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[Official Guidance]
Text of CMS FAQ: Deadline for Submission of Medical Loss Ratio Reports and Risk Corridors Data for the 2015 Benefit Year (PDF)
Unnumbered document, dated July 26, 2016. "[T]he MLR report for each reporting year must be submitted to HHS by July 31 of the year following the end of an MLR reporting year.... [A] Qualified Health Plan (QHP) issuer must submit risk corridors data by July 31 of the year following the benefit year. However, July 31, 2016 falls on a Sunday. Therefore, for the 2015 Reporting and Benefit Year, an issuer may submit its MLR and risk corridors data for the 2015 Benefit Year by 11:59 p.m. ET on Monday, August 1, 2016, which is the first business day following the July 31, 2016 regulatory deadline(s)."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
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[Guidance Overview]
Health Insurance Exchange Notices to Employers: To Appeal or Not to Appeal? (PDF)
"If the exchange notice relates to an individual who has enrolled in the employer's health plan all year, then the employer ... may be able to help the employee avoid having to repay a large subsidy amount at tax time. If the exchange notice relates to an individual who is not part of the employer's ACA compliance records, then the employer may wish to research whether the individual is a member of a class that was overlooked by mistake. If the employer unexpectedly receives exchange notices for a large number of employees in a particular division or geographic area, the employer may wish to explore whether an administrative error has occurred that resulted in an inadvertent failure to offer coverage to those employees."
Deloitte
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[Guidance Overview]
CMS Releases Draft Call Letter for Quality Rating System (QRS) and Qualified Health Plan (QHP) Enrollee Experience Survey
"The QRS and QHP Enrollee Experience Survey are used to derive a star rating that will be displayed ... on the marketplace shopping site to signal to consumers the quality of the alternative health plans available to them. The call letter proposes an annual call letter process for future years and minor changes for the 2017 and 2018 rating years.... The 2016 draft call letter also proposes a few refinements for data collection during the 2017 ratings year."
Timothy Jost, in Health Affairs
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[Guidance Overview]
Proposed Overhaul of Form 5500 Comes with Generous Lead Time (PDF)
"The lengthy delay in applicability of these changes gives employers and service providers a good amount of time to prepare for the more extensive Form 5500 filings. When the proposed changes are finalized it will be a good idea for plan sponsors to review their group health plans' terms and procedures, with a view to ensuring the sponsors can collect all the relevant information that will be required to prepare the new form[.]"
Lockton
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HHS Mental Health and Substance Use Disorder Parity Task Force Wants to Hear Your Experiences
"The Task Force wants to hear from patients, families, consumer advocates, health care providers, insurers, and other stakeholders on their experience with mental health and substance use disorder parity requirements.... [including] [1] Suggestions on how to improve understanding of parity among key stakeholders such as consumers, families, health care providers, and insurers. [2] What are some examples of the types of information you commonly see health plans and insurance issuers share with enrollees or providers when coverage for a mental health or substance use disorder benefit is denied? [3] When health plans provide parity compliance-related information, how easy or hard is it for consumers and providers to understand? Do consumers and providers know how to act on this information?"
U.S. Department of Health and Human Services [HHS]
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More Than Price Transparency Is Needed to Empower Consumers to Shop Effectively for Lower Health Care Costs
"[H]igh-deductible plans ... that provide extensive price information to consumers often have only limited impact because of the complexity of shopping for each service involved in a course of treatment -- something close to impossible for inpatient care. In addition, high deductibles are typically met for most hospitalizations ... so those consumers are less incentivized to comparison shop. Plans that have limited provider networks relieve the consumer of much complexity and steer them towards providers with lower costs[.]"
