[Official Guidance]
Text of CMS FAQs on Risk Corridors and Budget Neutrality (PDF)
"We anticipate that risk corridors collections will be sufficient to pay for all risk corridors payments. However, if risk corridors collections are insufficient to make risk corridors payments for a year, all risk corridors payments for that year will be reduced pro rata to the extent of any shortfall.... We anticipate that risk corridors collections will be sufficient to pay for all risk corridors payments over the life of the three-year program. However, we will establish in future guidance or rulemaking how we will calculate risk corridors payments if risk corridors collections (plus any excess collections held over from previous years) do not match risk corridors payments as calculated under the risk corridors formula for the final year of the program."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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[Guidance Overview]
It's Time to Gear Up for Employer Reporting Under the ACA (PDF)
"Employers should determine which reporting requirements apply to them and their plans. While much of the information required by section 6055 and 6056 is duplicative, there are differences and employers should familiarize themselves with the requirements so they know what information they must provide and, if necessary, implement steps to start collecting that information now."
(Wilkins Finston Law Group)
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[Guidance Overview]
Same-Sex Marriage Developments: Recent Guidance from CMS and HHS (PDF)
"This FAQ addresses a requirement for issuers of health insurance, not employer group health plans or employers. Employers are free to control the terms and conditions of the group health plan. The FAQ reiterates that [the ACA's guaranteed availability requirement] does not direct the definition of spouse and the terms of eligibility for group health plans. If a group health plan chooses to offer coverage to same-sex spouses, this FAQ clarifies that an issuer may not decline to cover that same-sex spouse on the same terms and conditions as opposite-sex spouses."
(Buck Consultants)
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CMS Overview of Cost-Sharing Reduction Advance Payments Process for 2015 (PDF)
29 presentation slides. Topics include: [1] The new methodology for determining CSR advance payments in 2015, which was finalized in the 2015 HHS Notice of Benefit and Payment Parameters final rule (2015 Final Payment Notice); [2] The role of the Marketplace and CMS in calculating CSR advance payments; and [3] The effects of this new methodology on CSR advance payment amounts.
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services)
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Provider Sponsored Health Plans: Five Necessities for Launching a Successful Plan
"[H]ospitals are discovering [that] serving as both provider and insurer often gives them the best chance to lower the cost of care, prevent unnecessary hospitalizations through patient tracking, unearth new market share potentials, and truly create a healthier community. What's more, they know that if done properly such a strategy will allow them to capture and retain dollars that otherwise would end up in the pockets of the insurance companies with whom they have historically contracted and often battled."
(Advance Healthcare Network)
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Characteristics of the Population with Consumer Driven and High Deductible Health Plans, 2005 2013
"The population of adults within consumer-driven (CDHPs), high-deductible (HDHP) and traditional health plans was split about 50-50 between men and women in 2013. The CDHP population was more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2006, 2009 and 2010. They were also more likely to be in households with $100,000-$149,999 in income in most years. CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have college or post-graduate educations in nearly all years of the survey."
(Employee Benefit Research Institute [EBRI])
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Can an Employer Force an Employee Onto FMLA Leave When the Employee Wants to Continue to Work?
"[W]hen you have a reasonable belief that your employee cannot perform the essential functions of the job (including when you are faced with mental health issues ...), you can keep the employee off work until you have that confirmation.... [E]ven if an employer wrongfully forces an employee to take FMLA leave ... the employee cannot successfully raise an FMLA interference claim unless the employee seeks FMLA leave at a later date and the leave is not available because the employee was wrongfully forced to use FMLA leave in the past."
(FMLA Insights)
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Paid Family Leave: Can a State-by-State Approach Work?
"After lobbying state by state for years, some supporters of paid family leave say it's time for a federal solution. A proposal in Congress ... would export the models used in California, New Jersey and Rhode Island nationwide. Those are the only three states with their own paid leave laws."
(The Pew Charitable Trusts)
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The Flexibility Bias
"What the flexibility bias literature shows us is that using work/life policies for other kinds of reasons -- such as for a personal health-related reason or even using it to do things like training for a marathon, are not stigmatized in the same way as taking leave for family care-related responsibilities."
(Human Resource Executive Online)
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New Data Signal Smaller Jump in Health Care Costs for 2015
"Statisticians working with insurers to project next year's insurance premium rates say they expect to see an average increase of about 7%, well below the feared double-digit increases making recent headlines.... [As] insurers dig through the new health exchange enrollees to figure out their ages and health conditions to determine next year's premiums, [Dave Axene, a fellow with the Society of Actuaries] expects an overall increase of 6% to 8.5%.... Before the [ACA], premiums rose an average of 7-10% a year."
(USA TODAY)
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Report and Recommendations for Price Transparency in Health Care
24 pages. Excerpt: "Transparency tools for insured patients should include some essential elements of price information, including: [1] The total estimated price of the service; [2] A clear indication of whether a particular provider is in the health plan's network and information on where the patient can try to locate a network provider; [3] A clear statement of the patient's estimated out-of-pocket payment responsibility; [and] [4] Other relevant information related to the provider or the specific service sought (e.g., clinical outcomes, patient safety, or patient satisfaction scores)."
