401(k) Administrator
Pollard & Associates, Inc.
in MD

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FSA Regs Transformed: Employer Action Items -- Recorded
January 13, 2014 WEBCAST
(Employee Benefit Adviser)

Wellness Plan Trends for 2014 -- Recorded
January 16, 2014 WEBCAST
(Employee Benefit Adviser)

Understanding the Patient Protection and Affordable Care Act Workshop
February 27, 2014 in MA
(Employee Benefits Security Administration (EBSA), U.S. Department of Labor)

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[Official Guidance]

Text of CMS Statement of Organization, Functions, and Delegations of Authority
"CMS modified its structure to: [1] conduct Marketplace eligibility appeals; [2] assist Medicare beneficiaries with complaints, inquiries, and grievances, and to gather the information necessary to file Medicare appeals; and [3] conduct administrative hearings for institutional appeals which fall under the jurisdiction of the Provider Reimbursement Review Board, the Medicare Geographic Classification Review Board, and the CMS Hearings Officers." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Advert.]

Leverage the On-Site Clinic Experience to Expand Employee Access and Drive Down Costs

Putting in motion changes to the healthcare delivery model is the only true way to drive down health care costs. Our 2014 event gives you access to the industry's leading minds, most innovative employers and case studies. March 11-12, Orlando. BLINK3 for discount.

[Guidance Overview]

San Francisco Authorizes Use of HRAs to Satisfy HCSO Spending Requirement
"Beginning on January 1, 2014, the [ACA] effectively bans new credits to HRAs unless the HRAs are 'integrated' with other health coverage or are excepted benefits. Preserving the stand-alone HRA option for San Francisco employers, the City of San Francisco will now allow a credit to this type of excepted benefit HRA to satisfy the City's spending requirement for up to 20 hours per week per covered employee. The HRA must provide full reimbursement without restrictions for all excepted benefits that qualify as health care expenditures." (Nixon Peabody LLP)  

Portland Sick Leave Mandate Catches Vancouver Businesses Off-Guard
"'A small Vancouver company with a single employee who telecommutes only one day per week from their home in Portland now has to grapple with this law,' said Clarence Belnavis, an employment law attorney at Fisher & Phillips LLP. 'The sales person who regularly meets clients for lunch or coffee in Portland may also be covered... The reality is that Washington employers need to review the nature of the work being performed by their employees to verify which individuals are covered.' Portland will join Seattle, San Francisco, Connecticut and Washington, D.C. as the only jurisdictions in the United States that require employers to provide sick leave." (Vancouver Business Journal)  

Supreme Court Temporarily Allows Religious Groups Not to Cover Contraceptives
"The ruling applied not only to the Little Sisters of the Poor, a nonprofit group that provides services to low-income elderly people, but also to more than 200 other faith-based groups that use insurance offered by the Christian Brothers Employee Benefit Trust, which adheres to Catholic principles.... The ruling did not apply more broadly. The vast majority of Catholic dioceses and other groups that oppose the contraceptive mandate did not go to court over it, and thus in many cases must provide the coverage or be fined." (The Washington Post; subscription may be required)  

Justice Sotomayor Blocks Enforcement of Contraception Mandate for Catholic Health Plan in Colorado
"Acting at the request of an order of nuns in Colorado, Justice Sotomayor issued the stay just hours before the requirement was to go into effect on New Year's Day. She gave the Obama administration until Friday to respond to the Supreme Court. Justice Sotomayor's order applies to the nuns, the Little Sisters of the Poor, and other Roman Catholic nonprofit groups that use the same health plan, known as the Christian Brothers Employee Benefit Trust. The groups' lawsuit is one of many challenging the federal requirement for contraceptive coverage[.]" [Little Sisters of the Poor Home for the Aged v. Sebelius, No. 18A691 (S.Ct. Dec. 31, 2013)] (The New York Times; subscription may be required)  

[Advert.]

23rd Annual National Health Benefits Conference & Expo - Jan. 28-29, FL

Hear Here: Sprint, L.L. Bean, We Energies, City of Houston, Eastman Chemical, Univ. of IA, AL & S.FL, Palm Beach Co Schools, Crowley Maritime Corp, Anoka Co, S. Shore Hospital, more. Jan 28-29 - Hi quality, moderate cost. Complete Program brochure online now!

