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[Official Guidance]
Text of Agency Final Regs: Coverage of Certain Preventive Services Under the ACA (PDF)
112 pages. "These regulations finalize provisions from three rulemaking actions: interim final regulations issued in July 2010 related to coverage of preventive services, interim final regulations issued in August 2014 related to the process an eligible organization uses to provide notice of its religious objection to the coverage of contraceptive services, and proposed regulations issued in August 2014 related to the definition of 'eligible organization,' which would expand the set of entities that may avail themselves of an accommodation with respect to the coverage of contraceptive services.... If additional questions arise regarding the application of the preventive services coverage requirements, the Departments may issue additional sub regulatory guidance... "These final regulations incorporate the clarification that a plan or issuer that does not have in its
network a provider who can provide a particular recommended preventive service is required to cover the preventive service when performed by an out-of-network provider, and may not impose cost sharing with respect to the preventive service.... "[For purposes of the religious accommodation for contraceptive coverage,] these regulations establish that to be eligible for the accommodation, a closely held, for-profit entity must, among other criteria, be an entity that is not a nonprofit entity, and have more than 50 percent of the value of its ownership interests owned directly or indirectly by five or fewer individuals, or must have an ownership structure that is substantially similar."
(U.S. Department of the Treasury, U.S. Department of Labor [DOL], and U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
Administration Issues Final Rules on Coverage of Preventive Services
"The first action announced today maintains the existing accommodation for eligible religious nonprofits, but also finalizes an alternative pathway for those organizations to provide notice of their objection to covering contraceptive services. A second action announced today provides certain closely held for-profit entities the same accommodations. Today's rules also finalize interim final rules on preventive services coverage generally, with limited changes."
(U.S. Department of Health and Human Services [HHS])
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[Guidance Overview]
Certain Mid-Sized Employers May Have Even More Time to Comply with ACA Play-or-Pay Rules
"Thanks to a special transition rule, employers with 50 to 99 full-time employees ... are generally shielded from the [ACA's] 'play-or-pay' penalties until January 1, 2016.... [A]ny such 'mid-sized' employer that already sponsors a health plan operating on a non-calendar-year basis has even more time to comply with these rules.... As a way of deferring the date by which they would have to comply with a number of other ACA mandates that took effect as of the first day of the 2014 plan year, many sponsors of insured health plans engaged in an 'early renewal' process during late 2013. This means that a number of mid-sized employers now sponsor health plans with a plan year that begins fairly late in the calendar year. And because those renewals took place before the magic date of February 9, 2014, those employers may now rely on this special transition rule for non-calendar-year
plans."
(Spencer Fane)
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[Guidance Overview]
Group Health Plans Must Limit Out-of-Pocket Expenses at Individual Level in 2016
"Employers who sponsor non-grandfathered self-funded health plans will need to evaluate their plan designs to determine how to implement this new rule, amend plan documents to expressly include the application of the requirement, amend and/or ensure summary plan descriptions (SPDs) are consistent with this new rule, and then determine the impact of this new rule on plan costs and, therefore, premiums."
(McAfee & Taft)
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[Guidance Overview]
CMS Proposes Major Initiative for Hip and Knee Replacements
"Through the proposed five-year payment model, health care providers in 75 geographic areas would continue to be paid under existing Medicare payment systems. However, the hospital where the hip or knee replacement takes place would be held accountable for the quality and costs of care for the entire episode of care -- from the time of the surgery through 90 days after discharge. Depending on the hospital's quality and cost performance during the episode, the hospital may receive an additional payment or be required to repay Medicare for a portion of the episode costs."
(U.S. Department of Health and Human Services [HHS])
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Paid Parental Leave: Boston Starts Another Party
"In a recent trail blazing move, Boston's Mayor Martin J. Walsh signed an ordinance establishing paid parental leave for city employees.... The new ordinance is noteworthy for more than just its relative rarity in the United States. Its scope is also unusually broad. Unlike other family leave policies -- which often are applied differentially based on gender -- the Boston ordinance provides both female and male city employees with six weeks of paid parental leave to be taken by day or week anytime during the first year after the birth or adoption of a child. In addition, the leave is available to employees regardless of the means by which they have become parents -- either through natural birth, adoption, surrogacy or stillbirth."
(Employee Benefit News)
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$1,200 to $12,000: Why Nobody Can Figure Out How Much Childbirth Actually Costs
"The good thing is that widely varying costs like this suggest big opportunities for savings. What, exactly, are the most expensive hospitals doing that jacks up their costs so much? What could they learn from a hospital that spends less? But that depends on understanding why the costs vary in the first place, and despite their best efforts, researchers could only figure out a small fraction -- 13 percent -- of the variation by factoring in differences such as the type of hospital or cesarean section."
