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HIPAA, HITECH and Privacy - How to Manage Privacy and Security Risks and Considerations
January 15, 2015 WEBCAST
(Worldwide Employee Benefits Network [WEB] - New York Chapter)

HIPAA HITECH 101
January 29, 2015 WEBCAST
(Clearwater Compliance)

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[Official Guidance]

Text of CMS Quality Rating System (QRS) Frequently Asked Questions (FAQs) (PDF)
FAQs include: "[1] If a [Qualified Health Plan (QHP)] issuer offers multiple products (e.g., EPO, HMO, POS, PPO) in the Marketplace, can products be combined for the Quality Rating System (QRS) and the QHP Enrollee Experience Survey (QHP Enrollee Survey) reporting? [2] Do the [QRS] and the QHP Enrollee Experience Survey requirements only apply to QHP issuers participating in State-based Marketplaces (SBMs)? [3] What are the deadlines for QHP issuers to contract with data validators and survey vendors in preparation for [QRS]) and the QHP Enrollee Experience Survey data submission? Are these deadlines flexible? [4] Will CMS accept state-mandated quality measure data to meet [QRS] requirements?" [Dated November 16, 2014; published online December 17, 2014.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Guidance Overview]

2014 Plan Sponsor ACA and Year-End Checklist (PDF)
12 pages. "2014 has been another busy year of regulations and guidance affecting health and welfare benefit plans.... Many of the rules and regulations went into effect in 2014, while others were issued in 2014 but will not be effective until 2015 or later.... To help you ensure that nothing slips through the cracks, [this article provides] the highlights for 2014." (Alston & Bird LLP)  

[Guidance Overview]

Explaining the ACA Look-Back Measurement Method to Employees
"At bottom, the look-back measurement method for determining an employee's full-time status affects whether and when an employee must be offered group health plan coverage. It is, therefore, something that must be communicated to employees.... For group health plans that are subject to ERISA ... this is the job of [an SPD].... Where an employer wants to get out ahead of the formal ERISA disclosure rules, or where an understanding of ERISA's disclosure requirements is in short supply, some employers have sought to explain the look-back measurement method in a separate memorandum or other informal communication to employees.... Nothing prevents an employer from supplementing the formal ERISA disclosure requirements, and better and more complete communication benefits both the employer and the employee." (Mintz Levin via Lexology)  

[Guidance Overview]

Reference-Based Pricing and the ACA's Rules on Out-of-Pocket Limits
"Plan sponsors of non-grandfathered plans that have or are considering a reference-based pricing program must review the program to ensure that it complies with several factors related to quality and access. The Departments will consider all the facts and circumstances when evaluating whether a plan is using a reasonable method to ensure adequate access to quality providers at the reference price, including the following: Type of Service ... Reasonable Access ... Quality Standards ... Exception Process ... Disclosure ... It is likely that existing programs will not fully comply with these new rules, particularly some of the participant disclosure and exception process rules, and will need to be revised." (Segal Consulting)  

[Guidance Overview]

Congress Extends Transit Benefit Tax Parity but Limited to 2014 (PDF)
"Some employers may have allowed employees to make after-tax elections in 2014 that exceeded the prior $130 limit. It is possible that the IRS will require that employers refund any excess FICA taxes that were withheld for 2014 and adjust the 2014 Form W-2 to reflect the correct income amount for federal income tax purposes. The IRS required similar adjustments when the transit limit was increased retroactively for 2012. Employees cannot retroactively increase their transit elections, however, so employers that did not allow after-tax transit benefit elections in 2014 would not have withholding and reporting adjustment obligations." (Buck Consultants at Xerox)  

[Advert.]

