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Milliman
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Affordable Care Act: Employer Shared Responsibility Provisions and Information Reporting
August 11, 2015 WEBCAST
(IRS [Internal Revenue Service])

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Text of CCIIO Letter to State Insurance Commissioners on Rate Review (PDF)
"Based on preliminary filings for the coming year, we are confident that, overall, consumers will retain access to a wide range of affordable options in 2016.... [CMS has] distilled several findings that we would ask you to carefully consider as you make your final rate decisions: [1] Recent claims data show healthier consumers.... [and] risk pools are expected to continue to get healthier ... [2] Recent data show a continued moderate medical cost trend.... [3] CMS will use a one hundred percent coinsurance rate for the 2014 reinsurance program ... [4] CMS remains committed to the risk corridor program ... [5] Public hearings are helpful." (Center for Consumer Information & Insurance Oversight [CCIIO], Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])

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Text of HHS OIG Advisory Opinion 15-09: Medigap Premium Credits and Discounts on Medicare Deductible for In-Network Hospital Services Would Not Constitute Prohibited Kickbacks (PDF)
"The Proposed Arrangement is a straightforward agreement by the Network Hospitals to discount the Medicare inpatient deductible for the Requestors' Policyholders -- an amount for which the Requestors otherwise would be liable.... In addition, the Requestors would pass back a portion of their savings, in the form of premium credits, to any Policyholder who has an inpatient stay at a Network Hospital.... [A]lthough the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute if the requisite intent to induce or reward referrals of Federal health care program business were present, the OIG would not impose administrative sanctions ... under sections 1128(b)(7) or 1128A(a)(7) of the [Social Security Act] ... in connection with the Proposed Arrangement. In addition, the OIG would not impose administrative sanctions ... under section 1128A(a)(5) ... in connection with the Proposed Arrangement." (Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS])

IRS Finds HRA Contributions for Retirees and Dependents Were Exempt from Gross Income
"Contributions made by the taxpayer to the retiree HRA on behalf of eligible retirees, spouses, and eligible dependents that were used exclusively to pay for eligible medical expenses were excludable from the retirees' gross income under Code Sec. 106. Further, contributions made to the retiree HRA on behalf of eligible retirees, spouse and eligible dependents were not wages subject to FICA taxes ... FUTA taxes ... or income tax withholding ... The taxpayer represented that amounts in the retiree HRA would only be used to reimburse health insurance premiums and medical expenses[.]" [ IRS Private Letter Ruling 201528004 , dated Apr. 6, 2015, released Jul. 10, 2015] (Wolters Kluwer Law & Business)

Some States Moving to Preempt Local Sick Leave Measures
"In response to the surge in local leave laws, some state officials have attempted to curb local governments' authority to enact such measures. New legislation in Michigan, Missouri, and Oregon demonstrate some of the varying approaches legislators have taken to curtail the proliferation of local [paid sick leave] laws.... [T]here remains a fourth approach (the California option): Do not ban local laws, and enact a state law. This is the alternative that presents the most compliance challenges/headaches for human resources, payroll, and in-house counsel." (Littler)

Departments Publish Final Rules for Preventive Services Under the ACA
"The final rule makes three changes to the governing regulations: [1] If a plan's network does not have a provider who can provide a required item or service, the plan must cover that item or service when provided or performed by an out-of-network provider, and may not impose cost sharing for that item or service.... [2] [P]lan sponsors may continue to rely on the relevant clinical evidence base and established reasonable medical management techniques, and do not generally have to defer to the recommendations of a treating physician.... [3]  [O]nce the underlying guideline or recommendation has been changed.... plan sponsors [generally must] continue to provide the coverage (without cost sharing) through the end of the plan year[.]" (Sibson Consulting)

Agencies Define the Closely Held, For-Profit Employers That May Invoke Accommodations for Religious Objections to Contraception
"The new regulations make the accommodation available to a for-profit entity that is closely held ... [which,] for this purpose, means: [1] No ownership interest in the for-profit entity is publicly traded; and [2] More than 50 percent of the value of the for-profit entity is owned directly or indirectly by five or fewer individuals (or a 'substantially similar' ownership structure applies). This change is effective for plan years beginning on or after September 14, 2015." (Lockton)

Text of the 2015 Annual Report of the Board of Trustees of the Medicare Trust Funds (PDF)
265 pages. "While the physician payment updates and new incentives ... avoid the significant short-range physician payment issues that would have resulted from the SGR system approach, they nevertheless raise important long-range concerns.... [The ACA] introduced large policy changes and additional projection uncertainty.... The methodology for projecting Medicare finances assumes a substantial long-term reduction in per capita health expenditure growth rates relative to historical experience, to which the ACA's cost -reduction provisions would add substantial further savings. Notwithstanding recent favorable developments, current-law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation." (The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds)

