disclosed in your next proxy ... for shareholder meetings between February 1, 2014 and September 15, 2014, you should consider participating so that ISS has your correct self-selected peer group when it develops its own peer groups for assessing your company[.]" (EdwardHauder.com)  

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