Premium Educational Event for Taft-Hartley Trustees

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[Guidance Overview]

Probationary Periods: ACA and California Law are Back in Sync (SB 1034)
"Senate Bill 1034 becomes effective January 1, 2015 and repeals the 60-day waiting period limit previously imposed on certain health insurance plans in California. Now employers can go back to the 90-day probationary period with benefits as a reward to employees who 'pass' probation. This comes just in time for the year-end employee handbook updates." (Fox Rothschild LLP)  

Text of Federal District Court Opinion Awarding Attorney's Fees to Providers Who Were Not Provided with ERISA Appeal Process by Health Insurer (PDF)
"The first factor requires a court to consider 'the degree of the offending parties' culpability.' ... Although [Independent Blue Cross (IBC)] may not have acted in bad faith, its failure to follow ERISA's notice and appeal requirements to the detriment of healthcare providers suggests some level of culpability.... As to the second factor, IBC does not dispute that it is able to pay an award of attorney's fees. The third factor also tilts in favor of a fee award, as it will deter other insurers from denying benefits without providing ERISA-compliant notice and appeal procedures. This is particularly important given the fact that cases like this one do not always result in a monetary damage award, at least not a significant award; as a result, insurers have less of a monetary incentive to provide ERISA-compliant procedures until after a suit is initiated. Finally, members of the plan who contract with IBC have benefited from [the Pennsylvania Chiropractic Association's] efforts to ensure that IBC provides adequate notice and appeal procedures. Thus, an award of attorney's fees is appropriate." [Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, No. 09 C 5619 (N.D. Ill. Dec. 17, 2014)] (U.S. District Court for the Northern District of Illinois)  

Class Action Suits Mounting for ERISA Plan Clawbacks
"A fractious and potentially costly family of provider-led class action lawsuits [is] moving through courts, pitting accusations of illegal clawbacks against the likes of Aetna and UnitedHealth Group. In New Jersey, a federal judge has certified a class of providers suing UnitedHealth Group for allegedly illegal payment recoupments under ERISA... Similar to complaints against other insurers, the providers suing UnitedHealth allege that the insurer conducted post-payment audits, concluded that it made erroneous overpayments, and then demanded to be repaid[.]" (Healthcare Payer News)  

Critics Challenge Corporate Wellness Program ROI
"Even with the modest rise in health care costs over the past several years, sources familiar with the issue believe businesses have reached a tipping point and that the expense of providing medical benefits to workers has become unsustainable. Cost-containment efforts therefore are putting more pressure on wellness programs to deliver on the promise of reducing health care expenses. However, as ... recent studies have shown, wellness plans may not be producing the return on investment (ROI) that employers expect and need." (Society for Human Resource Management [SHRM])  

Latest HIPAA Settlement: Compliance is an Ongoing Process
"[OCR Director Jocelyn] Samuels' statements underscore the importance of monitoring information systems and conducting compliance audits. Samuels calls for entities to 'review[] systems for unpatched vulnerabilities and unsupported software that can leave patient information susceptible to malware and other risks.' ... [T]he newly released Experian Data Breach Industry Forecast for 2015 predicts the health care industry will be 'plagued' with data breaches in the coming year, stating that '[t]he potential cost of breaches for the healthcare industry could be as much as $5.6 billion annually.' " (Davis Wright Tremaine LLP)  

Without Direct Employer Action, Alternate Health Care Delivery Models and Payment Reform May Stall at Current Levels
"[W]hile employers find alternative provider delivery models and payment reform attractive, most admit they do not understand them or the value they provide. As a result, they may miss a significant opportunity to lead and improve results (health and financial) for their workforce and business.... Despite their lack of understanding of the models, the survey showed 60 percent of companies are providing or are considering providing a financial incentive for employees and dependents to use these new models through plan design changes, narrow network options, HRA/HSA contributions or cash." (Aon Hewitt)  

The Dark Side to Uncontrolled Drug Benefits
"Obviously, plan sponsors have financial reasons for steering people toward a generic drug instead of a more expensive (and possibly heavily marketed) brand-name drug. Or for limiting how much of a costly drug people can get at one time. However, putting controls on access to prescription drugs can be healthier for plan participants, benefiting them far more than it might hurt them[.]" (International Foundation of Employee Benefit Plans [IFEBP])  

