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[Official Guidance]
Text of IRS Publication 5165, Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters, Processing Year 2016 (PDF)
50 pages, dated Nov. 2015. "[This publication] outlines the communication procedures, transmission formats, business rules and validation procedures for returns transmitted electronically through the AIR system.... The procedures in this publication should be used when the following information returns are transmitted electronically: Form 1094-B, Transmittal of Health Coverage Information Returns; Form 1095-B, Health Coverage; Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; [and] Form 1095-C, Employer-Provided Health Insurance Offer and Coverage."
(Internal Revenue Service [IRS])
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[Official Guidance]
Text of IRS Publication 5164: Test Package for Electronic Filers of ACA Information Returns (AIR), Processing Year 2015 (PDF)
24 pages, dated Nov. 2015. "Software Developers are required annually to pass pre-defined AATS submissions and test scenarios for the forms that they will support. Transmitters and Issuers are required to pass communication tests for the forms they will file.... This publication is for the more robust AATS testing environment beginning January 2016. This testing environment will provide additional improved error messages for business rule execution errors and will not use the character-by-character comparison tool for submission evaluation. Please note, if the tests were passed in the November AATS environment, passing the more robust January AATS is not required. However, we encourage you to retest under this new more robust testing environment."
(Internal Revenue Service [IRS])
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[Guidance Overview]
ACA Reporting Requirements for Carriers and Employers (Part 20 of 24): Reporting Affordability on Form 1095-C, Part II, Line 16
"The attractiveness of this safe harbor is that the amount at which an employee's contribution is affordable may be known up front. The challenges, however, are many. In the case of hourly employees, the hourly rate is multiplied by 130 hours, despite that the employee may work more hours. Also, the rate of pay for an hourly employee can change if the rate of pay decreases (but not where it increases). Worse, the rate of pay safe harbor is unavailable in the case of non-hourly employees whose monthly salary is reduced mid-year. Thus, the safe harbor cannot be used, as a practical matter, for tipped employees or for employees who are compensated solely on the basis of commissions. For these employees, the employer must use one of the two other affordability safe harbors."
(Mintz Levin)
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[Guidance Overview]
GINA and Wellness Incentives (PDF)
"These proposed regulations now clarify that under GINA an employer can offer limited incentives (rewards or penalties) for a spouse covered under the employer's group health plan to provide genetic information as a part of a health assessment or a biometric screening. The spouse must offer the genetic information voluntarily and provide prior, knowing, written authorization that can be obtained electronically.... [E]mployers cannot require an employee to waive GINA confidentiality provisions in order to participate in a wellness program or receive an incentive."
(Marsh & McLennan Agency LLC)
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ACA Reporting Software/Vendor Setup: What's with These Questions About Qualifying Offers, the 98% Offer Method, and Other Stuff? (PDF)
"Many employers working with vendors to accomplish Affordable Care Act (ACA) reporting have received questionnaires from their vendors, making inquiries related to how the employer is complying with the employer mandate. Some of these questions include who the employer treats as eligible, how the employer determines full-time employees, what periods of time the employer is using for measurement, administrative and stability periods (where the employer is using the look-back measurement method), and more. Some of these questions are bewildering to the employer and often are not well explained in the vendor's questionnaire."
(Lockton)
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Health and Welfare Plan Year-End Action Items
"Determine applicable large employer/applicable large employer member status for 2016. Determine whether any changes will be made to the measurement process for 2016 ... Ensure minimum essential coverage will be offered to at least 95 percent of ACA full-time employees ... Complete Forms 1095-C and distribute to applicable employees by February 1, 2016 ... Amendments to plan documents, summary plan descriptions, and related material, as necessary ... Determine whether to amend health care FSA to incorporate FSA carryover provision ... Determine whether to amend health care FSA to increase employee contribution limit to $2,550 ... Distribute Summary Annual Report(s) ... Pay 2015 Transitional Reinsurance Fee."
