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March 6, 2017 logo logo
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[Guidance Overview]

CMS Releases Market Stabilization Guidance (PDF)
"[It] is not clear that the changes will be enough to shore up the risk pools, particularly if the individual man date is repealed legislatively. This is likely why CMS sought comment on several of its proposals, including those related to CMS authority with respect to continuous coverage options.... [This article] summarize[s] the key points from the proposed rule, the revised QHP certification calendar, and the transitional plan guidance."
Groom Law Group


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HIPAA Phase 2 Audits Are Here. Are You Ready?
"Employer-sponsored plans providing health care benefits are generally Covered Entities, and this may include arrangements such as health care flexible spending accounts. Some employers with insured health care plans may be successful in taking a 'hands off' policy so as to avoid the need for the employer to take the many steps necessary to to satisfy the rules."
Tucker Ellis LLP

Are HIPAA Audits Moving Into Enforcement Territory?
"The [HHS] Office for Civil Rights [OCR] began a first phase of the compliance audits in 2011, focused solely on covered entities, while the current phase includes both covered entities and business entities.... OCR's current audits are focused on cybersecurity issues affecting cloud computing, patients' right to access information and health information exchanges."
Bloomberg BNA

Design of Transit Benefits Can Increase Employee Engagement
"[M]andates and tax considerations should not be the only driver of transit benefit design. Asking employees what they need to better manage their commutes to work could yield some important insight into how to expand these programs to meet the needs of a broader array of employees.... 69 percent of employers offering employee transit benefit programs reduced their need for parking spaces. 53 percent reduced local traffic congestion. 59 percent improved community relations."
Society for Human Resource Management [SHRM]

Congress Considers Bills to Reform More than the Affordable Care Act
"Not all health care legislation being debated in Congress is about repealing the [ACA]. Efforts to protect worksite wellness initiatives, address the regulation of self-insured health plans and help small businesses band together in shared health plans are also underway."
Society for Human Resource Management [SHRM]


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Obamacare Oversight: 112th to 114th Congress (PDF)
45 pages. "Since its passage in 2010, the committee has convened 31 oversight hearings on Obamacare and performed systematic and methodical oversight to examine how the administration implemented the most critical components of Obamacare. In these hearings, 107 witnesses testified before the committee, culminating in hundreds of hours of testimony. Of those witnesses, 38 have been administration officials.... The committee's oversight over the last six years, compiled here in its entirety for the first time, has exposed serious deficiencies in Obamacare that have harmed the American people and wasted taxpayer dollars. These oversight hearings and reports have paved the way to legislation that can repeal this harmful law."
Energy and Commerce Committee, U.S. House of Representatives

President Trump Announces Health Care Priorities: Repeal/Replace of Obamacare; Tort Reform on Agenda
"The President did not address value-based health care initiatives expressly, but his opening remarks on ACA reform emphasized the importance of ensuring access to quality health care at lower costs. President Trump's speech and the House Leadership Proposal both support the use of tax credits and health savings accounts, the repeal of the insurance mandates, and the protection of those with pre-existing conditions."
Ropes & Gray LLP

Assessing Premiums, Deductibles, and Plan Competition in's Individual Market (PDF)
17 pages. "Over the 2014-2017 window, [this study] found significant average growth in premiums and cost sharing and a general reduction issuer in between choices. CAHC's previous research shows a major reason for this is that risk pools are seriously unbalanced, with older and sicker enrollees. [These] findings show that the individual market is currently struggling and rapidly deteriorating. [The authors] speculate that in many markets, these pools are in or headed towards a death spiral, but could be saved by intervention to reduce risk and relief from the crushing mandates, restrictions, and rules imposed by current law."
Council for Affordable Health Coverage [CAHC]


Healthcare is Complicated: Is it Fixable?
"[C]onsumers think healthcare is too complicated for them to understand. Thus, they depend on their caregivers to educate them and are predisposed to be dependent on what they're told. It hasn't changed. In this digital health age, only one in eight consider themselves well-informed and capable of navigating the system. It's too complicated for most Americans and perhaps even more for the GOP lawmakers seeking to transform it in an environment of intense media scrutiny and partisan rancor."
Paul Keckley

Benefits in General

[Guidance Overview]

The DOL's Revised Regs Applicable to Disability Benefit Claims
"The easiest requirement to meet will be the inclusion of a statement as to when the limitations period will expire ... Writing decisions in a culturally and linguistically appropriate manner also should not present too much difficulty.... Insurers and benefit plans will also need to instruct their claims personnel and any consultants they retain on how to address conflicting opinions and Social Security findings. It will no longer suffice to simply note disagreement or assert that Social Security utilizes different standards."
DeBofsky, Sherman & Casciari, PC

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