Health & Welfare Plans Newsletter

March 17, 2016

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Employee Benefits Enroller/Presenter
Total Benefit Communications, LLC
in Contiguous U.S.

Executive Vice President
Community National Bank Retirement Plans Division
in KS

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Pension Corporation of America
in OH

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Loren D. Stark Company
in Contiguous U.S., TX

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Webcasts and Conferences

ACA Information Returns (AIR) Program: General ACA Information Returns Discussion
March 22, 2016 WEBCAST
(IRS [Internal Revenue Service])

Financial Wellness for the Generations
March 30, 2016 WEBCAST
(Employee Benefit News)

Determining Successful Benefit Strategy Approaches for 2017-2018
April 14, 2016 in IL
(Midwest Business Group on Health)

Fiduciary Workshop: Anticipating the DOL Regulations
May 9, 2016 in NC
(SPARK Institute)

Fiduciary Workshop: Anticipating the DOL Regulations
May 12, 2016 in CO
(SPARK Institute)

Ethics and ERISA for the Inside/Outside Attorney: Addressing Conflicting Voices
July 13, 2016 WEBCAST
(Practising Law Institute)

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Discussions


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[Official Guidance]

Text of CMS Guidance on Cost-Sharing Reduction Reconciliation for 2014 and 2015 Benefit Years (PDF)
39 pages, dated Mar. 16, 2016. "This manual provides information on the process for reconciling advance payment of cost-sharing reduction amounts ... This manual provides QHP issuers with general instructions on using the standard, simplified, and actuarial value methodologies ... for the purpose of determining the value of cost-sharing reduction amounts provided to eligible Marketplace enrollees, and further describes the data elements issuers are required to submit when the annual cost-sharing reduction reconciliation process begins in April 2016." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


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[Official Guidance]

AIR Composition and Reference Guide, Version 4.3 (PDF)
119 pages, dated March 2016. "The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to IRS.... This document covers details on composing and submitting Form 1094/1095-Bs and Form 1094/1095-Cs by transmitters to IRS." (Internal Revenue Service [IRS])  

[Guidance Overview]

CMS Moves Forward on Standardized Plan Offerings But Steps Back from Instituting Minimum Network Adequacy Standards
"[In the Notice of Benefit and Payment Parameters for 2017,] CMS declined to finalize the more stringent network adequacy requirements that it previously suggested in its proposed rule ... although the agency incorporated other new and revised standards for QHPs. Other CMS proposals ... were also finalized, including revisions to [1] the grace period and other enrollment-related provisions; [2] cost-sharing standards; [3] medical loss ratio ('MLR') requirements; [4] the rate review program; and [5] the risk adjustment, reinsurance, and risk corridors programs[.]" (Epstein Becker Green)  

[Guidance Overview]

Santa Monica Enacts Local Sick Leave Ordinance
"Under the Santa Monica ordinance, employees will accrue one hour of paid sick leave for every 30 hours worked (including overtime hours). While this is similar to a recently adopted state law, the ordinance creates accrual and caps that differ significantly from the California statutes." (Liebert Cassidy Whitmore)  

Is a Limited-Scope Dental Plan Permitted to Exclude Coverage for Preexisting Conditions?
"[B]enefits that qualify as HIPAA 'excepted benefits' (including limited-scope dental plans that meet the applicable requirements) are not subject to this prohibition and may continue to have PCEs. Many dental plans exclude coverage of dental work that started before coverage began, and these exclusions are still permitted under health care reform so long as the plan qualifies as an excepted benefit." (Thomson Reuters / EBIA)  


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Health Care Market Consolidations: Impacts on Costs, Quality and Access
"Health care markets are becoming more consolidated, causing price increases for purchasers of health services, and this trend will continue for the foreseeable future ... Government can still play an effective role in addressing higher prices that come from consolidation by pursuing policies that foster increased competition in health care markets. Many of these policies can be effective even in markets with high degrees of concentration, such as in Northern California." [Testimony before the California Senate Committee on Health on fostering competition in consolidated markets, Mar. 16, 2015.] (The Brookings Institution)  

Health Insurance Premiums Jump Amid General Deflation
"While the CPI for all items dropped 0.2 percent in February, health insurance increased 1.3 percent. Over the last twelve months, CPI has increased just 1.0 percent, while health insurance has increased 6.0 percent. Prescription drugs continue to stand out, as well, having increased 0.9 percent last month and 3.4 percent over twelve months. However, the increase in prescription prices alone cannot explain the health insurance premium hikes." (National Center for Policy Analysis Health Policy Blog)  

GAO Report: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
"GAO found CMS relies upon a contractor charged with document processing to report possible instances of fraud, even though CMS does not require the contractor to have any fraud detection capabilities. CMS has not performed a comprehensive fraud risk assessment -- a recommended best practice -- of the PPACA enrollment and eligibility process. Until such an assessment is done, CMS is unlikely to know whether existing control activities are suitably designed and implemented to reduce inherent fraud risk to an acceptable level." [GAO-16-506T: Published Mar. 17, 2016, publicly released Mar. 17, 2016.] (U.S. Government Accountability Office [GAO])  

GAO Report: Federal Oversight Premiums and Enrollment for Consumer Operated and Oriented Plans in 2015
"This report examines [1] how CMS monitors the COOPs' performance and sustainability; [2] how COOP premiums changed from 2014 to 2015, and in 2015, how they compared to premiums for other health plans; and [3] how COOP enrollment changed from 2014 to 2015, and in 2015, how it compared to projections." [GAO-16-326: Published Mar. 10, 2016, publicly released Mar. 17, 2016.] (U.S. Government Accountability Office [GAO])  


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Analysis of Proposed Health Reform Policies
"Health reform has remained a hot topic throughout the recent months leading up to the presidential election. Here is a breakdown and analysis of a few proposals put forth during the 2016 presidential campaign.... Completely repeal Obamacare.... Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.... Allow individuals to use Health Savings Accounts (HSAs).... Require price transparency from all healthcare providers" (William Gallagher Associates)  

The Push for Paid Sick, Family and Medical Leave in Minnesota
"Minneapolis is not alone in considering new paid leave requirements for employees. Saint Paul also is looking into whether it should adopt a paid sick time ordinance, and the Minnesota Legislature is currently considering bills addressing paid family and medical leave and pre-empting local units of government from enacting laws that require employers to provide benefits or other working conditions that differ from what is required under Minnesota law." (Faegre Baker Daniels LLP)  

[Opinion]

Reform the Cadillac Tax to Target Rich Benefits, Not High Costs
"Some of the advocacy for the excise tax is misguided, but its marketing as a tax on 'Cadillac' -- so by implication luxury -- coverage does state a principle that should be part of national health policy. Defining the level of benefits to be supported is appropriate; defining that in terms of a level of spending, as the law does, is not. The tax should be fixed so it applies to a clear definition of relatively luxurious benefits." (Health Affairs)  

Press Releases

Changes Coming to The ERISA Industry Committee
ERIC [ERISA Industry Committee]

PBGC to Pay Pension Benefits for A&P Grocery Chain Employees
PBGC [Pension Benefit Guaranty Corporation]

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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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