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December 24, 2013          Get Retirement News  |  Advertise
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[Official Guidance]

Text of IRS Corrections to Final Regs on Shared Responsibility Payment for Individuals Not Maintaining Minimum Essential Coverage
"This document [FR Doc. 2013-30742] contains corrections to final regulations (TD 9632) that were published in the Federal Register on Friday, August 30, 2013.... If a territory of the United States elects to establish an Exchange ..., a qualified health plan offered by that Exchange is a plan in the individual market.... For each individual, affordability ... is determined separately for each period ... that is less than a 12-month period." (Internal Revenue Service)  


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[Official Guidance]

Text of Additional IRS Corrections to Final Regs on Shared Responsibility Payment for Individuals Not Maintaining Minimum Essential Coverage
"This document [FR Doc. 2013-30740] contains corrections to final regulations (TD 9632) that were published in the Federal Register on Friday, August 30, 2013. The final regulations provide guidance to individual taxpayers on the liability under section 5000A of the Internal Revenue Code for the shared responsibility payment for not maintaining minimum essential coverage." [Editor's note: These appear to be generally technical corrections.] (Internal Revenue Service)  

[Official Guidance]

CMS Basic Health Plan State Report for Health Insurance Exchange Premiums: Submission to OMB with Request for Expedited Approval
"CMS is requesting that an information collection request to support the development of federal payment rates for the Basic Health Program (BHP) be processed under the emergency clearance process ... [T]he BHP is federally funded by determining the amount of payments that the federal government would have made through premium tax credits (PTCs) and cost sharing reductions (CSRs) for people enrolled in BHP had they instead been enrolled in an Exchange.... CMS recently determined that it does not have sufficient data from State Based Exchanges (SBEs) to determine the reference premiums for their [second lowest cost silver plans] and lowest cost bronze plans. Reference premiums are foundational inputs into the BHP payment methodology." [Includes Supporting Statements Part A and Part B.] (Centers for Medicare & Medicaid Services)  

[Guidance Overview]

DOL, HHS and Treasury Propose Amendments to Excepted Benefits
"Among other requests for input, [DOL, HHS and Treasury] are asking interested parties the following: How many employers offer coverage that provides minimum value and is affordable for a majority of the employees who are eligible for coverage? What is the total number of individuals who are eligible for primary plan coverage that provides minimum value and is affordable for a majority of eligible employees, but would not find it affordable? To what extent would this proposed rule cause employers to drop health insurance coverage or avoid newly offering it, and what is the dollar value associated with such dropped coverage? To what extent would wrap-around coverage be offered more widely as a result of this rule, and what is the average dollar value associated with such coverage? To what extent would premiums for relatively generous health coverage change in the presence and in the absence of this rule?" (Littler)  

[Guidance Overview]

Agencies Issue Proposed Regulations on Excepted Benefits
"[DOL, HHS and Treasury ('Agencies')] propose to eliminate the requirement that individuals must pay a premium or other contribution in order for otherwise limited scope dental and vision coverage to be an excepted benefit.... [T]he Agencies propose four criteria that must be satisfied in order for an EAP to be an excepted benefit.... [W]raparound coverage would only qualify as excepted benefits if five conditions are met[.]" (Seyfarth Shaw LLP)  

Day Is Added to Deadline as Rush Hits Health Portal
"More than one million people had logged on to the site by 5 p.m.... five times more than the previous Monday.... More than 60,000 people provided an email address on Monday to get invitations to return ... The high volume of visitors also prompted White House officials to abruptly establish a 24-hour grace period that will effectively extend the deadline, allowing those who sign up on Tuesday to still receive coverage from Jan. 1. Officials compared the last-minute decision to the kind often made by election officials to keep a polling place open late into the night to accommodate voters already in line at closing." (The New York Times; subscription may be required)  

Rule Change on Health Insurance Rattles Industry
"[AHIP's Karen] Ignagni expressed concern about any erosion of the 'individual mandate' requiring most Americans to carry health insurance or pay a penalty. That is the rock to which [insurers] have clung these past four years because it would bring new customers to her industry's product.... Having failed to kill the [ACA] when it was being debated in Congress, AHIP members are now pushing, tweaking and giving a little in hopes of getting a bit more. If the law works as it was designed to, insurers would reap billions of dollars in new policies. If it doesn't, the industry ... will share in the blame." (The Wall Street Journal; subscription may be required)  

