Health & Welfare Plans Newsletter

May 4, 2017

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Employee Benefits Jobs


Webcasts and Conferences

Ins & Outs of Socially Responsible Investing for Retirement Plans
RECORDED
Verrill Dana LLP

First 100 Days: What the New Administration Means For Benefits, Taxes, and Employment Compliance
May 9, 2017 in GA
Fisher & Phillips LLP

Disruption in Washington: Impact on Benefits and Compensation
May 10, 2017 in CA
Morgan Lewis & Bockius LLP

Choosing a Retirement Solution for Your Small Business Workshop
May 10, 2017 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

Affordable Care Act Compliance
May 10, 2017 WEBCAST
Employee Benefits Security Administration [EBSA], U.S. Department of Labor

EBRI Policy Forum #80: Retirement Policy Directions in 2017 and Beyond
May 11, 2017 in DC
EBRI [Employee Benefit Research Institute]

Disruption in Washington: Impact on Benefits and Compensation
May 12, 2017 in CA
Morgan Lewis & Bockius LLP

Offering the Right Mix of Medical Plan Choices
May 15, 2017 WEBCAST
Fidelity Health Marketplace

What Employee Benefit Plan Professionals Need to Know about Cybersecurity
May 24, 2017 in IL
Worldwide Employee Benefits Network [WEB] - Chicago Downtown Chapter

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[Official Guidance]

Text of CMS Memo: HHS-Operated Risk Adjustment Data Validation (HHS-RADV) -- 2016 Benefit Year Implementation and Enforcement (PDF)
"CMS has assessed the results of the 2015 benefit year HHS-RADV pilot and received feedback from issuers and their initial validation audit (IVA) entities suggesting the need for an additional transition year to ensure the successful implementation of risk adjustment data validation. Therefore, CMS is converting 2016 benefit year HHS-RADV to a second pilot year, forgoing payment adjustments until 2017 benefit year HHS-RADV, and implementing process refinements that will reduce the burdens of HHS-RADV." [Unnumbered document, May 3, 2017]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Advert.]

Online Learning Course: HIPAA Security

Sponsored by International Foundation of Employee Benefit Plans [IFEBP]

Health plans and business associates must comply with the HIPAA Security Rule. Topics covered include: Administrative Safeguards; Physical Safeguards; Technical Safeguards; and Organizational Requirements.


[Guidance Overview]

Five Items to Consider If You Are Assessed an Employer Mandate Penalty
"[The TIGTA report] states the IRS will contact the employer prior to any formal assessment of a section 4980H penalty.... [A] response to the IRS will be critically important in determining whether the employer will be assessed a penalty."
Accord Systems, LLC

[Guidance Overview]

HHS Final Rule Aims to Provide Some Stability to the Individual Health Insurance Market
"[T]he final rule makes a number of changes intended to promote full-year coverage and provide insurers with additional flexibility.... Plans or employers with active or retired participants that use the individual market for coverage should understand that the enrollment process for coverage will be slightly more difficult, and be prepared to answer questions that may arise from participants and their families."
Segal Consulting

Digital Diabetes Solutions
"With employers footing a major part of the nation's massive diabetes-driven $300 billion medical bill, new digitally based workplace programs are showing progress in managing those costs and improving employees' lives."
Human Resource Executive Online

OCR Announces First HIPAA Settlement with Wireless Health Services Provider
"OCR appears to be voicing its concern regarding HIPAA compliance and wireless health devices.... CardioNet's corrective action plan underscores OCR's expectations for HIPAA Security Rule compliance in this sector. During the last year, OCR has issued guidance for mobile health application developers, and developed a portal designed to provide guidance to health app developers."
Morgan Lewis

[Advert.]

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For over 20 years, we've helped employers find the best-informed candidates to fill their benefits job openings -- learn more!


Self-Insurance Options Continue to Attract Employers
"The proportion of self-insured companies has increased from 28.5% in 1996 to 39% in 2015 ... The biggest increase was in companies with fewer than 1,000 employees. The shift to self-insure represents a loss of group market share to the traditional health plans at a time when many are already finding it difficult to succeed with the imbalance of utilization costs and younger, healthier customers on individual plans."
HealthLeaders Media

What's in the Republican Health Care Bill?
"[1] Ends tax penalties ... for individuals who don't buy insurance coverage and larger employers who don't offer coverage.... [2] Ends tax increases on higher-earning people and a range of industry groups ... [3] [L]ets states impose work requirements on Medicaid recipients.... [4] Overhauls insurance subsidy system from one based largely on incomes and premium costs to a system of tax credits ... [5] Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones ... [and] exempting insurers from providing consumers with required coverage of specified health services ... [6] [Lets states that create high-risk pools get federal waivers from the] s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage.... [7] Retains requirement that family policies cover grown children to age 26."
Fox News

GOP Health Bill Jeopardizes Out-of-Pocket Caps in Employer Plans
"Under the House bill, large employers could choose the benefit requirements from any state -- including those that are allowed to lower their benchmarks under a waiver ... By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation."
The Wall Street Journal; subscription may be required

New $8 Billion for Those with Preexisting Conditions Appears to Boost AHCA; Critics Say Amount Is Too Low
"The amendment has been described as funding state high-risk pools. A state could certainly use its share of the $8 billion to fund risk pools as one approach to making coverage affordable to persons subject to high premiums because of their health status. But the money could also be used to directly subsidize the premiums or cost-sharing that high-cost consumers might have to pay for commercial insurance."
Health Affairs

For Health Insurers, Court Decisions Continue to Complicate Risk Corridors Program Payments
"Although an insurer can still properly file a case now, the ruling in BCBS suggests another possible approach: presenting the issue after the numbers are fully tabulated for the entire three-year risk corridors program. Such an approach could help courts focus on the ultimate issue: whether a statute stipulating that an agency 'shall pay' under specified conditions imposes a legal obligation on the government to make payment when those conditions are met." [Blue Cross & Blue Shield of N.C. v. U.S., No. 16-651C (Fed. Cl. Apr. 18, 2017) ]
Faegre Baker Daniels LLP

Iowa Obamacare Program on Verge of Collapse
"Iowa could be the first state to lack any insurers on its exchanges in all but a handful of counties. At the start of 2017, Iowa outwardly appeared to be an [ACA] success story, with three insurance companies selling competing plans on its exchanges statewide. But last month, two of Medica's competitors said they would exit the state's marketplace next year, citing financial losses. And on Wednesday, Medica released a statement saying its continued participation 'is in question'."
The Washington Post; subscription may be required

Aetna Adds Virginia to List of Obamacare Exits for 2018
"Health insurer Aetna Inc said on [May 3] it will not sell Obamacare individual insurance plans in Virginia next year ... Aetna, which had already sharply curtailed its 2017 participation in this marketplace to cover just four states, said last month that it would leave Iowa. It has not yet announced its plans for Nebraska or Delaware."
Reuters

[Opinion]

When 'Insurance' Is Not Insurance: The Preexisting Condition Debate
"[C]onsider a person who is currently uninsured but has recently been diagnosed with a serious medical problem. Given the opportunity, this person would love to purchase a health insurance policy. But make no mistake about it, this policy is no longer insurance in any traditional sense of the term. By skipping out on paying premiums until the illness strikes, this individual has consumed a lot more than everyone else when healthy, yet is able to consume almost the same as everyone else when sick (almost because there is likely to be some cost sharing). This isn't consumption smoothing, it is free riding, and this is what the prohibition on considering preexisting conditions encourages."
David Dranove and Craig Garthwaite, at Code Red

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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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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