Public Easily Swayed on Attitudes About Health Law
"Six in 10 respondents to the monthly tracking poll from the Kaiser Family Foundation ... said they generally favor the requirement that firms with more than 100 workers pay a fine if they do not offer workers coverage. But minimal follow-up information can have a major effect on their viewpoint, the poll found. For example, when people who support the 'employer mandate' were told that employers might respond to the requirement by moving workers from full-time to part time, support dropped from 60 percent to 27 percent. And when people who disapprove of the policy were told that most large employers will not be affected because they already provide insurance, support surged to 76 percent." (Kaiser Health News)  

State-Based Marketplaces Using 'Clearinghouse' Plan Management Models Are Associated with Lower Premiums
"State-based Marketplaces using 'clearinghouse' plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using 'active purchaser' models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits." (Health Affairs)  

ACO Quality Results: Good But Not Great
"Opportunity for continued quality improvement aside, a troublesome snag for the program could be a very low correlation between improved quality and earned savings: [the authors'] analysis shows that, in performance year one, improved quality and earned savings only correlate at 8.6 percent, so low that it is statistically insignificant. In practice, this means that better quality is not associated with better financial results." (Health Affairs)  

Healthcare Executives Are Vastly Underestimating Changes in Healthcare Utilization
"For the utilization of inpatient services, on average, executives expect a 3 percent decrease. Per [Milliman Health Care Guidelines (HCG)] benchmarks, a well managed population should expect to see a 30 percent decrease, relative to a loosely managed population. Fifty-three percent of executives expect growth in the utilization of emergency services. HCG benchmarks suggest a 35 percent reduction of visits per person between loosely and well managed populations." (Jeff Hoffman, for HFMA)  

2014 Form 5500 Released to the Public
"In addition to the changes to the form, there were also two changes made to the instructions worth noting: [1] The instructions now include a warning to check the filing status after e-filing. An error message saying the filing status is 'Processing Stopped' or 'Unprocessable' may indicate a problem with the electronic signature that could cause the form not be acknowledged as being filed. [2] The instructions to line 1c(13) of Schedule H have been changed to elaborate on the definition of interest in registered investment companies." (Bond Beebe Accountants & Advisors)  

Text of Federal District Court Opinion: ERISA Did Not Preempt State Law Claims by Former Executive Arising from Agreement to Terminate Benefits Under Section 457(f) Plan in Exchange for Cash Payment (PDF)
"Kirkindoll could not have brought his state-law claims regarding the March 2011 Agreement under Section 502(a)(1)(B) of ERISA....In his state-law claims regarding the March 2011 Agreement, Kirkindoll does not seek to recover benefits due to him under the terms of an ERISA plan, to enforce his rights under the terms of an ERISA plan, or to clarify his rights to future benefits under the terms of an ERISA plan. Instead, he complains that, by signing the March 2011 Agreement, he was entitled to receive $234,068.18 within 30 days, and that he was never paid as promised.... Kirkindoll does not contend that he is owed the sum of $234,068.18 under the terms of the Plan, nor could he." [Kirkindoll v. National Credit Union Administrative Board, as Conservator of Texans Credit Union, No. 3:11-CV-1921-D (N.D. Tex. Dec. 17, 2014)] (United States District Court for the Northern District of Texas)  

Introducing MMA MarketLink
Marsh & McLennan Companies, Inc.

Statement of the Pension Rights Center on Retiree Pension-Cut Legislation Included in Omnibus Bill
Pension Rights Center

Keightley & Ashner LLP Announce Harold Ashner Named 2014 Lawyer of the Year for Washington, DC in Employee Benefits Category
Keightley & Ashner LLP

QBI Introduces an Important New Fiduciary Service for Retirement Plan Clients
QBI, LLC

Trinity Pension Group, LLC is Certified to Industry Best Practices
Centre for Fiduciary Excellence [CEFEX]

Mercer Launches a Modern Digital Employee Experience - Mercer BenefitsCentral
Mercer

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