Obamacare's 'Orphans' and 'Ghosts' May Have Trouble Getting Care in January
"Patients with mismatched files may find that their doctors or pharmacists can't confirm that they have insurance next year. Such problems were widespread in 2006, when the government created a new drug benefit for Medicare patients, and the health-care industry is bracing for a replay of those chaotic days." (Bloomberg BusinessWeek)  

Operational Guidance for Issuers Conducting Operations with the Marketplace (PDF)
17 presentation slides address enrollment verification and data discrepancies and issues, including: Different QHP ID; Invalid/unsupported relationship codes; Total responsibility amount not equal to total premium less APTC; Missing dependents on policy; Consumer enrolled in plan in the wrong state; and Duplicate dependent in enrollment group. (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

ML Strategies Health Care Update, December 23, 2013 (PDF)
"The CMS Innovation Center released a Request for Information ... asking for input on the next version of Pioneer Accountable Care Organizations (ACOs). The Pioneer ACO program was the first ACO program launched by CMS. Using Innovation Center authority it is also more aggressive, with greater risk and reward, designed for providers with greater experience delivering coordinated care." (ML Strategies, LLC)  

Health Care Spending: A Giant Slain or Sleeping?
"Health care spending increased by only 0.8 percent in 2012, slightly less than the rise in gross domestic product per capita. This is a considerable slowdown: since 1969, annual health spending had increased an average of 2.3 percentage points more than GDP growth.... Some see the moderation in spending as part of slow recovery from the recession of 2007-09, and they fully expect costs to surge as the economy recovers. But others believe recent efforts to control health spending -- including some features of the [ACA] -- may be working." (The Commonwealth Fund)  

Consumers Beware: Not All Health Plans Cover a Doctor's Visit Before the Deductible Is Met
"Those who've bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims. But first-time insurance buyers may not realize they're on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums. Bronze and silver plans -- which have lower monthly costs but typically, higher deductibles -- are the most likely to require consumers to spend that amount themselves before the insurer pays any claims." (Kaiser Health News)  

[Opinion]

Price Transparency and the Cure for Healthcare Costs
"The obvious antidote to price opacity is price transparency, but such transparency may have a range of effects, depending on where it is applied in the many layers of health-care delivery.... Transparency, as a concept, has tremendous visceral appeal. How can more information not be better? But information is not knowledge, and efforts to bring transparency to health care have previously failed, or caused unintended harm." (The New Yorker)  

Benefits in General; Executive Compensation

Supreme Court Upholds Plan-Imposed Limitations Periods for ERISA Benefit Claims (PDF)
"The decision affords added flexibility and protection in defending claims, but by no means provides blanket protection for any and all types of statutes of limitations periods that are, or may be, incorporated into plan documents.... A plan limitation provision of three years is well-within the ambit of reasonableness and courts are likely to find that limitation terms of 12 months or more are also reasonable; going forward, it is unclear whether plan limitation periods of less than 12 months are enforceable." (Groom Law Group)  

Year-End Health and Retirement Plan Guidance Grab Bag
Topics include: FICA and Medicare tax refunds for individuals treated as married for tax purposes due to the Windsor decision; other compliance changes resulting from the Windsor decision, including election changes under cafeteria plans and administration of flexible spending accounts; the Supreme Court's recent decision that allows enforcement of some statutes of limitation in plan documents; IRS guidance on nondiscrimination requirements as applied to soft-frozen defined benefit plans; and IRS guidance on in-plan Roth conversions. (Winstead PC)  

The 2013 Directors Compensation Report (PDF)
"Director compensation levels have stabilized since the introduction of the Dodd-Frank act, with recent increases in the low to mid single digits (i.e., 3% to 6%). Compared to last year, small-cap companies had the largest increase in total director compensation. Director workload and oversight continues to increase, especially for Compensation Committee members, in light of regulatory changes like say-on-pay and mandated risk assessments." (Frederic W. Cook & Co., Inc.)  

Press Releases

US Department of Labor Files Suit Against Home Valu Inc. and Fiduciaries of Employee Health Plans
Employee Benefits Security Administration (EBSA), U.S. Department of Labor

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