HOME
ABOUT
SERVICES
NEWS
CONTACT NEWS

health reform updates

Health Care Reform Litigation Update On Monday, Nov. 14, 2011, as previously announced, the Supreme Court agreed to review three of the five separate appeals challenging the constitutionality of PPACA. Within the three appeals, the court selected for review only those issues tied to the overall question of how governmental power is divided between national and state governments, including: 1) the constitutionality of the individual mandate, 2) the issue of whether the mandate may be severed from the rest of PPACA, 3) the issue of jurisdiction or whether the Anti-Injunction Act bars the lawsuit before the tax is actually enforced, and 4) the constitutionality of PPACA's expansion of the federal Medicaid program. On Dec. 19, 2011, the Supreme Court announced that it will hear oral arguments on these issues for three days beginning on March 26, 2012, and ending on March 28, 2012, totaling 5 1/2 hours of actual argument. The court is expected to issue a decision by late June, in the middle of the presidential election year.Supreme Court Argument CalendarInitial HHS Proposal Gives States Flexibility to Define Essential Health Benefits On Dec. 16, 2011, HHS released a "pre-rule" bulletin to provide information and solicit comments on the regulatory approach that HHS plans to propose to define essential health benefits (EHB) under PPACA, § 1302(b). Non-grandfathered plans in the individual and small group markets inside and outside of the exchanges must cover EHB beginning in 2014. Section 1302(b)(1) provides that EHB include items and services within the following 10 benefit categories:Ambulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health and substance use disorder services, including behavioral health treatmentPrescription drugsRehabilitative and habilitative services and devicesLaboratory servicesPreventive and wellness services and chronic disease managementPediatric services, including oral and vision careUnder HHS' intended approach as announced in the bulletin, states would have the flexibility to select an existing health plan to set the benchmark for the items and services included in the EHB package. States would choose one of the following health insurance plans as a benchmark:One of the three largest small group plans in the stateOne of the three largest state employee health plansOne of the three largest federal employee health plan optionsThe largest HMO plan offered in the state's commercial marketTo meet the EHB coverage standard, HHS intends to require that a health plan offer benefits that are "substantially equal" to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories. The bulletin addresses only the services and items covered by a health plan, not the cost sharing, such as deductibles, copayments and coinsurance, which will be addressed in future bulletins. Final rules are expected to be issued sometime next year. HHS is accepting comments on the proposal, which are due by Jan 31, 2012, and may be sent to EssentialHealthBenefits_cms.hhs.gov. Essential Health Benefits BulletinFact SheetHHS Issues CO-OP Program Regulations On Dec. 13, 2011, HHS issued final regulations implementing the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to encourage the establishment of consumer-governed, private, nonprofit health insurers (referred to as CO-OPs). CO-OPs are designed to offer individuals and small businesses additional affordable, consumer-friendly and high-quality health insurance options. Starting Jan. 1, 2014, CO-OPs will offer health plans through the new, competitive health care marketplaces in each state, called the Affordable Insurance Exchanges. In addition to offering health plans through an exchange, CO-OPs may offer health plans outside of an exchange.Two types of loans are available under the program: startup loans for costs associated with establishing a CO-OP, and solvency loans to help CO-OPs satisfy state solvency and reserve requirements. The final regulations address eligibility standards for the CO-OP program, establish terms for loans and provide certain basic standards that organizations must meet to participate in the program and become CO-OPs. The regulations are effective Feb. 13, 2012, and finalize proposed regulations that were issued in July 2011. Regulations Fact SheetEnd Date Announced for Claims Under Early Retiree Reinsurance Program Congress appropriated $5 billion for the Early Retiree Reinsurance Program (ERRP), established under PPACA, and directed the Secretary of HHS to set up the program within 90 days of enactment. By law, ERRP is scheduled to end when its resources have been used to pay claims. Due to the significantly high response from employers, the program stopped taking applications as of May 6, 2011. On Dec. 9, 2011, CMS notified plan sponsors that $4.5 billion had been paid and issued further guidance informing plan sponsors that claims incurred after Dec. 31, 2011, will not be accepted. HHS has also announced that any claim list that includes a claim incurred after that date will be rejected in its entirety. Claims incurred on or before Dec. 31, 2011, but paid after that date may still be submitted, but not until the claim has been paid. Reimbursement requests received after the $5 billion has been fully exhausted will be held in the order of receipt, pending availability of funds. Sponsors with reimbursement requests on hold can expect to:Receive an email notifying them that their reimbursement requests have been placed on hold pending availability of funds;Have access to information about the position of their requests in the list of held reimbursement requests; andBe paid in the order in which reimbursement requests were received, if additional funds become available. In such cases, reimbursement requests will be honored until there are not sufficient funds to pay a reimbursement request in its entirety, at which time, that request will be partially paid and the balance will be paid if and when additional funds become available. Each time a partial payment is processed, the plan sponsor will receive an email notification regarding the specific amount paid and the balance remaining to be paid.In addition to the news release and notice, HHS issued an updated state-by-state list of amounts paid to approved sponsors.Notice News ReleaseUpdateHHS Releases FAQs Concerning Implementation of Exchanges On Nov. 29, 2011, HHS Released 13 FAQs addressing implementation issues for states and federally facilitated exchanges. The FAQs cover a range of topics, including funding responsibility and resources, information exchanges through federally managed data "hubs," and shared eligibility verification services. Among them are FAQs focused on issues raised by federally facilitated exchanges. FAQs New Release