Using Onsite Health Centers to Help Build High Performance Health Care Programs
Infographic. "Insights from the 2015 Employer-Sponsored Health Care Centers (ESHC) Survey[:] Some employers are renewing their focus on ESHCs to help improve the performance of health care programs for active employees. Here's how: Establish clear objectives ... Maintain or expand commitment ... Offer a broad range of services ... Outsource operations ... Define patient base ... Measure performance." (Towers Watson)

Hospital Cost-Shifting: The Hidden Tax Employers Pay to Compensate for Government Underfunding (PDF)
13 pages. "Federal and state payments for hospital care do not cover the cost of providing those services.... In order to offset the underfunding, hospitals must ... increase the revenue they receive from private payers more for the same medical services ... In southeastern Wisconsin, [this] cost shifting is responsible for 35 percent of the overall commercial rates paid. Cost shifting is a hidden tax on employers that affects their ability to compete economically; it has a greater impact on smaller employers[.]" (HCTrends)

A Plain English Guide to the Compensation Clawback Rules
"As accounting restatements occur relatively infrequently, and the severity is often modest, the proposed 'clawback' rules represent more of a 'check the box' compliance activity than a real enforcement threat. [Here is a brief summary of the rules:] When to comply? ... What compensation is covered? ... What executives are covered? ... What must be recovered? ... How is it recovered? ... When is a restatement required?" (Orrick)

Status of the Social Security and Medicare Programs: A Summary of the 2015 Annual Reports
"[T]he Trustees project [Disability Insurance] trust fund depletion late in 2016, the same year projected in the last Trustees Report.... After 2019, Treasury will redeem [Social Security] trust fund asset reserves to the extent that program cost exceeds tax revenue and interest earnings until depletion of total trust fund reserves in 2034, one year later than projected in last year's Trustees Report.... The Trustees project that the Medicare Hospital Insurance Trust Fund will be depleted in 2030, the same year projected in last year's report." (The Board of Trustees, Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds)

Text of Federal District Court Opinion: Reasonableness of Hourly Fee Rate for Disability Claim Is Based on National Group of ERISA Practitioners, Not Local Attorneys
"[W]hen 'the subject matter of the litigation is one where the attorneys practicing it are highly specialized and the market for legal services in that area is a national market,' the relevant 'community' is not the local market area, but the community of practitioners in that subject matter ... ERISA is a specialized field with a limited number of attorneys who specialize in representing plaintiffs seeking disability benefits ... [One California attorney's] affidavit indicates that over thirty percent of his cases are outside of California.... [A second attorney] estimates that there are fewer than 150 attorneys nationwide who regularly litigate ERISA disability claims for plaintiffs ... [T]he Court concludes that a rate within the range asserted by the affiants is justified[.]" [Boxell v. The Plan for Group Ins. of Verizon Communications Inc., No. 1:13-CV-089 JD (N.D. Ind. July 21, 2015)] (U.S. District Court for the Northern District of Indiana)

Maintained and Unmodified Since 1996, Severance Policy Plausibly an ERISA Plan
"In effect without revision since 1996, the medical center's written severance policy involved the kind of undertaking that came within the meaning of ERISA's 'any plan, fund, or program' language. To the court, the policy represented a decades-long commitment to provide severance benefits under a wide variety of circumstances; it required managerial discretion in its implementation and an individualized review whenever certain covered employees were terminated." [ Okun v. Montefiore Medical Center , No. 13-3928 (2d Cir. July 17, 2015)] (Wolters Kluwer Law & Business)

ACLI Comments to DOL on Proposed Fiduciary Regs and Prohibited Transaction Exemptions, and Regulatory Impact Analysis (PDF)
329 pages. "It is essential that revisions be made to the Proposal to: [1] Ensure that providers, plan sponsors, plan fiduciaries, and IRA owners retain the freedom to define the nature and scope of their relationship.... [2] Preserve reasonable and customary commission-based practices ... [3] Be protective of the interests of savers and retirees through a workable rule that ... supports and encourages key educational activities when interests align. [4] Encourage access to a savings plan at work and provide the opportunity to learn about and access annuities, the sole means available in the market place by which retirees can secure income for life. [5] Ensure access to important workplace benefits such as life, disability income, long-term care, and other non-medical insurance products.... [6] Base the cost-benefit analysis on a careful examination of the impact of the rule on the availability of annuities and workplace benefit insurance products." (American Council of Life Insurers [ACLI])

Unified Trust Hires Director Of Client Consulting Unified Trust Company, NA

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