Health & Welfare Plans Newsletter

September 5, 2014

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Webcasts and Conferences



[Guidance Overview]

Two More Cities Require Employers to Provide Paid Sick Leave (PDF)
"Eugene, Oregon and San Diego, California are the latest to join a growing list of cities that have enact ed laws requiring employers to provide paid sick leave. The laws share many common characteristics, but local variations can complicate employers' leave and attendance policies and their administration." (Buck Consultants at Xerox)  


[Advert.]

NBCH 19th Annual Conference -- November 10-12, 2014 - Washington, DC

Sponsored by National Business Coalition on Health [NBCH]

Employers, health plans, providers and other key stakeholders focus on improving health outcomes, lowering cost by benefit design, care management, payment reform, and reducing waste. Free admission for employers that are members of an NBCH coalition. Join us.



[Guidance Overview]

Draft Instructions for ACA Reporting Requirements: Get Ready for 2015
"[T]he IRS will not impose penalties on employers that can demonstrate that they made good faith efforts to comply with the information reporting requirements. This relief applies to returns and statements filed and furnished in 2016 to report offers of coverage in 2015 for incorrect or incomplete information reported on the return or statement, but the relief is not available if you fail to file.... With respect to the instructions themselves, to say that they are lengthy is an understatement.... However, between the draft forms and the draft instructions, employers should now be able to ascertain generally what is required of them in reporting." (Fox Rothschild LLP)  

Does Regular Mail Make the Cut?
"When appropriate, have employees sign an acknowledgment they were informed of their [1] eligibility for FMLA; [2] designation as being on FMLA leave, [3] specific obligations under the law; and [4] consequences for failing to meet those responsibilities. Where such an acknowledgment is not feasible, consider requiring a signature of receipt, or using a trackable delivery service." [Lupyan v. Corinthian Colleges Inc., No. 13-1843 (3d Cir. Aug. 5, 2014)] (Greenberg Traurig)  

Accountable Care States: The Future of Health Care Cost Control (PDF)
26 pages. "[The authors] propose that the federal government should implement a model that gives states the option to become 'Accountable Care States' -- meaning that they are accountable for health care costs, the quality of care, and access to care -- with sizable financial rewards for keeping overall costs low. This model would control costs across the system rather than shift costs from public programs to the private sector or to consumers. The Accountable Care States model offers the potential for substantial savings in health care spending." (Ezekiel Emanuel, Topher Spiro, Maura Calsyn, Carter Price, Stuart Altman, Scott Armstrong, John Colmers, David Cutler, Francois de Brantes, Paul Egerman, Bob Kocher, Peter Orszag, Meredith Rosenthal, John Selig, Joshua Sharfstein, Andrew Stern, and Neera Tanden)  

The Healthcare Payment Reform Landscape: Non-Payments
"Beyond the old-style 'denial of payment' based on 'medical necessity,' non-payment strategies are relatively uncommon. In some cases, the amount of savings generated by non-payment strategies can be difficult to quantify because providers may choose not to document care that others might judge as unnecessary.... [T]here remains a dispute as to which type of incentive (penalties or rewards) is most effective in motivating changes in provider behavior.... [S]trategies of non-payment are worth scrutinizing, as they may provide powerful incentives to cut costs and improve quality in our health care system." (Health Affairs)  

Costs of Government Administration of Health Care to Almost Double in Ten Years
"Government administration cost $35.1 billion in 2013 and will cost $66.7 billion in 2023 -- an increase of 90 percent overall and a compound annual growth rate of 6.63 percent. To put that in perspective, those costs were $29 billion in 2008, so they grew at a compound annual rate of only 3.61 percent in the subsequent five years.... Government spending on actual public health will increase by a significantly smaller compound annual rate of 4.84 percent, or 47 percent overall." (National Center for Policy Analysis Health Policy Blog)  

Analysis of 2015 Premium Changes in the ACA's Health Insurance Marketplaces
"The analysis examines premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. The findings show that in general, individuals will pay slightly less to enroll in the second-lowest cost plan in 2015 than they did in 2014, prior to the application of tax credits." (Henry J. Kaiser Family Foundation)  

New York State Gives Health Insurers Average Rate Rise of 5.7%
"The insurance companies had proposed increases averaging 12.5 percent, with some companies seeking as much as 28 percent more for some plans." (The New York Times; subscription may be required)  

Full D.C. Circuit Will Rule on ACA Subsidies
"It is unclear at this point whether the D.C. Circuit's grant of en banc review of the subsidies question will have any effect on the Supreme Court's consideration. The Justices might opt to wait to see if a conflict in lower court exists, but they also could go ahead and grant review of the pending case. That would proceed more slowly than will the new review in the D.C. Circuit, however." (SCOTUSblog)  

California Workers Get Ready to Start the Paid Sick-Leave Era
"Starting in July, most workers will earn an hour of paid leave for each 30 hours worked, as much as three days a year.... The country's first and only other statewide law requiring paid sick leave passed three years ago in Connecticut.... While industry groups in California and elsewhere have fought to stop such policies, supporters say the results show businesses have little to be concerned about." (Bloomberg Businessweek)  

Philadelphia Passes Breastfeeding Act
"Under the amendment, an employer's failure to reasonably accommodate employees who need to express milk constitutes sex discrimination. A reasonable accommodation for a breastfeeding employee includes 'providing unpaid break time or allowing an employee to use paid break, mealtime, or both, to express milk and providing a private, sanitary space that is not a bathroom where an employee can express breast milk.' The federal [ACA] contains similar requirements, but they apply only to non-exempt employees. The Philadelphia amendment covers all employees, both exempt and non-exempt." (Pepper Hamilton LLP)  

[Opinion]

The Brave New World of Rationing in PPACA
"Insurers are not sitting back with open arms and welcoming all of the poorest, sickest and most costly patients. Instead, we are now in a brave new world of rationing, restriction, and manipulation in order to nudge the worst risk among us to choose the other insurer's plan. [This article provides] an overview of the allowable ways insurers can restrict sick folks from flocking to their plans under PPACA.... Doctor Rationing ... Treatment Rationing ... Patient Rationing ... Drug Rationing ... Fraud and Abuse Protection Rationing." (Benefit Revolution)  

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