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Understanding FMLA in 2016: An Employer's Basic Guide
January 12, 2016 WEBCAST
(Cowden Associates, Inc.)

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[Official Guidance]

Text of IRS Publication 15-B: Employer's Tax Guide to Fringe Benefits, for Use in 2016 (PDF)
31 pages. "What's New: [1] Cents-per-mile rule ... [2] Retroactive increase in excludible transit benefits for 2015.... [3] Qualified parking exclusion and commuter transportation benefit.... [4] Contribution limit on a health flexible spending arrangement (FSA)." (Internal Revenue Service [IRS])  

[Advert.]

Health Care Management Conference – April 11-13, 2016

Attend the Health Care Management Conference in Phoenix, Arizona. Learn the latest news, legal requirements and strategies that plans are taking to implement the Affordable Care Act through case studies and action-oriented sessions. Register Today!

[Official Guidance]

Text of CMS Edge Server Business Rules, v. 5.0 (PDF)
98 pages, dated December 2015. "This document provides guidance to issuers on the business rules that CMS applies to enrollment, pharmacy, medical claims and supplemental diagnoses code files submitted to an issuers EDGE server.... The ESBR document provides file processing business rules based on five categories (general rules, enrollment, pharmacy claims, medical claims and supplemental diagnosis files)." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  

[Guidance Overview]

ACA Reporting Deadlines Extended
"The deadline extensions in the Notice apply only to the 2015 calendar year forms that are filed and furnished in 2016. There will no longer be a process in place for requesting or applying for extended due dates for the 2015 calendar year ... The IRS suggests that employers that fail to meet even these extended deadlines should still furnish and file the forms as soon as possible after the deadline because they may receive a reduced penalty (generally $250 per return), depending on a number of factors." (ABD Insurance & Financial Services)  

[Guidance Overview]

ACA Reporting Requirements for Carriers and Employers (Part 23 of 24): Notice 2016-4 Postpones Reporting and Filing Deadlines
"The notice recognizes that some employees and related individuals who enrolled in coverage through a public insurance exchange could be adversely affected by the extension. For 2015 only, these individuals are entitled to rely on 'other information received from employers about their offers of coverage' for purposes of determining eligibility for the premium tax credit when filing their income tax returns. Even these individuals are not required to file amended returns once they receive their Forms 1095-C." (Mintz Levin)  

[Guidance Overview]

IRS Provides ACA Reporting Extension for Forms 1094 and 1095
"[N]ext steps for most employers: [1] Get the word out to payroll providers, tech-stakeholders and other ACA reporting partners. [2] Develop talking points for call centers and consider issuing 'statements of coverage' that employees can keep with their tax records or show their tax preparer for purposes of premium tax credits and compliance with the individual mandate." (Dorsey ERISA)  

[Guidance Overview]

Reporting Deadline for Form 1094-C and Form 1095-C Extended
"Importantly, the automatic and permissive extensions discussed in the instructions to the Form 1094-C and Form 1095-C no longer apply. Therefore, the March 31, 2016 deadline for furnishing the 1095-C statements is now a hard deadline. Similarly, the May 31, 2016 deadline for employers who are not filing electronically and the June 30, 2016 deadline for employers who are filing electronically are now hard deadlines." (Health Care Attorneys P.C.)  

[Guidance Overview]

IRS Provides Further Guidance on ACA Market Reforms
"[Notice 2015-87] provides guidance on how to calculate the amount an employee is required to contribute toward the cost of coverage for purposes of determining whether that coverage is affordable under the employer mandate.... The notice categorizes disability benefit recipients based on their employment status. If the recipient is still regarded as employed, the employer must continue to determine the recipient's hours of service, regardless of whether the benefits are insured or self-funded (and without regard to the 501-hour cap that applies under retirement plan rules)." (Ballard Spahr LLP)  

[Guidance Overview]

Just in Time for the Holidays, New Brunswick Gives the 'Gift' of Paid Sick/Safe Time
"On December 17, 2015, New Brunswick, New Jersey passed a sick and safe leave ordinance that provides up to 40 hours of paid sick and safe leave to employees beginning on January 6, 2016. Although there are similarities between this ordinance and other sick leave ordinances in New Jersey, there are substantive differences as well." (Littler)  

[Guidance Overview]

Final Regs Clarify Some Provisions of Oregon Sick Leave Law
"The new rules clarify some issues, but leave a number of key questions unanswered.... Definition of Family Members Expanded ... Regular rate of pay further defined ... Consequences for failure to provide notice ... Application of sick time provisions to new businesses ... Sick leave and PTO policies that are substantially equivalent ... Shifts of indeterminate length.... On-call shifts.... Determining accrual for employees whose hours are not tracked." (Littler)  

Court Allows Plan Trustees to Continue Fiduciary Breach Claims Against Third Party Administrator
"The court declined to dismiss the trustees' fiduciary breach claims because the alleged breaches didn't arise out of the performance of merely ministerial tasks. The court noted that the allegations specified that Carewise and Connecticut General exercised considerable discretion by setting aside the usual, customary and reasonable rate for reimbursement and by applying their own schemes. The allegations offered sufficient support for the inference that Carewise and Connecticut General usurped authority over plan management from the trustees, and exercised discretion as a matter of fact." [ILWU-PMA Welfare Plan Bd. of Trustees v. Conn. Gen. Life Ins. Co., No. 3:15-cv-02965-WHA (N.D. Cal. Dec. 22, 2015] (Bloomberg BNA)  

ERISA Medical Treatment Class Actions Can Be Avoided with Arbitration Provisions
"Insurers are getting hit with more class actions regarding the denial of medical treatments, like behavioral therapy treatments for autism spectrum disorders.... Just two weeks ago the United States Supreme Court once again held that class action waivers contained in arbitration agreements are enforceable under the Federal Arbitration Act (FAA) and cannot be invalidated on state law grounds inapplicable to any other contract.... So, what does this all mean for ERISA plans? Can ERISA plans include arbitration provisions? Yes!" (Lane Powell PC)  

[Opinion]

The 2016 Regulatory Agenda for Healthcare: More Guidance, More Laws, More Risk
"So what's ahead for 2016? An even busier agenda for federal regulation of healthcare ... [1] Mega-merger decisions ... [2] Medicaid expansion and waivers ... [3] Drug pricing ... [4] Court challenges ... [5] Pending guidance and final rules ... [6] Medicare alternative payment program updates ... [7] New overarching laws that impact healthcare markets directly." (Paul Keckley)  

[Opinion]

ERIC Helps to Delay 2015 Information Reporting Requirements
" 'While ERIC and its members are pleased with today's announcement, we continue to be concerned about the horrendous burdens placed on health plans by the ACA. The countless new rules and regulations imposed by the ACA created huge financial and administrative complexities for employers, diverting focus and funds away from health plans' said [ERIC's Senior Vice President of Health Policy, Gretchen Young]." (The ERISA Industry Committee [ERIC])  

[Guidance Overview]

Provisions in the Appropriations Act Affecting Employee Benefit Plans
"Changes to the 'Cadillac' tax ... Moratorium on annual fee on health insurance providers ... Transit parity ... Rollovers from employer-sponsored retirement plans to SIMPLE retirement accounts ... Additional exceptions to 10 percent additional income tax on early retirement plan distributions." (McGuireWoods LLP)