Health Reform Updates
Federal Updates
State Updates
Industry News

Federal Updates

federal updates

Without Congressional Action, Transit Benefits to Be Adjusted in 2012 Unless Congress acts before the end of 2011, the monthly tax exclusion for employer-provided transit pass and vanpool benefits will decrease to $125 in 2012, from the current $230. Meanwhile, the monthly tax exclusion for employer-provided parking benefits is scheduled to increase by $10 to $240 for 2012. The limits for these qualified transportation fringe benefits provided by employers were previously adjusted on a temporary basis between Feb. 17, 2009, and Dec. 31, 2011, with passages of both the American Recovery and Reinvestment Act of 2009, and the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010. However, beginning Jan. 1, 2012, Revenue Procedure 2011-52 provides that the monthly exclusion for employer-provided transit pass or vanpool benefits is $125, and the monthly exclusion for qualified parking benefits is $240. Thus, it appears that without congressional action to keep these limits in line with the limits for preceding years, employers and employees should be prepared to comply with the new limits. Employers need to decide whether to restrict to $125 employees' monthly salary deductions for 2012, or instead allow employee salary deductions of up to $240 per month for transit passes and vanpools. If salary deductions for transit passes and vanpool benefits are permitted up to $240 per month and the law does not change, amounts in excess of $125 per month will be taxable for 2012. Revenue Procedure 2011-52IRS Announces 2012 Standard Mileage Rates On Dec. 9, 2011, the IRS announced in IRS Notice 2012-1 the 2012 optional standard mileage rates that employees, self-employed individuals and other taxpayers may use to calculate deductible costs of operating automobiles (including vans, pickups and panel trucks) for business, medical, moving and charitable purposes. Beginning on Jan. 1, 2012, the standard mileage rates for cars, vans, pickups or panel trucks will be:55.5 cents per mile for business miles driven (unchanged from the midyear adjustment that became effective on July 1, 2011)23 cents per mile driven for medical or moving purposes (a 0.5-cent decrease from the rate of 23.5 cents that was in effect for the last six months of 2011) 14 cents per mile driven in service of charitable organizations (unchanged from the midyear adjustment that became effective on July 1, 2011)IRS Notice 2012-1 contains the standard mileage rates, the amount a taxpayer must use in calculating reductions to the basis for depreciation taken under the business standard mileage rate, and the maximum standard automobile cost that a taxpayer may use in computing the allowance under a fixed and variable rate plan. Additional information about using the standard mileage rate may be found in Revenue Procedure 2010-51. Finally, use of the standard mileage rate is not mandatory, and taxpayers always have the option of calculating the actual costs of using a vehicle rather than using the standard mileage rates. IRS Notice 2012-1 Revenue Procedure 2010-51Press ReleaseIRS Releases Fall Edition of Retirement News for Employers On Nov. 23, 2011, the IRS released the fall 2011 edition of Retirement News for Employers, as well as FAQs on Form 8955-SSA reporting. The newsletter contains a number of articles, citations and links related to retirement plans, including:."Paying Retirement Plan Benefits": Distribution methods depend on the plan, participant and beneficiary elections"Maximize Your Retirement Savings in 2012": Making salary deferral contributions"SEPs and SIMPLEs": Amendment procedures and contribution limits"Disaster Relief for Retirement Plans and IRAs""Priorities for the Current Fiscal Year": From the IRS exam directorWebinars availableRevised Forms, including Form 5300, 5558 and 8955-SSARecurring Columns, including "Mark Your Calendar" and "DOL News"Click here to view the newsletter. FAQs on Combined Form 8955-SSA Reporting for 2009 and 2010 FAQs on Large Form 8955-SSA FilingsDOL Reissues Interim Policy on Electronic Distribution of Participant-level Fee Disclosures On Dec. 8, 2011, the DOL issued Technical Release 2011-03R, which revised the department's interim policy regarding the use of electronic media to satisfy the disclosure requirements under the department's final participant-level fee disclosure regulation. According to the DOL, the revised and reissued interim policy is identical to the original, except as necessary to clarify two points. First, the revised policy explicitly states that its alternative electronic disclosure method can be used to provide disclosures through a continuous access website. Second, the revised policy clarifies that investment-related information required by the participant-level fee disclosure rules may be furnished "as part of, or along with" pension benefit statements, but those disclosures may not rely on Field Assistance Bulletin 2006-03. Electronic disclosures of investment-related information must instead be made in accordance with the interim alternative method or the DOL's general safe harbor, which requires a recipient's affirmative consent unless a computer or other electronic system is an "integral part" of an employee's employment duties. DOL Technical Release 2011-03R News ReleaseIRS Issues 2011 Cumulative List of Changes for Cycle B Plans On Dec. 13, 2011, the IRS issued Notice 2011-97, which includes the 2011 Cumulative List, the list of statutory, regulatory and guidance changes that the IRS will look for when reviewing individually designed retirement plan documents submitted for determination letters during the Cycle B submission period. Remedial amendment Cycle B generally applies to an individually designed plan if the last digit of the plan sponsor's employer identification number is 2 or 7. The Cycle B submission period begins Feb. 1, 2012, and ends Jan. 31, 2013. The 2011 Cumulative List generally reflects law changes under the Pension Protection Act of 2006; the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007; the Heroes Earnings Assistance and Relief Tax Act of 2008; the Worker, Retiree, and Employer Recovery Act of 2008 (WRERA); the Small Business Jobs Act of 2010; and the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Qualification requirements that were not on the 2010 Cumulative List are designated on the 2011 Cumulative List as new. Sponsors of individually designed Cycle B plans, and their advisors, should carefully review the 2011 Cumulative List to ensure that their plan documents and determination letter applications address the issues the IRS has identified for review. Due to the small number of new items that could affect 401(k) plans, and the specialized nature of those items, many 401(k) plans that were already up-to-date with items on the 2010 list may discover that they do not have to make any documentation changes in response to the 2011 list. IRS Notice 2011-97

