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[Guidance Overview]

CMS Issues New Unified Rate Review Instructions
"The 2018 rate review instructions contain a number of changes from earlier versions, most of which are very technical. For example, the URRT forms have been modified to accept two decimal index rate entries so that insurers can enter the rate to the nearest penny. Modifications have also been made to reflect changes in the 2018 Benefit and Payment Parameters rule. Several changes have also been made in an attempt to avoid common data entry user errors in earlier versions."
Timothy Jost, in Health Affairs


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[Guidance Overview]

2016 San Francisco HCSO Annual Reporting Form Released with May 1 Filing Deadline
"You are a covered employer and are required to file [your 2016 Health Care Security Ordinance (HCSO) Annual Reporting Form] if you met the following three conditions in 2016: [1] employed one or more workers within the geographic boundaries of the City and County of San Francisco; [2] were required to obtain a valid San Francisco business registration certificate pursuant to Article 12 of the Business and Tax Regulations Code, and [3] employed 20 or more persons worldwide (for profit) or a nonprofit organization that employed 50 or more persons worldwide."
ABD Insurance & Financial Services

[Guidance Overview]

HIPAA Guidance Issued on Man-in-the-Middle Attacks
"OCR states that when electronic protected health information (ePHI) that is protected under the Health Insurance Portability and Accountability Act (HIPAA) is transmitted over the internet, covered entities and business associates should include factors for securing end-to-end communication in their security risk analysis required by the HIPAA Security Rule."
McGuireWoods, LLP

Paid Family Leave: Is Your Company Aware of the Latest Ordinances?
"New York's law will be the strongest state family leave law in the nation. Once in full effect, it will provide up to 12 weeks of paid job secured leave. Further, Washington D.C. is considering a plan similar to San Francisco's and a Wisconsin State Senator recently proposed legislation to create state leave insurance which would allow employees to take paid family leave for up to 12 weeks when welcoming a new child. A number of smaller localities have also enacted or are considering similar initiatives."
Foley & Lardner LLP

OCR Settlement Emphasizes Need for Swift Breach Response
"The Breach Notification Rule's reporting requirements for breaches of unsecured PHI vary according to the size of the breach and the type of the regulated entity.... For HIPAA-regulated entities, maintaining -- and regularly testing -- a breach response plan is critical to ensuring compliance with the Breach Notification Rule's reporting requirements.... OCR may find that a HIPAA-regulated entity has violated the Breach Notification Rule's timeliness requirements if it gathers sufficient evidence to demonstrate that the entity unreasonably delayed its provision of breach notifications -- even if the entity ultimately sent the notifications within the 60-day window."
Ice Miller LLP


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Employers Need New Evaluation Process of PBMs to Control Drug Costs
"For the first time this year, large employers noted a surge in spending on pharmaceuticals as a top cost driver of health costs ... Many companies follow a traditional RFP approach when selecting a PBM. Prescription drugs are listed and the costs associated with each drug are tallied in a spreadsheet. Benefit specialists need to try and understand the way a PBM manages prescription drug spending to get a clearer picture of costs for their organization."
Healthcare Trends Institute

How U.S. Health Care Became Big Business
"[Dr. Elizabeth Rosenthal's] new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it's far more lucrative to provide a lifetime of treatments than a cure. 'One expert in the book joked to me ... that if we relied on the current medical market to deal with polio, we would never have a polio vaccine,' Rosenthal says. 'Instead we would have iron lungs in seven colors with iPhone apps.' "
National Public Radio

Which Markets Are Most Likely to Be Disrupted by New Care Delivery Models
"To better evaluate the health markets poised for potential growth or disruption in care delivery models, Accenture examined market dynamics across payers, providers and consumers among more than 400 Core Based Statistical Areas (CBSAs) in the continental United States.... [A]pproximately 21 percent of CBSAs (86 CBSAs that comprise more than 37 million people) are well positioned for providers to disrupt local care delivery models.... These are the top 25 markets with a population base of more than 250,000[.]"

