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2018 Legislative Update
September 6, 2018 in MD
Worldwide Employee Benefits Network [WEB] - Baltimore Chapter

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CMS Issues New Proposed Regulation on Risk Adjustment Formula for 2018

"CMS does not propose substantive changes from previous risk adjustment regulations. Instead, the agency provides a more thorough explanation of its assumptions in developing the risk adjustment methodology.... The rationale in the proposed rule for the 2018 methodology is nearly identical to that laid out in the final rule for the 2017 methodology." Katie Keith, in Health Affairs

What Employers Need to Know About ACA 'Pay or Play' Mandates

Sept. 18 webinar will clear up any confusion about the ACA 'Pay or Play' mandates and help employers to avoid penalties. Discount for BenefitsLink readers .

An Analysis of Out-of-Network Claims in Large Employer Health Plans

"Nearly one in five inpatient admissions includes a claim from an out-of-network provider ... Patients using in-network facilities can still face claims from out-of-network providers, particularly for inpatient admissions ... Inpatient admissions that include an emergency room claim are more likely to include claims for an out-of-network provider ... Enrollees using outpatient mental health services are significantly more likely to have a claim from an out-of-network provider ... Outpatient service days that include an emergency room claim are much more likely to include a claim from an out-of-network provider ... Enrollees with anesthesia or pathology claims are more likely to have an out-of-network provider claim, even when using in-network facilities." The Peterson-Kaiser Health System Tracker

New York Moves on Bereavement Leave Legislation

"At the beginning of this year the New York Paid Family Leave Act (PFL) took effect.... The proposed bill would ... include a new qualifying event whereby individuals would be allowed to use up to 12 weeks of PFL for bereavement after the death of a family member (a spouse, domestic partner, child, parent, grandparent, grandchild, or in-law, under this law). The paid bereavement leave benefit would begin in 2020 if signed." Goldberg Segalla

The Risk Corridor is Closed: Insurers Seek Recourse in the Federal Circuit

"Moda argues that [1] an appropriations rider passed by Congress cannot abrogate a statutory obligation to pay funds, unless the rider clearly states such intent.... [2] there is no precedent allowing the Court to retroactively deny risk corridor payments that insurers earned based on past performance.... [and] [3] there was an implied contract between the government and Moda to make risk corridor payments[.]" Sheppard Mullin

CMS Continues to Push for Hospital Price Transparency

"CMS explains that it is aware of the challenges that continue to exist because the chargemaster data may not accurately reflect what any given individual is likely to pay for a particular service or visit.... [C]omments received in response to the proposed rule argue that the chargemaster data would not be useful to patients because it is confusing as to the amount of the actual out-of-pocket costs imposed on a particular patient." Sheppard Mullin

Social Determinants as Public Goods: A New Approach to Financing Key Investments in Healthy Communities

"Drawing on lesser-known economic models and available data, [the authors] show how a properly governed, collaborative approach to financing could enable self-interested health stakeholders to earn a financial return on and sustain their social determinants investments." Len M. Nichols and Lauren A. Taylor, in Health Affairs

Possible Compensation Planning Opportunities in New Code Sec. 199A

"A public company might look among its subsidiaries and find a qualifying trade or business that throws off predictable income, and that could be housed in an LLC or other pass-through entity, or is already in a pass-through. Then the company could award partnership interests to a few senior executives.... Existing pass-through entities, such as S-corporations or LLC/partnerships, could pay executives with more non-wage and non-guaranteed payments, which could qualify for the 20% deduction resulting in a lower tax rate to the recipient." Winston & Strawn LLP

Pay for the Top Executive at Long Island, NY Non-Profit Organizations (PDF)

12 pages. "Among the 118 organizations included in [this] study: [1] Revenue for the study group ranged from $20 million to $2.2 billion ... [2] Median number of employees equaled 581; [3] Median aggregate compensation paid to all employees equaled $27.0 million; [4] Median total compensation to the top executive equaled $458,059 for fiscal 2016 ... [5] Perquisites were provided and disclosed by 19% of the total sample." Steven Hall & Partners

Deferred Compensation Claim of Exec Fired for Not Accepting Transfer Revived

"The appeals court agreed with the employee that his refusal to accept the transfer to the new position could not reasonably be considered cause for terminating him. Rather, when he was offered the opportunity to assume a different position in Kansas, the offer involved a new set of 'material duties and obligations.' But the appeals court agreed with the district court's grant of summary judgment in favor of the employer on the exec's severance pay plan claims." [ Peck v. SELEX Systems Integration, Inc. , No. 17-7138, (D.C. Cir. July 17, 2018)]
Wolters Kluwer Law & Business

Ninth Circuit Withdraws Altera Opinion

"The Ninth Circuit ... announced that it is withdrawing its July 24 opinion in the Altera Corp. case. The order announcing the withdrawal says it is being done 'to allow time for the reconstituted panel to confer on this appeal.' ... The Ninth Circuit [had found Treas. Reg. Sec. 1.482-7A(d)(2)], which requires related entities to share the cost of employee stock compensation for their cost-sharing arrangements to be considered qualified cost-sharing arrangements (QCSAs) and avoid IRS adjustment, withstands scrutiny under general administrative law principles and is therefore valid. " [ Altera Corp. v. Comm'r , Nos. 16-70496, 16-70497 (9th Cir. Aug. 7, 2018)]
Journal of Accountancy

COBRA Cancelled, Terminated Employee Says Late Payment Warning Should Have Been Given

We are a TPA firm that does some COBRA administration. Received a call from a distraught person because his COBRA was stopped due to non-payment. He sent a partial payment to cover May then sent nothing for June & July. He was then notified that coverage was stopped due to lack of payments. His argument was that he never received any payment coupons nor did he receive any "warnings" that coverage was going to end. He had signed off on all of the initial COBRA paperwork which stated the costs, payment of premiums, etc. My question is whether he has any push back. BenefitsLink Message Boards

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Most Popular News Items in the Previous Issue

Understanding and Planning for the Excise Tax on Executive Compensation Paid by Tax-Exempt Employers Seyfarth Shaw LLP

Potential Repeal of the Michigan Health Insurance Claim Assessment (PDF) Marsh & McLennan Agency LLC

States Initiate Litigation Challenging Final Association Health Plan Rule Foley & Lardner LLP

Press Releases

ACOPA Honors Norman Levinrad with Edward E. Burrows Distinguished Achievement Award ASPPA College of Pension Actuaries [ACOPA]

DOL Investigation Results in Court Ordered Restitution of $491,890 After 28 Union Members Pleaded Guilty to Filing False Healthcare Claims Employee Benefits Security Administration [EBSA], U.S. Department of Labor

DOL Reaches Agreement to Distribute Assets to Eligible Participants of Sacred Heart Hospital Profit-Sharing 401(k) Plan Employee Benefits Security Administration [EBSA], U.S. Department of Labor

USI Consulting Group Hires VP, Retirement Services USI Consulting Group

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