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[Official Guidance]

ACA Assurance Testing System Test Scenarios for Tax Year 2015/Processing Year 2016 Are Online
"Tax Year 2015 ACA AATS will open for testing in early November 2015 using a Character-by-Character Comparison tool. A more robust testing environment will be available in January 2016. Scenarios for both versions of Tax Year 2015 AATS are posted. Information about AATS can be found in the Tax Year 2015 (Processing Year 2016) Publication 5164, Test Package for Electronic Filers of Affordable Care Act (ACA) Information Returns (AIR), at the AIR Program page." (Internal Revenue Service [IRS])  

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Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges (PDF)
19 pages. "In this model, the government retains control over sovereign exchange functions... but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites ... [The authors'] analysis suggests that a shift to privately facilitated exchanges could improve consumer experience and, consequently, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks... On net, ... the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift[.]" (RAND Corporation)  

Nine Questions to Ask Wellness Technology Vendors
"[1] How will this program support my company's business goals? ... [2] How can technology link to my existing people initiatives? ... [3] To what degree can I customize the look and feel of my program? Can I incorporate my company's color palette, graphics, logo and brand standards? ... [4] How do you use your platform to promote culture initiatives? ... [5] Will it allow my employees to set their own vision for improvement? ... [6] How will I manage and act on user data? ... [7] How many applications and device integrations does your platform offer? ... [8] What outside initiatives and programs can you partner with (such as career planning, financial advising or community volunteering programs)? ... [9] How does your platform connect benefit programs, interventions and communications in a cohesive way?" (Employee Benefit News)  

Supreme Court to Decide What Is Required for Equitable Tracing
"Affirmance of the Eleventh Circuit's decision would represent a practical solution to a common problem faced by fiduciaries and plans who attempt to recover from non-fiduciary plan participants or service providers asserting a right to plan benefits based on assignment.... [S]hould the Supreme Court reverse, non-fiduciary recipients of plan funds would be provided with a perverse incentive to spend plan money immediately upon receipt so as to avoid any repayment obligations set forth by plan terms." [Bd. of Trustees of the National Elevator Industry Health Benefit Plan v. Montanile, No. 14-11678 (11th Cir. Nov. 25, 2014; oral arg. sched. Nov. 9, 2015)] (Seyfarth Shaw LLP)  

Seventh Circuit: Preferred Provider Agreements Do Not Support ERISA Claim
"The court expressly aligned itself with the Second Circuit, and decisions from other circuits, which distinguish between a provider's status as an assignee of a particular claim, and its status as voluntary members of a network.... [T]he court disagreed with the notion that this was a question of 'standing' to sue under ERISA ... but 'whether their claim comes within the zone of interests regulated by [ERISA].' It explained that there was value in 'keeping standing distinct from statutory coverage.' " [Pennsylvania Chiropractic Assoc. v. Independence Hospital Indemnity Plan, Inc., Nos. 14-2322, 14-3174 and 15-1274 (7th Cir. Oct. 1, 2015)] (Begos Brown & Green LLP)  

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2015 Telehealth & Remote Patient Monitoring Summit – Jan 27-28 – Atlanta – Take $200 off your registration* use promo code BLINK2 (*not valid toward Webcast or Government Rate)

Cutting-Edge Reproductive Benefits Raise Cost Concerns
"One [school of thought] says that as fertility treatments and options grow in number and sophistication, employers may need to follow suit and cover these services.... The other ... focuses on the cost of these technologies and procedures ... Another issue regarding coverage for newer fertility-related procedures relates to the tax deductibility of these benefits, as egg extraction and freezing do not easily fit into the usual definition of deductible health care expenses." (Society for Human Resource Management [SHRM])  

Prescription Drugs: Advancing Ideas to Improve Access, Affordability, and Innovation
"Surveys suggest that as many as 25 percent of Americans cannot afford and, therefore, do not fill the prescriptions on which they depend. And, spending on medicines increased 13 percent in 2014, compared to 5 percent for health care spending growth overall, the highest rate of drug spending growth since 2001. An important element of this increase in costs is due to new specialty drugs.... [CMS has] issued a notice to all 50 state Medicaid directors and sent letters to the CEOs of several drug manufacturers about providing access to therapy for Hepatitis C patients." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

