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Employee Benefits Jobs
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Webcasts and Conferences
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[Official Guidance]
Text of CMS Final Rule: Basic Health Program -- Federal Funding Methodology for Program Year 2016
48 pages. "This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges.... [O]nce the final methodology has been published, we will only make modifications to the BHP funding methodology on a prospective basis with limited exceptions."
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
IRS Issues More Guidance on Premium Payment Arrangements
"The [IRS] continues to struggle with the question of how the [ACA] affects various arrangements through which employers attempt to pay premiums for employees to purchase health insurance coverage in the individual market.... On February 18, 2015, it released yet another guidance on this issue, this one focused on small employers.... The agencies have taken the position that employer payment plans are group health plans, and thus must comply with the ACA's market reforms. A group health plan must under these reforms cover at least preventive care and may not have annual dollar limits. A premium payment-only HRA or other payment arrangement that simply pays employee premiums does not comply with these requirements. An employer that offers such an arrangement, therefore, is subject to a fine of $100 per employee per day."
(Timothy Jost, in Health Affairs)
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[Guidance Overview]
Philadelphia Enacts Paid Sick Leave Ordinance
"From a big picture perspective, employers need to understand that paid sick leave has gained incredible traction over the last few years. In fact, all but four of the paid sick leave laws currently in effect were passed in 2013 or later. In addition, there is a movement to make paid sick leave a federally legislated mandate as the United States remains one of the few advanced countries that offers no paid sick leave to its employees."
(Ford & Harrison LLP)
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Handbook Snafu Resuscitates FMLA Claim
"[The employee] argued the [employer] was 'equitably estopped' from denying his FMLA eligibility based on that clear handbook misrepresentation. [He] further alleged he reasonably relied on that handbook provision to his detriment because he sought medical treatment prior to completing his work assignment based on the handbook's definition of FMLA eligibility. He thought he was eligible. [The] court accepted [the employee's] argument. In doing so, it characterized the [employer's] handbook passage as an 'unambiguous and unqualified statement' of the [employer's] FMLA eligibility criteria." [Tilley v. Kalamazoo County Road Commission, No. 14-1679 (6th Cir. Jan. 26, 2015)]
(Frost Brown Todd LLC)
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How Specialty Drugs Are Changing the Role of the Benefit Adviser
"Half of large employers say the cost of specialty pharmacy drugs is their second or third highest cost-driver, behind high-cost claims and special conditions, according to a recent survey by the National Business Group on Health.... Benefit advisers heeding their clients' concerns have begun offering solutions to reign in the costs of these drugs, including programs to limit the quantity of the drugs dispensed at any given time, the use of prior authorization to confirm the necessity of the treatment, and even the use of a freestanding specialty pharmacy."
(Employee Benefit News)
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U.S. Healthcare Spending Is On the Rise Again
"The jump in health spending for 2014 wasn't unexpected. Millions of Americans have now gained health insurance through the Affordable Care Act exchanges, expanded state Medicaid programs, and jobs created by employers. 'All three together are driving the coverage and presumably the spending,' says Altarum senior economist Paul Hughes-Cromwick. The federal government had anticipated that the spending slowdown would end in 2014, projecting total health care spending growth of 5.6 percent."
(Bloomberg)
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Risk-Spreading Tools for Healthcare Financing (PDF)
"[S]ignificant developments in the U.S. healthcare industry have begun to change how provider institutions and payers are aligned to achieve better health, affordability, and experience for targeted populations. As many insurers and providers are progressively focusing on population management, there is also an opportunity to develop risk management tools that can enable participants to spread the risk of above-average healthcare expense outcomes to third parties."
(Healthcare Finance News)
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Employers Should Disband Employee Weight Control Programs
"American corporations continue to expand wellness programs, which now reach an estimated 90% of workers in large organizations, yet no study has demonstrated that the main focus of these programs -- weight control -- has any positive effect. There is no published evidence that large-scale corporate attempts to control employee body weight through financial incentives and penalties have generated savings from long-term weight loss, or a reduction in inpatient admissions associated with obesity or even long-term weight loss itself.... Quite the contrary, overscreening and crash dieting can impact employee morale and even harm employee health."
(American Journal of Managed Care)
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[Opinion]
HRAs Need Permanent Legislative Relief, Not Just the Temporary Relief Provided By IRS Notice 2015-17
"HRAs have long-been used to help small business owners provide some level of financial support for their employees. As an unintended consequence of the [ACA], the prohibition placed upon the use of HRAs is detrimental to small businesses and their employees across the country. Although we welcome this temporary, first step [provided by IRS Notice 2015-17], we look forward to working with members on both sides of the aisle in Congress on a more permanent solution to this situation."
(National Association for the Self-Employed [NASE])
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[Opinion]
Comments by 18 Employer Groups to HHS Urging Delay in Expansion of Small Group Market Definition (PDF)
"As employer organizations, we urge you to issue a two-year delay of the expansion of the small group market definition as soon as possible.... [This delay is needed to:] [1] preserve the intended timeline in the ACA that afforded businesses subject to the employer responsibility requirements two initial years of offering coverage in the large group market before being subject to the more extensive benefit and rating requirements in the small group market; [2] Protect the ability of employers to select from a broader array of coverage options; and [3] Mitigate the dramatic premium increases that will occur with the expansion."
(U.S. Chamber of Commerce and 17 other employer organizations)
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Press Releases
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