The Brookings Institution
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Self-Insured Health Plans: Recent Trends by Firm Size, 1996-2015 (PDF)
"The percentage of private-sector establishments offering health plans at least one of which is self-insured has increased from 28.5 percent in 1996 to 39 percent in 2015 (a 36.8 percent increase). Between 2013 and 2015, the percentages of establishments offering health plans with at least one self-insured plan has increased for midsized establishments from 25.3 percent to 30.1 percent (a 19 percent increase) ... Similarly, the percentage of health-plan-covered workers enrolled in self-insured health plans has increased from 58.2 percent to 60 percent (a 3 percent increase) from 2013 to 2015."
Employee Benefit Research Institute [EBRI]
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Innovations for Controlling Self-Funded Plan Costs
"As employers gain a better understanding of the questionable value of PPO discounts and pricing optics, reference-based pricing and reference-based reimbursement provide possible solutions by addressing the demand for: [1] Price transparency; [2] Claims cost benchmarking; [3] Elimination of inappropriate charges; [4] A plan sponsor fiduciary/co-fiduciary."
Corporate Synergies
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What's Bad for Health Insurers May Be Good for Consumers
"Employees of large companies may have the most to gain from the blocked mergers, explained Gary Claxton, vice president of Kaiser Family Foundation. There are a lot of regional and small insurers that offer employer-sponsored insurance but only the big insurers have large national networks the likes of which giant corporations usually hire. The mergers would mean these employers would have even fewer choices and that would likely translate into fewer plan choices for employees."
CBS MoneyWatch
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Anthem Vows to Fight for Cigna Deal; Profit Beats Estimates
"Health insurer Anthem Inc ... said it was committed to its planned acquisition of Cigna Corp and again vowed to fight U.S. government efforts to block the deal, saying the merger will help lower costs for consumers.... Anthem said it expects the trial will likely begin in October and last about four months. Industry analysts have expressed serious doubts that the Cigna deal will go through."
Reuters
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Record Share of Private Industry Workers Have Paid Sick Leave
"Over the last year, the share of private industry workers with access to at least one day of paid sick leave increased from 61 percent to 64 percent, the highest on record. There has been a total increase of 7 percentage points over the last decade.... Further, the increase between 2015 and 2016 was almost entirely due to an increase in access among workers in low-wage occupations, that is, workers in occupations with average wages in the bottom 25 percent."
U.S. Department of Labor [DOL] Blog
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[Opinion]
Orszag and Emanuel Do Not Seem to Understand Bundled Payments
"The clinical course of a heart attack is highly variable and could involve only a few or a great many interventions. Under a bundled payment, the physicians and hospital are bearing the risk of the high costs of a potentially complicated, protracted course. Isn't it the role of the insurer, in this case Medicare, to pool risk? Shifting that risk to the health care delivery system creates the potential for either a reduction in important beneficial health care services, or exposing the delivery system to potential monetary losses and the risk of insolvency -- neither of which are desirable."
Physicians for a National Health Program [PNHP]
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Benefits in General
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[Guidance Overview]
Department of Commerce Issues Final Rule on Access to Death Master File
"The application package for access to the Limited Access DMF must now include documentation from an 'Accredited Conformity Assessment Body' determining that the applicant meets security and safeguarding requirements described in the final rule.... The final rule also imposes a penalty of $1,000 for each disclosure or use of Limited Access DMF to those not meeting the certification requirements or for non-legitimate purposes, as outlined in the rule."
Drinker Biddle
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ERISA Advisory Council to Meet August 23-25, 2016
"The purpose of the open meeting is for Advisory Council members to hear testimony from invited witnesses and to receive an update from [EBSA]. The EBSA update is scheduled for the morning of August 25, subject to change. The Advisory Council will study the following topics: [1] Participant Plan Transfers and Account Consolidation for the Advancement of Lifetime Plan Participation, on August 23 and [2] Cybersecurity Considerations for Benefit Plans, on August 24."
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]
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Forum Selection Provisions in ERISA Plans (PDF)
15 pages. "This article discusses in detail how courts are divided on the issue of the enforceability of forum selection clauses in ERISA plans."
The Wagner Law Group, via Benefits Law Journal
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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2016 BenefitsLink.com, Inc. All materials
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