(Haynes and Boone, LLP)
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Transcript of Oral Argument Before the Supreme Court Addressing ERISA Preemption of Vermont Statute Mandating Data Collection from Self-Insured Health Plans (PDF)
65 pages. "[Justice Kagan, to counsel for the DOL, appearing as amicus for petitioner Vermont:] [W]hen 50 States devise 50 different requirements for this, different formatting, different particular information requested, that just all adds up to a lot of hassle, which all adds up to a lot of money.... [Justice Kagan, to counsel for respondent Liberty Mutual:] [T]he State here clearly is not attempting to, and is not regulating, payment of benefits. It's doing something that has an effect on your operations, no doubt, but the State is operating in a completely separate area for completely separate purposes in a way that does not trump or conflict with, or anything else, the choices that ERISA has made as to payment of benefits." [Gobeille v.
Liberty Mutual Ins. Co., (2d Cir. Feb. 4, 2014, argued Dec. 2, 2015)]
(Supreme Court of the United States)
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Supreme Court Justices Spar Over ERISA Preemption of State Health Care Databases
"The presentations of Bridget Asay (representing Alfred Gobeille, the responsible Vermont official) and John Bash (representing the federal government, supporting Vermont) were hampered by caustic criticism from Chief Justice John Roberts and Justices Antonin Scalia and Samuel Alito. Those Justices made two general points. First, consuming much of Asay's presentation, Scalia and Alito suggested that the collection of health-care data was a core ERISA function because of a provision added to the act by the ACA that gives the Secretary of Labor broad authority to collect such data.... Conversely, Justices Ruth Bader Ginsburg and Elena Kagan dominated the argument time of Seth Waxman on behalf of Liberty Mutual. From their perspective, the purposes of all-payer databases are so far removed from ERISA's core goals that it makes no sense to impute to ERISA an intent to prevent the data
collection." [Gobeille v. Liberty Mutual Ins. Co., (2d Cir. Feb. 4, 2014, argued Dec. 2, 2015)]
(SCOTUSblog)
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High Court Considers State Health Care Databases
"Breyer and other justices appeared convinced during argument Dec. 2 of the value of these databases, which more than a dozen states now use to shape health-care policy in an effort to improve outcomes and lower costs. He pressed counsel about why states have developed varying standards for data collection -- which arguably creates administrative and financial burdens for health plans -- rather than petitioning federal agencies such as the Labor Department to facilitate a more uniform system."
(Bloomberg BNA)
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Amicus Brief of 46 U.S. Representatives Supporting Challenge to ACA Under Constitution's Origination Clause (PDF)
34 pages. "The history of the Origination Clause, its purpose, and a proper reading of the relevant Supreme Court decisions, early federal court opinions, and State court decisions that interpreted their respective State Constitution Origination Clauses, all demonstrate that the court below fundamentally erred in devising this novel 'primary purpose' test. If allowed to stand, the 'cornerstone' of the Great Compromise of 1787 could easily be rendered a dead letter simply by the Senate labeling any revenue raising bill with a regulatory 'primary purpose.' ... The Origination Clause is not a relic so easily subverted and discarded[.]" [Sissel v. HHS, No. 15-543 (D.C. Cir. Aug. 7, 2015; cert. pet. filed Oct. 26, 2015)]
(U.S. Rep. Trent Franks, R-Tex, and 45 Other Members of the U.S. House of Representatives)
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Court Rules Out State Law Claims for Anthem Data Breach
"For the second time this year, the U.S. District Court for the Northern District of California has ruled that state law claims arising from Anthem's February data breach are preempted by [ERISA] ... The participants sought to enforce their rights under the ERISA plan through their breach-of-contract and unjust-enrichment claims. Since these claims were premised on the insurance contract between the participants and Anthem they could have brought their actions under [ERISA] Section 502(a), the court concluded. In addition, Anthem didn't have an independent legal duty to protect participants' privacy pursuant to state law, the court said." [In re Anthem, Inc. Data Breach Litig., No. 15-CV-04739-LHK (N.D. Cal. Nov. 24,
2015)]
(Bloomberg BNA)
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Interpreting New Data on Health Care Spending Growth
"Evidence suggests that the slowdown started before the recession and affected populations not as strongly or directly affected by the recession.... Evidence ... suggests that spending growth has indeed begun to rebound, rising from 2.9 percent in 2013 to 5.3 percent in 2014. Interpreting these new figures is complex, and they may not be as alarming as they seem."