Lack of Specialists Found in Federal Marketplace Insurance Plans
"Using a 100-mile and 50-mile search radius, 18 (13%) and 19 (14%), respectively, of 135 plans were specialist deficient (plans without a specialist physician). Endocrinology, rheumatology, and psychiatry were the most commonly excluded specialties. It is notable that psychiatry is among the largest-volume nonsurgical specialty, and endocrinology and rheumatology are specialties that treat common outpatient conditions. An additional 7 to 14 plans had fewer than 5 in-network physicians in those specialties." (American Journal of Managed Care)  

Congress Continues Probe Into Failing Obamacare CO-OPs
"The government should pursue all means to get back federal loan dollars from failing co-ops, according to written testimony on Thursday from Gloria Jarmon, an official with the Department of Health and Human Services' Office of Inspector General.... John Morrison, vice chair of Montana's co-op, said both Congress and the Obama administration contributed to the co-ops' struggles by changing their federal grants to loans, cutting their funding and making co-op reserve requirements higher than those for other insurers." (McClatchyDC)  

Kentucky's Exchange Success Doesn't Translate to Small Business Participation
"Kentucky has run one of the most successful Obamacare individual health insurance exchanges ... But Kentucky's online health insurance marketplace for small employers also created by the Affordable Care Act has mostly been a dud. Just 92 employers have signed up and a total of 901 people, both workers and their dependents, have received coverage through the specialized exchange.... As of October, several state-run SHOP exchanges in addition to Kentucky had sold coverage to fewer than 200 employers including Idaho, Maryland, Minnesota and Washington." (Kaiser Health News)  

[Opinion]

State of the TPA Industry and Market; Forecast for 2016
"There has been a shift in the perception among employers of self-funding and insured.... Meanwhile, insurers have seen fully-insured health plans shrink dramatically in their percent of business ... [W]hen will insurers (or their investors) say enough is enough and pull out of not only ACA Exchanges but the whole fully-insured health market? ... [I]nsurers withdrawing from fully-insured sounds crazy, but some fallback plans have already been made.... What would happen to the large chunk of insurer ASO self-funded business? ... Are there any bad or scary factors? Yes.... Inexperienced 'TPAs' are a concern.... Buying a TPA ... Single Payer (national insurance or state-by-state) ... The medical provider community is undergoing massive shifts & changes[.]" (Fred Hunt, for Society of Professional Benefit Administrators [SPBA])  

[Opinion]

Wellness Doesn't Work: Part 3 of the Proof
"If indeed workplace wellness prevented [a] huge increase [in wellness-sensitive medical admissions (WSMEs)] in the privately insured population, one would expect that these very same events would have risen by something similar to 60% in the non-privately insured population -- meaning the combined Medicare, Medicaid, and uninsured.... As wellness spending snowballed, the separation between those two populations' WSME trendlines should have increased significantly. Instead, we find these populations WSME-as-percent-of-total-admissions also flat-lined, just like the private-pay population." (Al Lewis and Vik Khanna)  

Domestic Partnership Converted Retroactively to Marriage After Death Provides Basis for VA Spousal Benefits
"In a case that has obvious implications for employee benefit plans, the Veterans' Administration (VA) has just provided survivor benefits to the partner of a service member, even though the partners were not married before the service member's death.... The Obergefell decision allowed Krumbach to retroactively amend Hatcher's death certificate to show they were married. The VA then allowed the benefits to Krumbach as the surviving spouse.... [An] employer needs to give serious consideration to how it will currently treat same-sex marriages entered into before it changed its policies to recognize such marriages. [This article] focuses on steps the employer may consider to mitigate liability in the future[.]" (Calhoun Law Group, P.C.)  

Benefits Litigation Update, Fall 2015 (PDF)
Articles include: [1] Will a third wave of suits over the contraceptive mandate bring the culture wars to corporate employee benefits? [2] Okun v. Montefiore: Are your severance policies subject to ERISA? [3] The House of Representatives challenges the ACA in court; [4] Increased litigation risks for fraudulent concealment fiduciary breach claims; [5] Data breach litigation targeting employers; and [6] LeBlanc v. SunTrust Bank: beware the payroll practices exemption under ERISA. (Epstein Becker Green, for the ERISA Industry Committee)  

Financial Engines to Acquire The Mutual Fund Store to Expand Independent Advisory Services for 401(k) Plan Participants
Financial Engines, Inc.

Rally Health Launches Rally Choice, New Benefits Tool
Rally Health, Inc.

New Fellows - November 2015
Society of Actuaries

Harper Danesh Celebrates Fifth Anniversary
Harper Danesh LLC

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