White House Stands by Birth-Control Rule
"'We defer to the Department of Justice on litigation matters, but remain confident that our final rules strike the balance of providing women with free contraceptive coverage while preventing non-profit religious employers with religious objections to contraceptive coverage from having to contract, arrange, pay, or refer for such coverage,' a White House official said." (Politico)  

Overview of Litigation: 'HHS Mandate Information Central' Published by The Becket Fund for Religious Liberty
Complete list of challenges to ACA contraceptive mandate, with links to all court documents, and infographic summarizing results to date. Excerpt: "45 non-profit lawsuits with a score card of 19 injunctions granted to 1 injunctions denied.... 46 for-profit lawsuits: Of the 39 cases with rulings touching on the merits, the current scorecard is 33-6." (The Becket Fund)  

D.C. Circuit Blocks Enforcement of Contraceptive Mandate for Three Catholic Organizations
"An emergency injunction granted [on December 31] in the U.S. Court of Appeals for the D.C. Circuit means that Priests for Life will not have to obey the contraception mandate contained in the [ACA] as its appeal is being heard. It also means that, [on January 1], Priests for Life will not have to cancel health insurance for its employees." [Priests for Life v. U.S. Department of Health and Human Services, No. 13-5368; other plaintiffs: Roman Catholic Archibishop of Washington D.C. and Thomas Aquinas College, No. 13-5371 (D.C. Cir. Dec. 31, 2013)] (Priests for Life)  

Sixth Circuit Blocks Enforcement of Contraceptive Mandate for Michigan Catholic Organizations (PDF)
"[It] is not clear that the accommodation violates the RFRA. But the possibility that the plaintiffs' constitutional rights may be violated weighs heavily in our decision, particularly given that there does not appear to be a substantial harm to others.... The contraceptive mandate itself does not apply to three groups, all of which are large in number -- employers with less than fifty employees, religious employers, and employees subject to grandfathered plans. Moreover, the government has already delayed implementation of the contraceptive mandate to the plaintiffs, and other entities similarly situated, during the safe harbor. Therefore, at this juncture, we believe that the factors weigh in support of an injunction pending appeal." [Michigan Catholic Conference and Catholic Family Services v. Sebelius, No. 13-2723 (6th Cir. Dec. 31, 2013)] (U.S. Court of Appeals for the Sixth Circuit)  

Nationwide ACA Health Plan Enrollment Surpasses 2.1 Million
"The federal figures and numbers from New York state's exchange suggest people continued to enroll even after the deadline for Jan. 1 coverage passed.... Administration officials now are bracing for paperwork problems that may crop up as consumers try to start using their new insurance at doctors' offices and pharmacies." (The Wall Street Journal; subscription may be required)  

The Risk Pool, Contraceptive Coverage Litigation, and Other Developments
"One telling statistic from the October and November enrollment reports is that only half those determined eligible for coverage through the exchange were also determined eligible for premium tax credits. Clearly these are people who can afford insurance and were presumably already insured prior to 2014.... Although some states have released demographic data, the federal exchange has not. What the state data show is that in many (but not all) states, enrollees tend disproportionately to be in the 55-64 age range, while fewer are in the 18-34 range." (Timothy Jost in Health Affairs Blog)  

Beyond Participation: How to Sustain Healthy Changes in Employee Behavior
"To get the best picture of how engaged your employees are in your wellness programs, take a look at three key measurements: [1] How many employees are enrolled? [2] How long do employees continue to participate in the programs? [3] Are employees engaging in meaningful daily behaviors? ... [Here are] five proven tips to drive long-term, sustained behavior change and how to use them: [1] Create a habit... [2] Develop a daily routine.... [3] Make it social.... [4] Offer rewards.... [5] Make it fun." (Virgin Pulse; free registration required to view full report)  

Statement by HHS Secretary Sebelius: A New Day in Health Care Coverage
"Before you go to the doctor or pharmacy using your new insurance for the first time, check out this tip sheet, and make sure to: [1] Get your insurance card or a temporary card with your new plan's information. If you don't have your card yet, ask your insurance company to give you another way to confirm your coverage. [2] Make sure you know when your first premium payment is due and pay it by the due date; [3] Check to see which doctors and pharmacies are in your network." (Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services)  

