Health & Welfare Plans Newsletter

March 10, 2016

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Senior Pension Benefits Analyst
Willis Towers Watson
in CO, MA, MI, PA, TX

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Willis Towers Watson
in CO, MA, MI, PA, TX

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ERISA Services, Inc.
in TN

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Webcasts and Conferences

How a Fiduciary Standard and the 2016 Elections Could Change Your World
March 22, 2016 WEBCAST
(InvestmentNews)

Health Benefits Laws Compliance Assistance Seminar
April 19, 2016 in AZ
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor)

Best Behavioral Practices in 401(k) Plan Design
April 21, 2016 in TX
(ASPPA Benefits Council [ABC] of Dallas/Fort Worth)

SALGBA 2016 National Conference
April 24, 2016 in TX
(State and Local Government Benefits Association [SALGBA])

2016 IRA BootCamp
April 25, 2016 in VA
(PenServ Plan Services, Inc.)

SPARK National Conference
June 19, 2016 in DC
(SPARK Institute)

Benefit Communication and Technology Institute
July 18, 2016 in MA
(International Foundation of Employee Benefit Plans [IFEBP])

62nd Annual Employee Benefits Conference
November 13, 2016 in FL
(International Foundation of Employee Benefit Plans [IFEBP])

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Discussions


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[Official Guidance]

Text of CMS Memo: Suspension of Policy Providing for Automatic Reduction of Star Ratings for Medicare Advantage Contracts Operating Under Intermediate Sanction (PDF)
Dated Mar. 8, 2016. "[CMS] is issuing this memorandum to announce a change concerning the effect of intermediate sanctions (e.g., suspension of an organization's marketing and enrollment activities) on the calculation of Star Ratings.... [E]ffective immediately and on a prospective basis, CMS is suspending the automatic sanctions-based reduction in Star Ratings. We note that CMS retains the right to impose Civil Money Penalties as appropriate. CMS will re-examine the appropriate relationship between sanctions and Star Ratings. We will propose a revised approach in the draft CY 2018 Call Letter." (Modern Healthcare Online; free registration required)  


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[Guidance Overview]

IRS Health Care Tax Tip 2016-29: New Reporting Responsibilities for Certain Employers in 2016
"Employers that are subject to the employer shared responsibility provisions have new information reporting responsibilities that require them to report information about health coverage offered to each full-time employee, or to report that the ALE didn't offer coverage to the full-time employee. This includes the requirement to send information statements to full-time employees and to the IRS on new forms." (Internal Revenue Service [IRS])  

Is It Time for a Third-Party Administrator 'Check-Up' for Self-Insured Employers?
"It is imperative that self-insured employers develop and implement a monitoring system of their TPA. The monitoring should include an audit which offers an unbiased view on the accuracy of the claims payment process and verifies a TPA's self-reported results.... [R]easons why an employer should audit a TPA or an Insurer under an ASO contract ... A typical TPA audit process includes the following components ... Typical errors discovered during an audit include but are not limited to the following[.]" (WithumSmith+Brown, PC)  

The Next ACA Constitutional Hurdle: Employer Due Process vs. Taxpayer Privacy
"[T]he drafters [of the ACA] directed [HHS] to address this issue in a report to Congress by January 1, 2013, and to work with the Department of Treasury and other agencies to establish an advance notice and appeal process in compliance with employees' and employers' rights. HHS and the Department of Treasury have not cleared this hurdle, which may prevent the Department of Treasury from collecting employer shared responsibility excise taxes for failure to provide affordable coverage. Will HHS belatedly step up to resolve this issue, or will we be back in the U.S. Supreme Court?" (Tucker Ellis LLP)  

