Spencer & Benefits NetNews – September 11, 2015

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September 11, 2015

 

CRS report highlights variation in and adjustments to state EHB choices

Essential health benefit (EHB) coverage varies widely from state to state, which can be attributed to the fact that each state selected its own EHB-benchmark plan for 2014-2016, according to a recently-released report from the Congressional Research Service (CRS). The variation, says CRS, occurs in terms of specific covered services as well as in terms of amount, duration, and scope….

(Read Intelliconnect) »

ACOs serve more Americans while increasing quality and savings

Accountable care organizations (ACOs) are serving more Medicare beneficiaries while generating larger savings to the Medicare Trust Funds and delivering higher quality care. In the third year of the Pioneer ACO program and Medicare Shared Savings Program (MSSP), both programs showed significant improvements, according to CMS’ 2014 quality and financial performance results. CMS Acting Administrator Andy Slavitt said, “These results show that accountable care organizations as a group are on the path towards transforming how care is provided. Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending….”

(Read Intelliconnect) »

September 10, 2015

 

HHS moves towards health care equity, proposes to leave sex discrimination behind

The Department of Health and Human Services (HHS) published a proposed rule to update the agency’s nondiscrimination regulations to prohibit sex discrimination in health programs and activities. The update, under the Patient Protection and Affordable Care Act (ACA), also would impose new requirements for communication with disabled individuals and enhance language assistance for individuals with limited English proficiency. The proposed rule would allow individuals to seek remedies for sex discrimination under ACA Section 1557. HHS is accepting comments on its proposal related to both the breadth of the protections and potential accommodations through November 9, 2015….

(Read Intelliconnect) »

Are association health plans a viable small business health insurance option?

Association health plans (AHPs) are one way to provide employee benefits while reducing costs and utilizing less administrative overhead. According to the Washington Policy Center, AHPs actually provide better health insurance coverage while carrying a smaller regulatory burden for employers than the Small Business Health Options Program (SHOP), which was created under the Patient Protection and Affordable Care Act (ACA). Therefore, the Washington Policy Center believes that Congress should amend the ACA and allow small employers and their workers to make greater use of the benefits of AHPs….

(Read Intelliconnect) »

September 9, 2015

 

ERISA plan administrators must notify claimants of contractual suit-limitations periods

The administrator of a health insurance plan governed by ERISA violated its regulatory obligations by failing to include in a denial-of-benefits letter the plan’s one-year deadline for filing suit, the U.S. Court of Appeals for the Third Circuit ruled. Accordingly, the court set aside the plan’s deadline and borrowed the statute of limitations from the most analogous state-law claim, which the parties agreed was New Jersey’s six-year deadline for breach of contract actions. Because the claimant in this case had filed his complaint well before the expiration of this six-year period, his suit was not untimely….

(Read Intelliconnect) »

 

Multiemployer plans closely watching MPRA

More than six months after the passage of the Multiemployer Pension Reform Act of 2014 (MPRA), multiemployer plans are closely monitoring and discussing the law, but few are taking any drastic measures, according to a recent International Foundation of Employee Benefit Plans (IFEBP) survey….

(Read Intelliconnect) »

TIGTA reviews the IRS’s ACA Information Sharing and Reporting Project

In a recent report, the Treasury Inspector General for Tax Administration (TIGTA) reviewed the IRS’s ACA Information Sharing and Reporting Project (ACA IS&R), one of the core projects in ACA Release 5.0. The overall objective of the audit was to determine that the IRS sufficiently identified and mitigated risks affecting the ACA IS&R and had properly managed requirements testing. TIGTA found that, while the ACA IS&R project was deployed by the IRS on time, lapses occurred in risk and requirements management….

(Read Intelliconnect) »

September 8, 2015

 

More and more, Californians like the ACA

Californians are embracing the Patient Protection and Affordable Care Act (ACA) ((P.L. 111-148) at an increasing rate, according to a field poll of California voters conducted in June and July of this year. Sixty-two percent of respondents say they support the law, up from 56% in 2014, and support by majorities of voters was found in all major regions of the state, among all races and ethnicities, and among all age groups. The percentage of California voters who supported the law had remained fairly stable in the first four years following its passage, ranging from 52% to 54%….

(Read Intelliconnect) »

Premium increases being finalized as open enrollment nears

As open enrollment approaches, states’ final approvals of rate increases are rolling in. While some states were able to keep increases in the single digits, higher-than-expected health care costs resulted in hikes of more than 20 percent in some states. The Patient Protection and Affordable Care Act (ACA) requires review of rate increases of 10 percent or more for non-grandfathered health plans sold in the individual or small group market….

(Read Intelliconnect) »

 

401(k) plan participants allowed to pursue claim for disgorgement following transfer of account assets to pension plan

Participants in a 401(k) plan had standing to pursue the restoration of profits by their employer following the transfer of their individual account assets to a defined benefit plan, according to the Fourth Circuit U.S. Court of Appeals. The fact that the participants did not incur a financial loss following the transfer did not prevent them from pursuing their ERISA claims for disgorgement….

(Read Intelliconnect) »