Health Reform Updates
Federal Updates
State Updates
Industry News

State Updates

state updates

Colorado On Dec. 5, 2011, the Colorado Department of Labor and Employment (DLE) issued a press release relating to a partnership with the DOL aimed at reducing misclassification of employees as independent contractors. The press release announces that the DOL and the Colorado DLE recently signed a memorandum of understanding on such misclassification, and that the two entities will embark on new efforts to protect the rights of employees by reducing the practice of misclassifying employees. According to the press release, the memorandum of understanding arose as part of the DOL Misclassification Initiative. Ten other states have also signed such memorandums, including Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Montana, Utah and Washington. Employers should be aware of the increased attention given to the misclassification issue by the DOL and by state agencies. Colorado DLE Press Release DOL Misclassification Web Page New Mexico On Nov. 21, 2011, the New Mexico Insurance Division issued Bulletin No. 2011-012. The bulletin is directed toward all group health plans and health insurers offering group or individual health insurance coverage in New Mexico. The purpose of the bulletin is to advise such insurers and plans of the application of internal claims and appeals and external review processes to all traditional fee-for-service indemnity health plans (except for grandfathered indemnity plans). In the past, there have been no New Mexico state appeals procedures for indemnity plans. As a result of PPACA, and pending the establishment of a permanent rule for internal and external review procedures for indemnity plans, indemnity plans are required to comply with New Mexico's currently available internal and external review procedures. The bulletin provides more information on those procedures, as well as contact information for any related questions. Bulletin No. 2011-012 New York On Dec. 12, 2011, the governor signed both A05502-B and A07779 into law. The first legislation, A05502-B, prohibits insurers or employers from requiring patients to use mail-order plans for prescription drugs, except for plans negotiated by unions. Instead, insureds have the choice of having prescriptions filled either through mail order or in person, without any added copayments or fees. A similar law is already in effect in Maryland. The second legislation, A07779, is similar to the first in that it requires every policy that provides prescription drugs to provide the same coverage for prescription fertility drugs, whether purchased through a mail-order pharmacy or not, without an additional copayment, coinsurance, deductible or other fees. Both changes to the law are effective Jan. 11, 2012. A05502-BA07779

