Health & Welfare Plans Newsletter

January 15, 2016

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Webcasts and Conferences

Role of the Small Employer in the Affordable Care Act
January 20, 2016 WEBCAST
(Hill, Chesson & Woody)

Affordable Care Act 2016 - Extensions, Updates, Delays and Modifications
February 24, 2016 in VA
(Willcox Savage)

2016 City Event
March 15, 2016 in NE
(PSCA [Plan Sponsor Council of America])

2016 City Event
March 22, 2016 in AZ
(PSCA [Plan Sponsor Council of America])

View All Webcasts and Conferences


Discussions


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[Guidance Overview]

Year-End Agency FAQs Address Many Unanswered ACA Concerns
"While many of [the FAQs in Notice 2015-87] simply reiterated points made in earlier agency guidance, the Notice contained guidance on a series of previously unanswered questions, such as determining the 'affordability' of coverage where the employer provides a 'fringe' contribution under the Service Contract Act or where the employer provides an opt-out credit for employees who decline employer-sponsored coverage. This [article] summarizes some of the highlights of this new agency guidance." (Seyfarth Shaw LLP)  


[Advert.]

Designing Your Wellness Plan to Avoid Enforcement Action and Litigation Risks

Sponsored by Lorman and BenefitsLink

February 8 webinar - Make sure you are up to speed and fully compliant on the latest issues surrounding wellness plans. BenefitsLink discount.



[Guidance Overview]

Top Five ACA-Related Legislation and Final Rules for 2015
"While 2015 saw upwards of 25 final rules implementing the ACA, those addressing the contraceptive mandate, the Medicare Shared Savings Program MSSP, and various provisions including preexisting condition exclusions are significant. Even more important was Congress's successful passage of an omnibus spending bill that delayed key provisions of the ACA." (Wolters Kluwer Law & Business)  

[Guidance Overview]

IRS Extends Deadlines for Reduced Penalties for Correcting ACA Information Returns and Statements
"Because this is the first year that returns and statements must be provided, and these requirements are both unfamiliar and complicated, many large employers and insurers may find themselves needing to correct information involving the ACA information reporting requirements. As a result, the lower penalty amounts for these corrections, whether for 30-day or August 1 (as extended) corrections, could result in significantly reduced penalties." (Practical Law Company)  

[Guidance Overview]

East Meets West: Spokane Joins Western Washington Cities By Adopting Paid Sick Leave Law
"Similar to Tacoma's law, employees can use this paid leave for their own sick time, to care for a sick family member, to seek treatment or safety from domestic violence, because of public closures, or for bereavement in connection with the death of a family member.... Spokane employers can require employees to provide reasonable documentation if they take three or more consecutive days of paid leave." (Fisher & Phillips LLP)  

Federal Court Says Employer's All-or-Nothing Requirement that Employees Submit to Wellness Program or Lose Health Insurance is ADA-Safe
"In the preamble to its April 2015 proposed wellness rule, the EEOC claimed that '[r]eading the insurance safe harbor as exempting these [workplace wellness] programs from coverage would render the 'voluntary' provision superfluous.' That can't be right. Had Congress intended this result, it would not have provided two, separate exceptions. Flambeau, however, raises the opposite prospect: does the court's holding mean that the bona fide plan exception has rendered the voluntary plan exception superfluous?" [EEOC v. Flambeau, Inc., No. 14-cv-638 (W.D. Wis. Dec. 30, 2015)] (Mintz Levin)  

A Win for Wellness Programs: Federal Judge Rules No ADA Violation (No Matter What the EEOC Says)
"[T]his case is significant because the Western District of Wisconsin followed the ruling and analysis of the Eleventh Circuit Court of Appeals in ... Seff v. Broward County ... Despite this ruling, however, the EEOC specifically discounted the Eleventh Circuit's Seff findings in a footnote to the preamble of its April 2015 proposed rules, claiming that the 'safe harbor' exemption is not the proper method for a wellness program (and its rewards or penalties) to achieve ADA compliance." (Ogletree Deakins)  