Summary of Individual Market Enrollment and ACA Subsidies
"While it is unknown if the ACA will be unchanged, amended, or repealed in the immediate future, data from the individual marketplace can be useful in informing future policy decisions. This data can enable stakeholders to better understand the population currently receiving assistance and the amount of assistance being provided."

Lack of Obamacare Subsidies Could Cause Premium Spikes in 2018
"If insurers have to foot the bill for the [ACA]'s cost-sharing subsidies, which are expected to cost $9 billion in 2017, silver tier plans that cover an average of 70 percent of claims could end up costing more than gold tier plans that cover 80 percent ... Moreover, the 20 percent-plus increases wouldn't cover other costs such as medical inflation, the aging U.S. population or the sicker population being covered in the exchanges[.]"
Bloomberg BNA


ERIC Comment Letter to State of New York Workers' Compensation Board on Proposed Rules to the State's Paid Family Leave Program (PDF)
"Employers offering paid family leave should have the flexibility to decide whether their policies cover workers other than full-time employees.... The definition of care recipient, or the family member whom employees may use leave to care for, requires employers to do more than what federal law mandates.... The requirement that employees be in close and continuing proximity to the care recipient should be clarified to inform employees that it must be 'physical proximity.' "
The ERISA Industry Committee [ERIC]

Archive of News Items on the BenefitsLink Web Site Now Available in Optional Compact Format

Our Benefits in the News web page displays previously published news items as always, but now you can view them in a new, optional compact format -- you can hide the excerpts, at your option. Just look for the "Hide excerpts" checkbox. (The full list, which includes excerpts, continues to be the default view.)

Remember that you can limit the list to a particular type of news item (in either the compact or full format), such as Official Guidance. Other types are Guidance Overview, General, and Opinion. Just use the checkboxes at the top right corner of the list.

And you can narrow the list further to only show a particular type of news item that concerns a particular kind of plan. For example:

Benefits in General

How to Avoid Costly Beneficiary Designation Litigation: Helpful Hints for All Benefit Plans
"When there is a beneficiary dispute, the plan's written terms must be followed, to save the plan and its sponsor from costly litigation, avoid double liability, eliminate the need to examine and evaluate extrinsic documents to discern an employee's intent, and to make sure that benefits are paid quickly. Using the Supreme Court opinion as a guide, [a recent district court] opinion thus concluded that it does not matter if a participant 'substantially complies' with designation procedures. Instead, a designation will not be changed unless the plan's specific requirements are precisely followed." [Ruiz v. Publix Super Markets, Inc., No. 16-735 (M.D. Fla. Mar. 30, 2017)]
Foley & Lardner LLP

Total Wellness: Going Beyond Basic Wellness Programming
"[Employers] are beginning to think more broadly about wellness -- they're thinking about employee satisfaction and work/life balance more so than directly measurable ROI. Moving away from quantifying financial results to refocusing on the worker's own experience and needs opens the door to more sought-after programming. Instead of solely offering services to target healthcare claims, strategically mixing in other events can lead to higher levels of employee activation, productivity, retention, and job contentment."
Frenkel Benefits

Executive Compensation
and Nonqualified Plans

Follow-Up on Litigation Over Non-Employee Director Stock Awards
"[T]he Delaware Chancery Court upheld the decision of Investors Bancorp directors' to award themselves restricted stock and stock options under a plan previously approved by the company's stockholders.... However, the Court indicated that it would not automatically waive through all non-employee director awards under shareholder approved equity compensation plans -- even plans with limits on awards to non-employee directors."
Winston & Strawn LLP

Wells Fargo Shows Its Claws
"Months after the revelations that Wells Fargo had engaged in highly questionable (some say illegal) practices, including creating fraudulent accounts, its board of directors has taken action to recoup some of the compensation from the bank's leaders during the time the nefarious schemes were ongoing."
HRE Daily

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, 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 those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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