(The Washington Post; subscription may be required)
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The Underexploited Big Data Sweet Spot for Healthcare
" 'They want predictive analytics derived from big data that can help them to better understand consumer behaviors and patterns in their service areas so they can determine which of their services is most likely to be in demand for certain demographic segments,' said [Matt Elson, a senior vice president for Evariant].... [For example,] analytics can be employed to assist hospital personnel in keeping add-on revenues within the institution by measuring which doctors regularly make referrals out of network where these add-on revenues are lost -- or even preventing costs by identifying patients who should be reached out to for preventive care, which in turn can lessen visits to the ER."
(TechRepublic)
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As Health Insurers Scramble to Get Bigger, UnitedHealth Sits Pretty
"Aetna's agreement to buy its rival Humana is only the first deal to come out of an amazing merger-and-acquisition free-for-all going on among the largest publicly held health insurance companies.... About the only thing that's clear in this latest round of industry consolidation is who the winner will be when it's all over. That's going to be Minnetonka-based UnitedHealth Group."
(StarTribune)
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Small Business Owners Tell Senators Obamacare Flaws Making Insurance Expensive
"Three small business owners told a Senate hearing [on July 7] that Obamacare is riddled with problems that are leading to more expensive insurance policies, which is making it harder for companies to provide high-quality healthcare to their workers.... [B]ecause the ACA bases the price of coverage on age, it is considerably cheaper to hire a younger person.... Additionally, 'available carrier choices are becoming more and more limited' as the medical care costs differ between states, and 'health reform implementation' also varies between areas."
(Washington Examiner)
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Maryland Revamps Its in Vitro Coverage Mandate to Accommodate Same-Sex Couples
"Maryland same-sex couples who wanted to take advantage of a state law that requires insurers to cover pricey in vitro fertilization treatments used to face insurmountable obstacles.... This month, however, those restrictions were eliminated for married same-sex couples under a new law. It also prohibits insurers -- when they cover other types of fertility treatments -- from applying those conditions to same-sex couples. The law doesn't change the IVF coverage rules for married, heterosexual couples."
(Kaiser Health News)
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Benefits in General; Executive Compensation
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[Guidance Overview]
SEC Proposes Dodd-Frank Act Clawback Rules
"The proposed rules reflect an unfortunate lack of trust in boards of directors as to when pursuing clawback may be in the best interests of the issuer and its shareholders. The clawback requirements as proposed could influence companies to move away from incentive compensation that is tied to financial performance metrics ... to avoid the clawback issue altogether. The proposed rules do not address potential significant tax ramifications for executive officers who experience a substantial clawback on a pre-tax basis years after the officer has paid income taxes on that compensation (an especially harsh result for a nonculpable individual). Clawbacks of incentive compensation based on stock price or total shareholder return may necessarily require the board to estimate (rather than mathematically calculate) the excess compensation that should be clawed back, which is likely to result in
disputes or even litigation between affected current (or former) executive officers and employers."
(Jones Day)
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[Guidance Overview]
SEC Proposes Broad Executive Compensation Clawback Rules
"Executive officers may seek higher compensation, either to take into account the risk of the proposed rules or to make themselves 'whole' after having compensation clawed back.... Executives may insist upon provisions in their employment agreements and indemnification agreements that obligate the issuer to bear such legal fees and expenses. In turn, issuers may insist upon coverage of these expenses by D&O insurers ... Executives may consider purchasing insurance policies for themselves that cover clawed-back compensation amounts."
(Pillsbury Winthrop Shaw Pittman LLP)
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[Guidance Overview]
SEC Wants Companies to Adopt, Disclose, and Comply with Clawback Policies on Erroneously Awarded Executive Compensation
9 pages. "Because the focus of the recovery policy is on the performance period for which the excess compensation was paid, the actual payment date of the compensation is not relevant.... [A] company's principal financial officer and principal accounting officer or controller are specifically defined to be executive officers for purposes of the proposed rules. Recovery would be required regardless of whether there was any misconduct and even if an executive officer had no role in preparing the company's financial statements that were later required to be restated."
(Morgan Lewis)
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[Opinion]
Hodak Value Advisors Comment Letter to SEC on Proposed Disclosure of Pay for Performance (PDF)
16 pages. "[T]he proposed rule could distort investors' view of pay-for-performance, either by making reasonable pay-for-performance look bad, or by making poor pay-for-performance look good.... Some unintended consequences that the proposed rule would likely encourage:.... [1] A greater emphasis on short-term performance ... [2] A reduced emphasis on equity awards ... [3] Greater use of stock-based metrics driving variable compensation ... By being conscious of the role that variable compensation plays in creating alignment, as well cost, we can derive an improved method for determining 'pay' that avoids the potential ramp-up, path-dependence, and other distortions of the proposed rule."
(U.S. Securities and Exchange Commission [SEC])
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