Spencer’s Benefits Report NetNews – January 6, 2017

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January 6, 2017

 

Senate introduces budget resolution to begin debate on ACA repeal

The Senate took initial steps towards repeal of the Patient Protection and Affordable Care Act (ACA) with its release of a budget resolution containing reconciliation instructions, which could serve as the foundation for the passage of future health legislation through the budget reconciliation process. The technique is designed to allow Senate Republicans to pass legislation with a simple majority, in a process where the bill could not be filibustered. Although the instructions are vague, the 52-Republican majority is sufficient to effectuate at least a partial repeal….

(Read Intelliconnect) »

GAO undercover operation revealed possible ACA fraud loophole

In an effort to test whether federal and state-based Patient Protection and Affordable Care Act (ACA) marketplaces were requiring application information during Special Enrollment Periods (SAPs), which allow applicants to obtain subsidized coverage outside of the general enrollment period, a GAO undercover operation discovered information collection practices that could make the ACA vulnerable to fraud. Information collection for SAPs is believed to be needed to prevent individuals who otherwise refused to sign up from improperly gaining access to subsidized insurance coverage only when they became sick….

(Read Intelliconnect) »

January 5, 2017

 

EEOC’s ADA, GINA wellness regs survive AARP’s attempt to thwart them

Refusing to preliminarily enjoin the EEOC’s regulations under the ADA and GINA that say the use of a penalty or incentive of up to 30 percent of the cost of self-only coverage does not render “involuntary” a wellness program (either a participatory or health-contingent program) that seeks the disclosure of ADA- or GINA-protected information, the federal district court in the District of Columbia found that AARP had associational standing—bringing suit on behalf of its members—to challenge the regs, but it did not establish irreparable injury. Specifically, the potential disclosure of health information required by the regs is not public disclosure, and employers are statutorily forbidden from using it to discriminate against employees. Further, paying higher premiums is economic harm, which is not irreparable. The court also found the EEOC entitled to some deference given that “voluntary” is not defined in either the ADA or GINA, and that on this limited record (resulting from AARP’s delay in challenging the regs), the EEOC had offered an apparently reasonable explanation for its change of course to allow the use of penalties or incentives….

(Read Intelliconnect) »

IRS reminds employers of important health care reporting dates

In the IRS’s latest tax tip, the agency has provided employers with some important health care reporting information. Under the Patient Protection and Affordable Care Act (ACA), insurance companies, self-insured companies, and large businesses and businesses that provide health insurance to their employees must submit information returns to the IRS and individuals reporting on health coverage….

(Read Intelliconnect) »

January 4, 2017

Guidance describes premium age curves and state reporting

The premium rate charged by health insurance issuers in the individual or small group market (in or outside of an exchange) may only vary by age within a 3:1 ratio as defined by uniform age bands set by 45 C.F.R. 147.102(a)(1)(iii), according to a Center for Consumer Information and Insurance Oversight (CCIIO) guidance document. Issuers must use a uniform age rating curve established by the state. If such a rate is not applied, issuers must use a uniform age rating curve established by HHS. Additionally, states are obligated to submit to CMS certain rating information regarding the scope and establishment of rating curves….

(Read Intelliconnect) »

New EBSA guidance includes clarification of effect of CURES Act on HRAs

The EBSA has issued frequently asked questions (FAQs) addressing special enrollment for group health plans, coverage of preventive services, and health reimbursement arrangements (HRAs), as impacted by the implementation of the ACA, HIPAA, and the recently-enacted 21st Century Cures Act (Cures Act; P.L. 114-255). The FAQs were prepared jointly by the Departments of Labor, Treasury, and Health and Human Services….

(Read Intelliconnect) »

Service credit denial barred under equitable estoppel, fiduciary duty rules

An employer’s refusal to recognize a participant’s 10 years of service at a Canadian facility when calculating his pension credits violated the principle of equitable estoppel as well as ERISA fiduciary duty and anti-cutback rules, the Sixth Circuit U.S. Court of Appeals has ruled….

(Read Intelliconnect) »

January 3, 2017

 

Text: HHS, final regulation, notice of benefit and payment parameters for 2018

(Read Intelliconnect) »

Nearly three-quarters of U.S. employees would like a customized benefits package

Seventy three percent of U.S. employees across all age groups would like the ability to customize their workplace benefits to suit their individual needs, according to a LIMRA Secure Retirement study….

(Read Intelliconnect) »

Final rule updates ACA risk adjustment, cost sharing, and consumer choice

Updates to payment parameters and other provisions of the risk adjustment program of the Patient Protection and Affordable Care Act (ACA) are designed to improve the ability of risk models to estimate risk for qualified health plan (QHP) issuers. In addition to taking steps to improve the risk adjustment program of the ACA, a HHS final rule makes adjustments to ACA cost-sharing parameters and makes amendments intended to increase consumer choice in the QHPs offered on ACA exchanges. The regulations are effective January 17, 2017….

(Read Intelliconnect) »

First open enrollment period provided only coverage option for millions

Analysis of insurance coverage rates before and after the first Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) open enrollment period shows that ACA coverage options account for about 76 percent of the decline in the uninsured rate during this time frame. The Commonwealth Fund reviewed factors that could have played into the increase in the percentage of insured Americans and concluded that the majority of those enrolling from fall 2013 through spring 2014 would not have had coverage without the ACA’s provisions….

(Read Intelliconnect) »

ERISA and other claims against noncompliant group health plan for ACA violations dismissed

Participants in a group health plan whose terms violated both ERISA and the Patient Protection and Affordable Care Act (ACA) lacked constitutional standing to sue the plan, the Sixth Circuit ruled. The mere fact that the participants paid money into a noncompliant plan did not satisfy the injury-in-fact requirement of constitutional harm necessary to establish standing, the appeals court held, finding the court below had properly dismissed their complaint….

(Read Intelliconnect) »