Health & Welfare Plans Newsletter

April 26, 2017

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Webcasts and Conferences

Confessions of a HIPAA Auditor
May 4, 2017 WEBCAST
HIPAA One

Plan Audits and Corrective Action What Your Plan Auditors Wish You Knew
May 18, 2017 in MD
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter

Difference a Union Makes: Dealing with Taft-Hartley and Multiemployer Plans
May 18, 2017 in NY
Worldwide Employee Benefits Network [WEB] - New York Chapter

Employee Benefits and Executive Compensation Summit - Critical Issues For 2017 and Beyond
May 23, 2017 in NY
Littler Mendelson

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[Guidance Overview]

The MacArthur Amendment Language, Ethnicity in the Federal Exchange, and Risk Adjustment Coefficients
"[T]he amendment would repeal the enigmatic language included in a March 23, 2017 amendment to the AHCA that would have allowed states, beginning in 2018, to define the essential health benefits for purposes of determining premium tax credits ... In its place the amendment would allow states to apply for waivers to 'encourage fair health insurance premiums.' ... On April 18, 2017, [CMS] released the Final HHS risk Adjustment Model Coefficients for 2018.... They include for the first time ... enrollment duration factors ... as well as a number of prescription drug factors[.]"
Timothy Jost, in Health Affairs

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Plan Administrator's Failure to Notify Beneficiary of Life Insurance Conversion Rights Was Breach of Fiduciary Duty
"The Court found that that LINA had provided an Administrative Services Manual to WellStar that explained the conversion process, and stated that WellStar was required to give notice of conversion rights. However, WellStar did not have a process for giving that notice, and did not give it to plaintiff or her husband.... [The Court imposed a surcharge of] $750,000, the amount of coverage lost by their failure to convert." [Erwood v. Life Ins. Co. of North America and Wellstar Health System, Inc. Group Life Ins. Program, No. 14-1284 (W.D. Penn. Apr. 13, 2017)]
Robinson & Cole LLP

Annual Planning for Your Company's Health Benefit Programs: Best Practices Check List
"The list [in this article] contains 25 health benefit best practices from the Mercer National Survey of Employer-Sponsored Health Plans. Each year [Mercer compares] the performance of employers that use the most of these best practices with those using the fewest (the top and bottom quartiles). And each year [the comparison indicates] that those using the most best practices have lower average healthcare cost increases. (In 2016, the two groups had average increases of 3.8% and 4.8%, respectively.)"
Mercer U.S. Health News

That Section 125 Cafeteria Plan Needs a Second Look
"An increase in [DOL] audits warrants a much closer look at Section 125 Cafeteria Plans to ensure compliance and proper administration.... [1] Understand which health & welfare benefits should be pre-taxed ... [2] Test for nondiscrimination early rather than later ... [3] [D]ependent domestic partners prompt tax confusion."
Corporate Synergies

HIPAA Risk Analysis Lapses Lead to OCR Enforcement: How Is Your Security Management Process?
"[In] its guidance materials, OCR describes several baseline expectations for a compliant risk analysis.... With these enforcement actions, OCR continues to hammer home the message that the security management process should be top-priority for CEs and BAs that create, receive, maintain, or transmit ePHI and that risk analysis and risk management are indeed foundational to achieving and maintaining Security Rule compliance. HIPAA-regulated entities should not only thoughtfully plan, carry out, and implement a risk analysis and RMP but also be mindful of organizational and environmental changes that require them to review and revise their processes to best safeguard ePHI."
Ice Miller LLP

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Federal Contractors Still Burdened with Paid Sick Leave Requirements
"The DOL regulations created a complex set of rules that are difficult to understand and administer, which often lead diligent contractors to do more than is necessary out of fear of non-compliance. Which federal contractors are affected by these regulations? ... How is sick leave allocated under the regulations? ... How can paid sick leave be used under the regulations?"
Graydon Head & Ritchey LLP

Preventive Services Task Force Release: Preeclampsia
"[The ACA] requires group health plans and health insurance issuers that are not grandfathered health plans to provide a wide array of preventive care items and services with no cost-sharing.... [T]he U.S. Preventive Services Task Force released a final recommendation statement on screening for preeclampsia. The Task Force recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy."
Compliance Dashboard

Increased Cost-Sharing Makes Voluntary Benefits More Attractive
"As national leaders debate ways to tackle health care troubles, employers may need to get creative in helping employees afford the health care they need. One way they can do that is by offering supplemental benefits.... When handled properly, voluntary benefits are not covered by ERISA ... The plan must be completely voluntary for the employees; premiums must come only from the employees -- no employer contributions allowed; the company must not endorse the plan; and any monies that come back to the employer because of the plan must be limited only to reasonable reimbursements arising from the collection and payment of premiums."
HRDailyAdvisor

Health Policy's Gordian Knot: Rethinking Cost Control
"The central, intractable obstacle to long-term cost containment ... is the near impossibility of saying 'no' to ever-more-expensive care that yields small marginal benefits.... [The authors] propose, instead, to circumvent [this barrier] through redirection of cost-control policy away from efforts to limit use of existing, low-benefit technologies and toward strategies for influencing the emergence of new technology. To this end, [the authors] urge: redesigning value-based payment to emphasize future rewards for tests and treatments that haven't yet emerged, and varying the duration of intellectual-property protection so as to tie its rewards to therapeutic effectiveness."
Health Affairs

Setting Targets for State Health Care Improvement
"Interactive [tool] shows the health care gains your state could make if it improved on coverage, quality, and other measures.... Using the interactive tool ... if the insured rate among working-age adults in Georgia [for example] rose to the expansion-state average of 91 percent, an estimated 619,770 more adults in Georgia would be insured. Similarly, if the share of adults not able to get care because of cost in Georgia dropped to the expansion-state average of 11 percent, about 382,207 fewer Georgians would skip needed care."
The Commonwealth Fund

Mortality Rates Suggest Obamacare Could Be Killing People
"[A 2009 study] found that private health care insurance was associated in 2005 with a 40 percent mortality risk reduction among the pre-Medicare U.S. adult population ... This study had a huge effect on the political debate surrounding Obamacare.... Since Obamacare provisions extended insurance coverage, the [all-cause] death rate has substantially increased, by more than 20,000 deaths per year.... [W]hen we calculate the death rate after excluding all external causes of morbidity ... this death rate should fall to 238 per 100,000. The 2014-15 data show the actual reported death rate among U.S. adults, excluding external causes, is ... 252.9."
The Federalist

Benefits in General

Overall Public/Private Sector Compensation Gap Has Widened, CBO Finds
"The cost of providing benefits for federal civilian workers from 2011-2015 was estimated to be 47 percent higher on average than for comparable private sector employees. CBO said the biggest factor in the difference in the cost of benefits from was that much of the federal workforce still falls under systems that include a defined benefit pension, a concept that has largely disappeared in the private sector. And due to the uncertain nature of future costs of pension plans, cost differences in the realm of benefits are 'difficult to quantify,' analysts said[.]"
Government Executive

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

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