Marketplace Data Deficiencies Signal Employer ACA Headaches
"Large employers should be prepared to receive and defend against IRS assertions that the employer is liable for paying employer shared responsibility payment under IRC Section 4980H when an employee ... is one of those individuals that a marketplace improperly classifies as eligible to receive subsidies because of deficient marketplace eligibility or enrollment data collection and verification practices.... [E]mployers, health plans and individual Americans alike should brace to receive inquiries from the IRS, HHS, marketplaces, health plans and others seeking to verify and reconcile marketplace data ... [A]ll parties should be careful to verify the legitimacy of the request and the identity and credentials of the party making the request ... to minimize their exposure to liability for violations of the confidentiality, privacy or data security requirements ... under the IRC, [HIPAA] or various other federal or state laws." (Solutions Law Press)  


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Three Reasons Personalization Matters in Employee Benefits
"Year-round communication is key, and that message has to be relevant to the employee's specific scenario.... A guided, online enrollment experience that presents employees with best-matched plans based on their individual history, behavior and preference can be that personal touch that helps them select the plan that fits their specific needs -- and leads to a greater return on your investment.... Voluntary benefits have become a core component of a competitive benefits package.... The common thread in each story is the data[.]" (Benefitfocus)  

Preemption, Again -- This Time as to a Michigan Tax
"The Sixth Circuit's decision clearly rests in part on a theory that seems discredited by [Gobeille]. In particular, the Sixth Circuit found that the ERISA preemption doctrine does not apply in part because the court found that the Michigan tax did not interfere with the administration of ERISA plans, viewing any administrative burden imposed on the plans to be incidental to the plans' operations. In light of the strong language in Liberty Mutual that state law impingements on plan operations by means of incremental reporting requirements involve core ERISA functions that are accordingly subject to ERISA preemption, this portion of the Sixth Circuit's approach may be subject to modification on remand." (Morgan Lewis)  

Supreme Court Preemption Ruling Could Have Broader Implications (PDF)
"The Supreme Court has already followed up on the promise that Gobeille indicates a shift in preemption analysis. Just a few days after the decision, on March 7, 2016, the Court addressed a case challenging a Michigan law that imposes a tax on health claims paid, including those under self-insured plans.... The Supreme Court has now sent the case back to the Sixth Circuit for consideration in light of Gobeille." (Alston & Bird LLP)  

Health Apps Routinely Sell User Data with Little Notice
"Researchers were surprised that these apps -- all for Android phones and related to diabetes care -- were collecting phone data and sharing it with third parties ... Researchers also were surprised at how difficult it was to determine an app's privacy policies, even when they were made available before download[.]" (Bloomberg BNA)  


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New Hampshire and California Seek to Help Consumers Get Details on Health Care Prices
"New Hampshire, which already had the nation's most advanced website allowing people to compare the cost of specific medical procedures, ... added prices for 16 dental procedures and 65 prescription drugs.... California ... released an expanded version of its quality report cards on 154 large physician groups.... Instead of drilling down on specific procedures, the report cards summarize the total cost of medical services run up by the average patient of each group. The medical groups care in total for more than 9 million people." (Kaiser Health News)  

Cigna Could Save $350 Million from New Medicare Advantage Policy Shift
"The new policy means sanctioned plans won't face lower star ratings at least through 2017, therefore temporarily taking some of the teeth out of enforcement actions. The CMS will propose a revised approach in next year's Medicare Advantage notice.... Barclays analyst Josh Raskin estimated the policy change will save Cigna about $350 million in taxpayer-funded bonus money." (Modern Healthcare Online; free registration required)  

Senate Committee Leaders Press AHIP, Top Insurers for Information on Illegal Taxpayer-Funded Giveaway Under Obamacare
[The letter to AHIP states:] "Although some reinsurance payments have already been disbursed to insurance companies, the Committee understands that substantial payments have not yet been made. If CMS continues to make these payments to insurers, it would constitute a violation of the Anti-Deficiency Act. Additionally, given the collaborative relationship between insurance companies and their regulators, there have been questions raised about the role of insurance companies in securing and negotiating reinsurance payments from CMS." [Letters were sent also to Aetna, Anthem, Blue Cross Blue Shield Association, Cigna, Humana, and UnitedHealth Group.] (Energy & Commerce Committee, U.S. House of Representatives)  

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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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