401(k) Relationship Manager
MVP Plan Administrators, Inc.
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Jack A. Cross & Associates, Inc.
in CA

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TPA Firm in St. Louis, MO
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Aspire Financial Services LLC
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Northwestern Benefit
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United Retirement Plan Consultants
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Pension De-Risking for Employee Benefit Sponsors: Avoiding Litigation and Enforcement Action
RECORDED
(Strafford)

Employer Only Roundtable: Exploring the Benefits and Challenges of Private Exchanges
June 30, 2015 in IL
(Midwest Business Group on Health)

2015 San Antonio Mid-Sized Retirement & Healthcare Plan Management Conference
September 27, 2015 in TX
(University Conference Services)

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[Official Guidance]

Text of HHS Inspector General Advisory Opinion 15-08: Medigap Premium Reduction for Use of Specific Network Hospitals Does Not Violate Anti-Kickback Statute (PDF)
"We are writing in response to your request for an advisory opinion regarding the use of a 'preferred hospital' network as part of Medicare Supplemental Health Insurance (Medigap) policies, whereby [name redacted] would indirectly contract with hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay (the Proposed Arrangement) ... [A]lthough the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute ... the [OIG] would not impose administrative sanctions on [name redacted] under sections 1128(b)(7) or 1128A(a)(7) of the Act ... in connection with the Proposed Arrangement. In addition, the OIG would not impose administrative sanctions on [name redacted] under section 1128A(a)(5) of the Act in connection with the Proposed Arrangement." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])  

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[Official Guidance]

Text of CMS Announcement: Cost-Sharing Reduction Amounts in Risk Corridors and Medical Loss Ratio Reporting (PDF)
"As a result of the new timetable for CSR reconciliation, the actual value of CSRs provided by the issuer will not be available in time for risk corridors and medical loss ratio (MLR) program reporting for the 2014 benefit year. Therefore, for the purpose of adjusting allowable costs in the risk corridors calculation and incurred claims in the MLR calculation for the 2014 benefit year, issuers should use the amount of the CSR portion of the advance payments received by the issuer for 2014 ... [To] ensure the integrity of data used in risk corridors and MLR calculations, we intend to propose a policy in the HHS Notice of Benefit and Payment Parameters for 2017 under which CMS would implement an adjustment to the risk corridors and MLR calculations for 2015 to correct for any inaccuracies in the estimated CSR provided in 2014 that were reported in the 2014 risk corridors and MLR reporting form." [Unnumbered document dated June 19, 2015.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Official Guidance]

Text of CMS Memo: System Validations for the 2014 MLR Reporting Year (PDF)
5 pages. "When an issuer uploads the annual MLR reporting form or Risk Corridors Plan-level Data forms into the Health Insurance Oversight System (HIOS), the submission undergoes several automated validations. Some of the validations result in an error message and the issuer must resolve the problem before they can attest to their submission. Other validations result in warning messages to indicate a potential problem with their submission but do not prevent the company from attesting to their submission." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

ACA Information Returns (AIR) Working Group Meeting: Overview of the Early Look AIR Submission Composition and Reference Guide (PDF)
41 presentation slides. "This session will focus on the overview of the AIR Submission Composition and Reference Guide.... This publication provides guidance to all types of external transmitters about composing and successfully transmitting compliant ACA Information Return submissions to IRS. Scope: [1] Covers details on composing and submitting Form 1094/1095-Bs and Form 1094/1095-Cs by transmitters to IRS. [2] Addresses the Application to Application interface (A2A-application based via SOAP messages exchanged between client and exposed Web Service endpoints) and the Web User Interface (Web UI-browser-based requiring human initiation)." (Internal Revenue Service [IRS])  

[Guidance Overview]

IRS Releases Draft 2015 Versions of Form 1094/1095 Information Returns
"Based on these drafts, it appears that the IRS does not anticipate making significant changes to the reporting forms for 2015. While this is good news, until instructions are made public, filers (and advisors) lack crucial information as they gear up for fast-approaching 2016 filing deadlines." (Thomson Reuters / EBIA)  

[Guidance Overview]

Agencies Issue Final SBC Regulations Consistent With Proposals, Generally Effective September 1, 2015
"The good news -- particularly for plans with open enrollment periods just around the corner -- is that the final regulations do not contain any surprises for plan sponsors. And, consistent with the proposed regulations and the agencies' stated purpose, they should make the SBC more useful to readers and perhaps less burdensome to provide. The missing pieces are the final revisions to the SBC template and related materials; the SBC remains something of a moving target for another year[.]" (Thomson Reuters / EBIA)  

Third Circuit Issues Bright-Line Interpretation of FMLA's 'Overnight Stay' Rule
"After rejecting several approaches offered by the parties, including a 'sunset-sunrise' definition to 'overnight stay' and a 'totality of the circumstances' approach, the court ultimately held that 'overnight stay' means a stay 'for a substantial period of time from one calendar day to the next calendar day as measured by the individual's time of admission and time of discharge.' In addition, the court held that the stay must be for a 'substantial period of time,' and opined that a minimum of eight hours would be an appropriate period of time." [Bonkowski v. Oberg Ind., No. 14-1239 (3rd Cir. May 22, 2015)] (Mintz Levin)  