CDHP Users Cost-Conscious, But Price Shopping Limited
"[M]ore large employers are contracting with a specialty vendor to provide their employees with a transparency tool -- an online resource to help them compare provider price and quality. Among employers with 20,000 or more employees, 24 percent provided transparency tools in 2015, up from just 15 percent the year before." (Society for Human Resource Management [SHRM])  

Secrets to Making Reference-Based Pricing Work
"The best [reference-based pricing] programs should have a patient advocacy process.... Any such negotiation would still require the plan administrator to determine any maximum payable amount within the parameters the plan defines for reasonable and appropriate reimbursement. Also, the plan administrator should be able to offer to cover any patient deductible." (Thompson SmartHR Manager)  

Alternative Payment Model (APM) Framework White Paper and Addendum (PDF)
22 pages. "[P]opulation based payments ... offer providers the flexibility to strategically invest delivery system resources in areas with the greatest return, enable providers to treat patients holistically, and encourage care coordination. Because these and other attributes are very well suited to support the delivery of high valued health care, the Work Group and the LAN as a whole believe that the health care system should transition towards shared risk and population based payments." [Also available: Summary of Public Comments.] (Alternative Payment Model Framework and Progress Tracking [APM FPT] Work Group, Health Care Payment Learning & Action Network)  

Paying Providers For Value: The Path Forward
"Among stakeholders in the U.S. health system, there is an emerging consensus that the traditional methods used to pay health care providers tend to hinder their ability to deliver person-centered care by favoring volume over value.... By making a commitment to changing payment models, by establishing a common framework and aligning approaches to payment innovation, and by sharing information about successful models and encouraging use of best practices, the [Health Care Payment Learning & Action Network (LAN)] can help to reduce barriers and accelerate the adoption of [alternative payment models]." (Health Affairs)  

Discretionary Spending Under the ACA (PDF)
51 pages, updated Jan. 13, 2016. "[CBO] estimated that the ACA's discretionary spending provisions, if fully funded by appropriations acts, would result in appropriations of approximately $100 billion over the 10-year period FY2012-FY2021.... [F]ew of the new grant programs authorized under the ACA have received any discretionary funding. However, several of the new programs have received mandatory funds from the ACA." (Congressional Research Service [CRS])  

Some Marketplace Customers Spend 25 Percent of Income on Health Expenses
"Even with subsidies to make coverage more affordable, many people who buy health insurance on the marketplaces spend more than 10 percent of their income on premiums, deductibles and other out-of-pocket payments ... Ten percent of people with incomes between 200 and 500 percent of poverty ($23,540 to $58,850) will pay at least 21 percent of their income toward premiums and out-of-pocket costs[.]" (Kaiser Health News)  

Benefits in General; Executive Compensation

[Guidance Overview]

Annual ISO and ESPP Information and Reporting Requirements
"Participant statements may be provided on Form 3921 (for ISOs) and Form 3922 (for ESPPs) or may be provided using a different format that complies with the substitute form requirements found in IRS Publication 1179.... [C]ompanies with a limited number of transactions will likely use Forms 3921 and/or 3922 (as opposed to substitute statements) since these forms will need to be prepared and submitted to the IRS in any event.... [C]ompanies that provide Form 3921 and/or 3922 to participants (again, as opposed to providing substitute statements) will deliver the form(s) to their participants, along with a cover letter explaining the statement in a manner similar to this statement for ISO transactions and this statement for ESPP transactions." (Orrick)  

[Guidance Overview]

Changes to Benefit Plan Financial Statements Under ASU 2015-12
"In July 2015, the Financial Accounting Standards Board (FASB) issued Accounting Standards Updated (ASU 2015-12), titled Plan Accounting. This ASU is effective for defined benefit pension plans, defined contribution pension plans and health and welfare plans.... [A chart] generally accepted accounting principles (GAAP) before ASU 2015-12 and after the implementation of ASU 2015-12." (WithumSmith+Brown, PC)  

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of that content. You may not alter or remove any trademark, copyright or other notice from copies of the content.

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