HHS Report to Congress on Verification of Household Income and Other Qualifications for the Provision of ACA Premium Tax Credits and Cost-Sharing Reductions (PDF)
"[Federally-facilitated Exchanges (FFEs) and State-based Exchanges (SBEs)] use the operational process of electronic data matching with SSA and [the Department of Homeland Security (DHS)] to carry out the verification of citizenship, status as a national, or lawful presence.... If the information provided about an applicant 's residency is not reasonably compatible with other information provided by the applicant, the Exchange must examine electronic data sources available to the Exchange ... The FFEs and SBEs currently do not have access to a data source with information that could be used to verify an applicant's attestation regarding family size ... and are therefore accepting applicant attestations at this time .... FFE s and SBEs use the operational process of electronic data matching with IRS, SSA, and current sources of income to verify annual household income .... FFEs and SBEs use the operational process of electronic data matching with current income sources including, for the FFEs and some SBEs, data matching with Equifax Workforce Solutions. For SBEs, another common data source used to verify current income is state wage data from the State Wage Information Collection Agency (SWICA).... The Exchange accepts the applicant's attestation regarding the employer-sponsored coverage verification unless the applicant's attestation is not reasonably compatible with the foregoing verification information obtained by the Exchange, other information provided by the applicant, or other information in the records of the Exchange." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Opinion]

HIPAA Failure Results In Penalties: Lack of Compliance Is Key
"This result is significant [because] it is the first reported settlement of a claim brought under the Breach Notification rules under the HITECH Act. Second, it shows that the Office of Civil Rights is serious about investigating instances of an alleged breach and enforcing the rules related to privacy compliance." (Fox Rothschild LLP)  

[Opinion]

What 2014 Means for Obamacare
"The Affordable Care Act has essentially flipped a multibillion-dollar industry upside down.... This is great news for people who are very sick -- and a mixed bag for the very healthy people.... It's impossible to know how many people are gaining insurance today.... There are still people who want Obamacare coverage but aren't able to sign up.... The next Obamacare fight is going to be about access." (Sarah Kliff in The Washington Post; subscription may be required)  

[Opinion]

The Obamacare We Deserve: Single-Payer
"Obamacare's rocky start -- clueless planning, a lousy website, insurance companies raising rates, and the president's telling people they could keep their coverage when, in fact, not all could -- is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go." (Michael Moore in The New York Times; subscription may be required)  

District Court Finds Waiver of Right to Civil Action Upon Electing Independent Review Was Ineffective
"[N]either the letters nor the Grievance and Appeal Rights enclosure 'includ[es] a statement of the claimant's right to bring a civil action under section 502(a) of the Act following an adverse benefit determination on review[.]' 29 C.F.R. 2560.503-1(g)(1). The language that Defendant points to in the Grievance and Appeal Rights enclosure is not a statement of Plaintiff's right to bring a civil action. Defendant argues Plaintiff should have inferred this right based on that language. I disagree. In addition to being hidden in a paragraph that focuses on the IRO process, a statement that requires Plaintiff to infer that she has a right to sue does not meet the requirements of the regulations. I find that Defendant's notification was inadequate to alert Plaintiff to her right to file a civil action and thus, Plaintiff did not waive her right to sue." [Yox v Providence Health Plan, No. 3:12-cv-01348-HZ (D.C. Oregon Dec. 13, 2013)] (U.S. District Court for the District of Oregon)  

[Opinion]

Text of Comments by SHRM to SEC on Proposed Pay Ratio Disclosure Rules (PDF)
"The Commission should limit the employees included in the identification of the median employee to those employed within the United States or who are paid through a U.S. payroll system.... The final rule should allow employers to annualize the compensation of non-full-time employees.... The Commission should establish a safe harbor method which provides for estimating median employee compensation, such as through the use of a formula or algorithm.... SHRM recommends that the initial compliance date be at least two years from the effective date of the final rule. Such a delay would allow employers to gather necessary information, and to review various approaches for compliance.... Finally, the pay ratio disclosure provided by registrants to the Commission should be considered to be 'furnished' rather than 'filed'.... By requiring that these disclosures be 'filed' in an annual or quarterly report, a registrant's chief executive officer and chief financial officer will be required to certify the accuracy of the disclosure pursuant to Section 302 of the Sarbanes-Oxley Act of 2002." (Society for Human Resource Management)  

Cities Have New Website Options to Communicate Benefits To Employees with Colonial Life
Colonial Life

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