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T R Paul Inc.
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Wipfli LLP [Formerly Galusha Higgins & Galusha]
in MT

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Retirement Planners
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ASOPs Update
September 30, 2015 WEBCAST
(Conference of Consulting Actuaries)

2015 ASPPA National Conference - Ahead of the Curve
October 18, 2015 in MD
(ASPPA [American Society of Pension Professionals & Actuaries])

Executive Benefits: Choices and Concerns from the Practical to the Prudent
November 11, 2015 WEBCAST
(Conference of Consulting Actuaries)

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[Official Guidance]

Text of Final HHS Regs on Medicare Shared Savings Program: Accountable Care Organizations
592 pages (!) -- "This final rule addresses changes to the Medicare Shared Savings Program including provisions relating to the payment of Accountable Care Organizations participating in the Medicare Shared Savings Program. Under the Medicare Shared Savings Program, providers of services and suppliers that participate in an Accountable Care Organizations continue to receive traditional Medicare fee-for-service payments under Parts A and B, but the Accountable Care Organizations may be eligible to receive a shared savings payment if it meets specified quality and savings requirements." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

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[Official Guidance]

Text of Instructions for CMS Medical Loss Ratio (MLR) 2014 Annual Reporting Form (PDF)
Published on CMS website on June 5, 2015. "These are the filing instructions for the report to the Secretary required by ... the Public Health Service Act (PHSA), which includes elements that make up the medical loss ratio (MLR) and the calculation and provision of rebates to enrollees. The data included in the MLR Annual Reporting Form (MLR Form) are the exact data that will be used to calculate an issuer's MLR and rebates, if any, under section 2718 of the PHSA[.]" [Also posted on June 5, 2015: MLR 2014 Annual Reporting Form and MLS 2014 Calculator and Formula Tool. All appear to be replacements of items previously released on May 29, 2015; the extent of the substantive changes, if any, is unclear.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

PCORI Filing Due to IRS by July 31 (PDF)
"The PCORI fee is $2.08 per covered life for plan years ending on or after Oct. 1, 2014, and must be reported on (and remitted with) IRS Form 720 by July 31, 2015. For self-funded plans, the employer/plan sponsor will be responsible for submitting the fee and accompanying paperwork to the IRS. Third-party reporting and payment of the fee is not permitted for self-funded plans. The process for remitting payment by sponsors of self-funded plans is described in more detail [in this article]." (Lockton)  

[Guidance Overview]

GASB Approves New Statements for OPEB Accounting and Non-Trust Pension Benefits
"Similar to what was done for pension plans, the new statements include: [1] Discount rate... [2] Actuarial cost method ... [3] Balance sheet liability ... [4] The [Annual Required Contribution] and Annual OPEB Cost will be eliminated and replaced with the OPEB Expense. OPEB Expense will be determined using substantially shorter amortization periods for actuarial gains and losses and changes in actuarial assumptions.... [5] The requirements for note disclosures and required supplementary information will be greatly expanded." (Cheiron)  

[Guidance Overview]

HHS Seeks Public Comments on HIPAA Health Plan Identifiers
"HHS's unexpected announcement of the enforcement delay has prompted many to wonder about the future of HPIDs. The [request for information (RFI)] suggests that changes may be coming. Unfortunately, the RFI does not address the impact of the HPID enforcement delay on health care reform's separate requirement for health plans to certify compliance with HIPAA's transaction standards -- proposed regulations would require certifications beginning as soon as December 31, 2015." (Thomson Reuters / EBIA)  

Fiduciary Could Not Use ERISA 502(a)(3) to Seek Disability Benefits for Employee
"The court determined that the employer was not a plan fiduciary for purposes of making claims determinations, and therefore could not rely on [ERISA section 502(a)(3)] to sue the fiduciary that held such authority (i.e., the insurer). The court noted that even if the employer was considered to be a fiduciary, ERISA does not afford a fiduciary the right to sue if the relief sought can be obtained directly by the participant under 502(a)(1)(B) ... Thus, an employer's leverage, if any, to pressure insurers to pay benefits rests with the power to move the business to a different insurer." [Duda v. Standard Ins. Co., No. 12-1082 (E.D. Penn. Apr. 30, 2015)] (Benefits Bryan Cave)  

Yet Another Municipal-Level Paid Sick Leave Measure Passes in California
"[T]he ordinance that the Emeryville City Council unanimously approved on June 2, 2015 will provide paid sick leave to employees in Emeryville -- over and above what is already provided to employees under state law.... [The] ordinance includes a provision -- similar to that of the San Francisco and Oakland paid sick leave laws --requiring employers to allow employees to designate a non-family member for whom they may use their sick leave. It also permits employees to take leave to care for an ill guide dog, signal dog, or service dog." (Ogletree Deakins)  