Health Reform Updates
Federal Updates
State Updates
Industry News

Industry News

industry news

>January 10, 2012NewsireAGS Benefits Combines with NFP Dreyfuss & Birke to Build NY Metro Corporate Benefits TeamNEW YORK, Jan. 9, 2012 /PRNewswire/ -- National Financial Partners Corp. (NYSE: NFP), a leading provider of benefits, insurance and wealth management services, today announced the acquisition of AGS Benefits Group, LLC (AGS Benefits). Simultaneously with this acquisition, NFP....read more>November 14, 2011 By Reed AbelsonNew York Times:Study Finds Co-Payments Discourage Drug TreatmentsA new study published on Monday shows patients are more likely to take their medicine when they do not have to help pay for the prescriptions. The study, which appears online in the New England Journal of Medicine, focused on patients with health insurance who had heart attacks......read more>November 14, 2011 by By Reed Abelson, Gardiner Harris and Robert PearNew York Times:Justices to Hear Health Care Case as Race Heats Up For the nation’s health care system, there may be no going back.No matter what the Supreme Court decides about the constitutionality of the federal law adopted last year, health care in America has changed in ways that will not be easily undone.....read more >November 14, 2011 By Rob LynchForbes:Five Reasons Small Businesses Shouldn't Dump Health Care BenefitsThat true harbinger of winter is here: open enrollment. As the seasons change, employees will be spending a little extra time in the HR department picking out a health plan for next year.....read more>October 27, 2011 By Nina BernsteinNew York Times:7 More Insurers End Objections on Rate Filings In a competitive stampede toward transparency in health insurance premiums, seven more large carriers have dropped their objections to the public disclosure of their filings with New York State in support of rate increases....read more>October 20, 2011 By Steven Greenhouse and Reed AbelsonNew York Times:Wal-Mart Cuts Some Health Care BenefitsAfter trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff....read more>October 18, 2011 By Robert PearNew York Times:U.S. Moves to Cut Back Regulations on Hospitals WASHINGTON — The Obama administration moved Tuesday to roll back numerous rules that apply to hospitals and other health care providers after concluding that the standards were obsolete or overly burdensome to the industry....read more>October 14, 2011 By Robert PearNew York Times:Health Law to Be Revised by Ending a Program WASHINGTON — The Obama administration announced Friday that it was scrapping a long-term care insurance program created by the new health care law because it was too costly and would not work....read more>October 11, 2011 by Nina Berstein New York Times:In Seeking Rate Increases in New York, Health Insurers Fight to Keep Secrets Major health insurance companies seeking steep premium increases in New York have submitted memos to state officials to justify the higher rates. Now they are fighting to keep the memos from the public, saying they include trade secrets that competitors could use against them....read more>Monday October 10, 2011Yahoo Finance:Analyst: 2012 Price Hikes May Affect InsurersINDIANAPOLIS (AP) -- The cost of health insurance could grow at a slower pace next year, and that may squeeze profit margins for smaller insurers that focus on commercial coverage, according to a Wedbush analyst...read more >October 7, 2011 by Avik Roy, ContributorForbes:Health Care Questions I'd Ask Each Candidate at the Bloomberg-Washington Post Republican Presidential DebateThere have been some good and bad moments at the Republican Presidential debates so far. But, when it comes to health policy, both the moderators and the candidates have mostly disappointed. So, in advance of the Bloomberg Television / Washington Post debate on Tuesday, October 11 at Dartmouth College in New Hampshire, I thought I might don my bowtie and post the questions that I would ask each candidate, if I were sitting at the moderator’s table....read more>Wednesday October 5, 2011Yahoo Finance:Cigna Invests in Edington Associates to Reinforce Focus on Culture of HealthBLOOMFIELD, Conn.--(BUSINESS WIRE)-- Cigna (NYSE:CI - News) has become a minority investor in Edington Associates, a start-up company founded by University of Michigan Professor Dee W. Edington, Ph.D. The new company will work with corporate clients to help them develop a culture of health as a business strategy to improve productivity and lower health care costs through healthy behavior change. Cigna will hold a seat on the company’s board of directors....read more>September 27, 2011 by Reed Abelson New York Times: Health Insurance Costs Rising Sharply This Year, Study ShowsThe cost of health insurance for many Americans this year climbed more sharply than in previous years, outstripping any growth in workers’ wages and adding more uncertainty...read moreMonday September 12, 2011 by Sakthi Prasad>September 12, 2011 by Avik Roy, ContributorYahoo Finance:WellPoint, IBM tie up for medical-data technology(Reuters) - U.S. health insurer WellPoint Inc and computer giant IBM agreed to commercially use IBM's Watson technology that could help physicians identify best treatment options....read more

Health Reform Updates
Federal Updates
State Updates
Industry News

Master Page 1HOMEABOUTSERVICESCONTACT