(Healthcare Financial Management Association [HFMA])
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Average Retiree Health Costs Could Overtake Social Security Benefits
"Retirement health care costs will increase from 69% of Social Security benefits for a couple retiring next year to 98% of Social Security benefits for a healthy couple retiring 10 years from now ... For couples retiring two decades from now, the gap will be even more dramatic. They would need 127% of average Social Security benefits to cover their health care costs in retirement."
(InvestmentNews)
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Obamacare and the Early Retiree: Health Law Offers Relief
"The system was designed to make health-care costs comprehensive and affordable at all income levels. Right or wrong, by ignoring assets as a criteria, the system can also provide benefits for those who are relatively affluent. Whether or not the early retiree is eligible for subsidies or prefers to shop outside the exchanges, advisors now have better tools for predicting future health-care costs than in the past."
(Morningstar Advisor)
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Early Estimates Indicate Rapid Increase in Health Insurance Coverage Under the ACA
"[N]either the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. [The authors] use the March 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates."
(Urban Institute)
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State Marketplace Design and Policies
"In an effort to ensure independence in governance and policy setting, avoid conflicts of interest, and ensure long-term viability, 11 states created a quasi-governmental agency to operate their marketplaces. Governing boards composed of experts and key stakeholders oversee the new agencies; the majority of states prohibit insurers and/or brokers from serving on the board.... [S]everal require that issuers offer a standardized plan design to enable consumers to more easily compare plans based on price and provider networks.... States used a variety of interactive web features to provide a customer-friendly application and shopping experience, including allowing consumers to browse plans before creating an online account or submitting an application."
(Center on Budget and Policy Priorities)
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California Makes It Harder for Insurers to Deny Autism Treatment
"In tightening its rules on covering behavioral intervention for children with autism, California is tackling a problem encountered by numerous states seeking to improve access to therapies for children with autism ... The new rules make it clear that insurers must cover behavioral interventions for children with autism at the same level that they cover visits to a medical doctor[.]"
(Reuters)
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New York City Earned Sick Time Act Expanded Before Taking Effect on April 1
"Under the revised Act, employers must provide written notice to all existing employees by May 1, 2014 in addition to the original Act's requirement that employers provide written notice to new employees hired on and after April 1, 2014....[A] model notice ... is available in English, Spanish, Italian, and Russian ... The amendments expand the Act's coverage to more employers by reducing the threshold number of employees from 15 to five.... [A]ll covered New York City employees must start accruing sick leave on April 1, 2014 (at an accrual rate of at least one hour of sick leave for every 30 hours worked)."
(Morgan Lewis)
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Bay Area Approves Mandatory Commuter Benefits Pilot Program
"By September 30, 2014, employers with 50 or more full-time employees in the San Francisco Bay Area will be required to offer commuter benefits to their employees.... Employers will need to select one of the following benefit options to offer to covered employees: [1] Pre-Tax Benefit.... [2] Employer-Provided Subsidy.... [3] Employer-Provided Transit.... [4] Alternative Commuter Benefit Program."
(Mazursky Constantine, LLC)
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New York Court Guts a Unique Health Care Fund for Taxi Drivers
"In 2012, the city's Taxi and Limousine Commission had voted to take six cents on every fare for a fund that would ... [provide] upwards of $300 per week in assistance as soon as a driver could produce a doctor's note.... [T]he approach of creating a communal benefits pool to supplement commercial plans by levying independent workers in a regulated industry is actually unique, and an example of how alternative labor groups can provide services for people who aren't represented by traditional unions.... The court decision is a serious blow, and makes several assumptions."
(The Washington Post; subscription may be required)
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Benefits in General; Executive Compensation
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Executive Compensation Clawbacks: 2013 Proxy Disclosure Study (PDF)
18 pages. Excerpt: "This study presents [an] analysis of 2009 through 2012 year-end proxy disclosures for 100 large public companies relative to their compensation recoupment or 'clawback' policies.... Of the companies in [this] study, 92% have policies to recoup compensation if there's a restatement of financial results.... 27% require repayment in the event of a restatement without personal accountability.... Another prevalent reason for recoupment of incentives was misconduct (84%), which includes breaking a company's code of conduct or ethics policies, being convicted of a criminal offense, or other transgressions[.]"
(PricewaterhouseCoopers)
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Retirement Security Tops List of Employee Concerns
"Older DC plan-only participants are more likely to expect most of their retirement income to come from Social Security. Almost seven in 10 workers were happy with their health plans in 2007, but satisfaction rates dropped to 59% in 2013. Sixty-two percent would give up some pay for a guaranteed retirement benefit, and more than half would sacrifice pay for a more generous benefit."
(Towers Watson)
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Press Releases
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