Eight Steps That Could Save Employers $500 Billion and Delight Their Workforce
"Despite the fact that health benefits are typically the second biggest expense (after wages) for most employers, far too many CEOs and CFOs have failed in their fiduciary responsibility [to the shareholders] to manage such a large cost item effectively. This passivity and reliance on so-called 'experts' to advise their benefits strategy has cost them and their employees dearly. Simply shifting the burden to employees in the form of high deductible health plans just adds financial stress to employees that indirectly costs the company down the road. Fortunately, there are some employers who have taken the bull by the horns." (Forbes)  

Evaluating Private Exchanges: A Two-Step Process
"First, an employer needs to decide what they hope to accomplish by moving to an exchange. Reflecting on their own structure and strategy around employee benefits and determining what they want to accomplish by moving to an exchange will streamline the decision-making process.... The second step is vetting and evaluating the different exchanges based on the employer's specific strategy, structure and budget." (The Institute for HealthCare Consumerism [IHCC])  

Thanks But No Thanks: Cigna Declines Anthem Bid
"Anthem, the for-profit Blue Cross Blue Shield company, made a $53.8 billion bid for Cigna -- roughly $3,680 for each of its 13.7 million health plan members and $184 per share.... But Cigna's leaders have balked at the bid, describing the $53.8 billion as insufficient, rife with corporate governance problems and also lacking in the face of Anthem's own uncertainties going forward." (Healthcare Payer News)  

CBO Finds 19 Million Would Become Uninsured If Health Law Repealed
"The report is the first time CBO has analyzed the costs of the health law using a format favored by congressional Republicans that factors in the effects on the overall economy.... CBO projected that a repeal would increase the federal deficit by $353 billion over 10 years because of higher direct federal spending on health programs such as Medicare and lower revenues. But when including the broader effects of a repeal on the economy, including slightly higher employment, it estimated that the federal deficit would increase by $137 billion instead. Both estimates are higher than in 2012, the last time that the CBO scored the cost of a repeal." (Kaiser Health News)  

[Opinion]

A Question of Balance (PDF)
"With healthcare, once we're in the system, we've pretty much lost control of the costs. Due to asymmetry of information, the ethos we grant providers, and our own insecurities about the fate of our unwell bodies, the providers make the vast majority of the testing and treatment decisions and, hence, make the cost decisions too. In response to the ever-rising costs, employers are increasing their use of high deductible health plans and the defined contribution approach to finance employee healthcare. These cost-shifting techniques raise the question: will employers continue to provide enough healthcare currency for their employees to maintain equilibrium with the additional services and higher provider prices?" (Chelko Consulting Group)  

[Opinion]

Business Roundtable Comment Letter to EEOC on Wellness Programs
"We strongly urge the EEOC not to undermine the value of these programs.... Under the current regime, private employers must offer programs that are well-designed to achieve the goals established; must offer reasonable alternatives for employees who cannot participate for medical reasons; and must ensure that strong privacy protections are in place. Business Roundtable believes that EEOC should not unnecessarily regulate those employers who are in compliance with the ACA. Rather, EEOC should focus their resources on identifying employers who are not compliant." (Business Roundtable [BRT])  

[Opinion]

U.S. Chamber of Commerce Comment Letter to EEOC on Proposed Wellness Regulations: 'Fundamentally Flawed' (PDF)
30 pages. "[T]he Chamber believes that the EEOC's approach to restricting workplace wellness program incentives is fundamentally flawed. The Proposed Rule, if promulgated, will discourage employers from instituting or sponsoring workplace wellness programs -- a tool authorized by Congress in amending [HIPAA] through the [ACA] -- to improve employees' health and lower employees' health care costs. With this Proposed Rule, the EEOC not only exceeds its jurisdiction and authority under the ADA, but the Commission also contradicts both the text of the ACA and the Tri-Agency Regulations." (U.S. Chamber of Commerce)  

[Opinion]

HR Policy Association Comments to EEOC on Proposed Wellness Program Rule: 'EEOC Does Not Have the Statutory Authority'
"Although the proposed rule would restrict the ability of employers to administer gated health care plans, the EEOC does not have the statutory authority under the ADA's insurance safe harbor provision to impose such restrictions ... The EEOC's blanket rejection of a key 11th Circuit decision involving the ADA's 'safe harbor' (Seff v. Broward County) is inappropriate, and the agency should recognize that some wellness plans may fall within that provision." (HR Policy Association)  

[Opinion]

Republican Proposals to Extend Obamacare Subsidies Would Create Big Problems
"While both the Republican House and Senate plans would create a means for people to continue to be covered in the wake of any Supreme Court finding that ended the Obamacare subsidies in the federally run states, what we so far know about these proposals is clearly unworkable in the market and would lead to very big and unfortunate unintended consequences." (Forbes)  

Top CEOs Make 300 Times More Than Typical Workers: Pay Growth Surpasses Stock Gains and Wage Growth of Top 0.1 Percent
"The chief executive officers of America's largest firms earn three times more than they did 20 years ago and at least 10 times more than 30 years ago, big gains even relative to other very-high-wage earners. These extraordinary pay increases have had spillover effects in pulling up the pay of other executives and managers, who constitute a larger group of workers than is commonly recognized. Consequently, the growth of CEO and executive compensation overall was a major factor driving the doubling of the income shares of the top 1 percent and top 0.1 percent of U.S. households from 1979 to 2007[.]" (Economic Policy Institute)  

Healthstat Celebrates Customer Achievement In Healthiest Employer Award
Healthstat

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