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[Official Guidance]

Text of CMS Guidance on Annual Eligibility Redetermination and Re-Enrollment for Marketplace Coverage for 2017 (PDF)
"This guidance describes these alternative procedures for benefit year 2017, which are the same as the alternative procedures specified by the Secretary for benefit year 2016, except that the procedures for benefit year 2017 will include a new group for which advance payments of the premium tax credit (APTC) and income-based cost-sharing reductions (CSR) will be discontinued[.]" [Unnumbered document, dated May 10, 2016.] (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])  


Accounting and Auditing Institute for Employee Benefit Plans

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

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[Guidance Overview]

EEOC Weighs In on Leave as a Reasonable Accommodation
"The content of the publication generally represents no break from EEOC's existing positions. However, the fact that the EEOC issued guidance dealing specifically with the concept of leave as an accommodation sheds light on the priority it places on leave issues, which one EEOC commissioner has called 'some of the toughest situations for employers and employees to deal with in our workplaces.' " (Littler)  

[Guidance Overview]

HIPAA Covered Entities: Are Your Business Associates Ready for a Security Incident?
"While business associates are now directly liable under the Security Rule and many aspects of the Privacy Rule, covered entities remain responsible for selecting their BAs, properly vetting their physical, technical, and administrative safeguards, an embodying the parties' agreement in a compliant BAA. OCR has provided suggestions on how CEs can help manage risks to ePHI held by business associates to a manageable level. Covered entities should be particularly mindful of their own, and their BAs', minimum necessary obligations to appropriately limit the amount of PHI that could be exposed by a breach at the BA." (Ice Miller LLP)  

[Guidance Overview]

Starting July 1, 2016, Employees in Los Angeles Get Three Additional Days of Paid Sick Leave
"An employee will be entitled to the paid sick leave if, on or after July 1, 2016, the employee works in the City of Los Angeles for the same employer for 30 days or more within a year. Employers may provide that new employees may not use paid sick leave for the first 90 days of employment. Employees may use paid sick time for themselves and to care for family members." (Ford & Harrison LLP)  

Chicago Task Force Proposes Five Days of Paid Sick Leave for Employees
"[T]he task force provided the following recommendations for the proposed paid sick leave ordinance: [1] It would apply to employers of all sizes; [2] Employees would earn 1 hour of sick time for every 40 hours worked, up to 5 days in a year ... [3] New employees would not be able to use paid sick days until they had been employed for 180 days (thus exempting many seasonal or temporary employees) ... [4] Unused sick days would not be paid out upon an employee's exit from the company[.]" (Proskauer's Law and the Workplace)  


Learn how this year's election will effect ACA compliance

Sponsored by Institute for Healthcare Consumerism [IHC]

IHC FORUM & Expo Atlanta, May 24-26, the go-to conference to learn how the 2016 presidential election will affect ACA compliance and reporting. Attend FORUM & Expo for critical insights & expert outlooks on plan design, compliance and reporting.

Offering Employees a Price Transparency Tool May Not Lead to Lower Health Care Spending
"Two large employers represented in multiple market areas across the United States offered an online health care price transparency tool to their employees.... The tool provided users information about what they would pay out of pocket for services from different physicians, hospitals, or other clinical sites.... [B]eing offered the tool was associated with a mean $59 increase in outpatient spending.... Being offered the price transparency tool was associated with a mean $18 increase in out-of-pocket spending ... In the first 12 months, 10% of employees who were offered the tool used it at least once." (JAMA)  

Health Insurers Push to Tie Drug Prices to Outcomes
"Health insurer Cigna Corp. will get extra price discounts from drugmakers if new cholesterol medications don't help patients as much as expected, a significant step in a broader push to tie the cost of drugs to how well they work.... If Cigna-insured patients who take the drugs aren't able to reduce LDL cholesterol at least as well as what was shown in clinical trials, the manufacturers will further discount the costs of the drugs -- and not just for patients who didn't meet the cholesterol goals. If the drugs meet or exceed expectations, the original negotiated price stays[.]" (The Wall Street Journal; subscription may be required)  

U.S. Probes Contracts Between Drugmakers, Pharmacy Benefit Managers
"The U.S. Attorney's Office for the Southern District of New York is investigating contracts between drugmakers and companies that manage prescription benefits, according to regulatory filings. Federal prosecutors have approached at least three companies, including Johnson & Johnson, Merck & Co and Endo International Plc, demanding information about their contracts with pharmacy benefit managers." (Reuters)  

CMS Acting Administrator Offered False Testimony to Congress on State Exchanges (PDF)
"Mr. Slavitt's testimony that 'over $200 million' has been returned to the federal government is not supported by any CMS documents ... Mr. Slavitt's testimony greatly overstated the sum returned to the Treasury from state-based exchanges -- by nearly $180 million. CMS only recouped $21.5 million from the 16 states and the District of Columbia that actually established state-based exchanges." (Majority Staff, Energy & Commerce Committee, U.S. House of Representatives)  


In a Country with Paid Family Leave, It's No Magic Bullet
"[In] Germany, women receive 14 weeks of fully paid maternity leave and an additional 12 months of partially paid support.... Research confirms that other European employment mandates and family-friendly programs -- such as the right to work part-time and the mandatory provision of child care -- make women more expensive to employ and result in lower take-home pay and fewer job opportunities." (The Washington Post; subscription may be required)  

Benefits in General

Ninth Circuit Decision Creates Uncertainty Regarding the Burden of Proof in Benefit Claim Cases
"The majority opinion leaves room for future litigants to argue that the ruling does not apply in all benefit claim contexts.... The decision, unfortunately, draws no bright lines between cases where claimants should bear the burden of proof, and cases where the burden should rest with administrators." [Estate of Barton v. ADT Security Serv. Pension Plan, No. 13-56379 (9th Cir. Apr. 21, 2016)] (Trucker Huss)  

Many Employers Want Guidance From Financial Advisors About Voluntary Benefit Options
"Two of five employers that currently do not rely on guidance from a financial advisor say they would welcome such help with voluntary benefit options such as retirement plans, life and disability insurance, and other protection benefits ... Firms that would characterize such assistance as 'extremely' or 'very' valuable range from 33 percent for those with fewer than 25 employees to 55 percent for those with 1,000 or more employees ... The percentages of employers that would see such advice as at least 'somewhat' or more valuable range from 75 percent for the smallest employers to 80 percent for larger firms[.]" (MassMutual)  

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016, 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, 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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