(Health Affairs)
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Health Spending in U.S. Topped $3 Trillion Last Year
"Health spending in the United States last year topped $3 trillion -- an average of $9,500 a person -- as five years of exceptionally slow growth gave way to the Affordable Care Act's expansion of Medicaid and private insurance coverage, and as prescription drug prices resumed their sharp climbs ... Health spending grew faster than the economy in 2014, and the federal share of health spending grew even faster, as major provisions of the Affordable Care Act took effect."
(Robert Pear, in The New York Times; subscription may be required)
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Are Nonprofits Requesting an Accommodation for Contraceptive Coverage?
"[O]verall 3% of nonprofits offering health benefits (with 10 or more workers) reported that they elected the accommodation. Only 2% of very small nonprofits offering health benefits (with between 10 and 49 workers) reported that they elected the accommodation. The share was considerably higher for larger nonprofits with more than 1,000 employees; 10% of nonprofits with 1,000 to 4,999 workers, and 10% of nonprofits with over 5,000 workers reported that they elected the accommodation. Many of the larger nonprofits are likely faith-based health systems or educational institutions."
(Henry J. Kaiser Family Foundation)
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How Might Proposed Payer Mergers Impact State Insurance Markets?
"If the mergers are finalized, Georgia, Connecticut, and Colorado could potentially experience 40 percent or higher increases in commercial insurance concentration. Kansas, Alaska, Iowa, and Ohio could experience 60 percent or higher increases in Medicare Advantage concentration.... Understanding payer concentration trends and potential future scenarios will inform policy and decision makers as they discuss the implications of consolidation and competition within the United States health care system."
(Health Affairs)
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How the Government as a Payer Shapes the Health Care Marketplace (PDF)
15 pages. "The federal government is the largest single payer of health care in the United States ... [The] various ways in which the U.S. government in its role as payer attempts to influence U.S. health care beg the question of what other players in the space will do in response -- and what this could possibly mean for the nation's health care system in the future.... The key question is whether the changes undertaken by these players will, together with government, enhance or detract from the widely proclaimed goal of better quality of health care at a more affordable cost."
(American Health Policy Institute [AHIP])
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Potential Fiscal Consequences of Not Providing Cost Sharing Reduction Reimbursements (PDF)
"[If] the federal government did not reimburse insurers for CSRs, insurers would increase plan premiums to cover these costs. As a result of the ACA's structure, these higher premiums would translate into higher federal costs for Premium Tax Credits (PTCs).... [T]he result would be a substantial increase in total federal costs ... In effect, the federal government would pay CSRs indirectly, through increased PTCs, at much greater total expense. This analysis focuses on the long-term consequences of not reimbursing insurers for CSRs."
(Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS])
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Benefits in General; Executive Compensation
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[Guidance Overview]
DOL Proposes to Bring ERISA Disability Denials in Line with the ACA
"Plans should consider the effect of this proposal on their arrangements with claims administrators and third-party vendors.... [M]any claims administrators contract with outside vendors to identify factors that warrant rescinding disability coverage. Coupled with other provisions in the Proposed Rule, the outside vendor's determination may constitute an adverse benefit determination and the information it considered in rendering its determination may have to be produced to the claimant."
(Proskauer's ERISA Practice Center)
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2015 MassMutual Generations@work Study Research Results (PDF)
13 pages. "The most desirable employer-provided benefit is vacation days, ahead of key financial benefits like better 401(k) matches or no healthcare premiums.... Men are more likely to say they think it's easy to manage their finances and claim to be less distracted by their finances than women are. Men also have a stronger preference for financial benefits than women do, while women have a stronger preference for lifestyle benefits ... What benefits Americans say are most important to them varies widely by gender, generation and ethnicity."
(MassMutual)
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Press Releases
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