Fifth Circuit Finds Manager of Welfare Benefit Plan Was Not ERISA Fiduciary
"A federal district court erred in finding that the manager of an employee welfare benefit plan was an ERISA fiduciary with statutory standing to recover third-party settlement funds paid to a plan participant who was injured in an automobile accident ... Contrary to the district court's conclusion, the 'plan management agreement' at issue did not give the manager independent power to investigate and prosecute claims. Thus, the agreement failed to show that the manager had discretion over the plan or its assets." [Humana Health Plan, Inc. v. Nguyen, No. 14-20358 (5th Cir. May 11, 2015)] (Wolters Kluwer Law & Business)  

Ten 'Breakthrough' Therapies Alone to Increase Government Spending by Nearly $50 Billion Over a Decade
"Despite claims by pharmaceutical manufacturers that new therapies offset other health care costs, the exorbitant price tags lead to significant increases in health care spending.... Given the significant cost impact associated with the prescription drug pipeline, greater transparency around drug pricing, specifically related to the cost of developing these medications, will help inform policy discussions and solutions for improving patient access to lifesaving treatments." (America's Health Insurance Plans [AHIP])  

Hitting the Wall: When Health Care Costs Are No Longer Manageable (PDF)
15 pages. "The concurrent strains in both [employer-sponsored insurance] and government-run programs, which combined cover or subsidize the vast majority of Americans, could leave millions of Americans without any affordable health care options. This paper will examine some of these pressures, and look at independent estimates of when each of them will be reaching a crisis point. According to these analyses, each system will be facing its own crisis in a narrow window of time, specifically the years between 2025 and 2030." (American Health Policy Institute)  

Addressing Health Care Cost Growth in Medicare: A Framework (PDF)
"A common focus in discussions about slowing the growth of health care spending in Medicare, as well as the health system as a whole, is the introduction of payment and delivery system reforms. Most of these types of proposals focus on realigning financial incentives to lower costs and improve health care quality and outcomes.... [Briefly described are these:] [1] Accountable Care Organizations (ACOs) ... [2] Bundled and Capitated Payments." (American Academy of Actuaries)  

Engineer Develops Wallet-Size Plan to Fix Health Care
"[Robert Higgs] has spent eight years and $25 million developing a medical-records technology that can put each patient's lifelong medical history and images onto a wallet-size card.... [He is] in talks with Louisville-based Humana Inc., one of the nation's largest health insurers, on a $475 million contract to deploy ICUcare's technology. Humana has estimated it can use ICUcare to pay doctors and hospitals faster, yet still save $20 million per year." (Indianapolis Business Journal)  

Republicans Propose ACA Fix Eliminating Exclusion of Value of Employer-Paid Health Benefits
"The Republican Study Committee's American Health Care Reform Act would fully repeal the ACA and create an above-the-line tax deduction applied to both income and payroll taxes of $7,500 for individuals or $20,500 for a family -- available to all Americans with qualifying health insurance. The deduction would be applicable to existing, employer-sponsored insurance or to the purchase of insurance on the individual or small group market. It would eliminate the tax exclusion for employer-paid health insurance and the self-employed health deduction[.]" (Employee Benefit News)  

Ninth Circuit Extends ERISA Deadline, Revives Untimely Appeal
"The majority ... missed a significant issue. As argued by the dissent, the court was simply interpreting the unambiguous terms of an ERISA plan; there were no terms in the plan that extended the time if the deadline landed on a Saturday, Sunday, or holiday.... The opinion will not be hugely significant if it is limited to its specific facts. However, it will be far more problematic if it is a signal by the Ninth Circuit that the express and unambiguous terms of a plan can be changed or modified through the application of federal common law." [LeGras v. Aetna Life Ins. Co., No. 12-56541 (9th Cir. May 28, 2015)] (Ogletree Deakins)  

SEC Mulling Tweak of Pay-Ratio Disclosure Rule
"Public comments on the proposal have suggested excluding segments of a company's workforce in calculating the ratio of the median of the annual total compensation of all employees of the issuer to the annual total compensation of the chief executive officer of the issuer. According to an SEC staff analysis that was made available [on June 4] for public comment, such an exclusion could cause variations in the pay ratio of 3.4% to 15%. Public comments are due by July 6." (CFO)  

Marsh & McLennan Agency Survey Reveals Lowest Benefit Cost Increase in 10 Years for Michigan Employers
Marsh & McLennan Agency LLC – Michigan office

SPARK Institute Announces New Award Program
SPARK Institute

SPARK Institute Names New Executive Director
SPARK Institute

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