cmonfils | November 30, 2011
In a Frequently Asked Question (“FAQ”), the Departments of Health & Human Services, Labor, and the Treasury (the “Departments”) stated that group health plans are not required to comply with the Summary of Benefits and Coverage and Uniform Glossary requirement until final regulations are issued.
On August 22, 2011, the Departments issued proposed regulations that require group health plans subject to the Patient Protection and Affordable Care Act to furnish a Summary of Benefits and Coverage and Uniform Glossary to plan participants and beneficiaries (the “Summary Requirement”). At that time, the Departments also issued a proposed template for compliance with the Summary Requirement and proposed an effective date of March 23, 2012.
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Category: Health Care Legislation, HHS, PPACA |
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cmonfils | November 30, 2011
The US Court of Appeals for the Third Circuit held that, under ERISA Section 502(a)(3), an employee benefit plan was not entitled to full reimbursement for medical expenses it incurred on behalf of a participant and was limited by equitable principles and defenses to “appropriate” relief, despite plan language specifying full reimbursement. In its decision in US Airways v. McCutchen, the court held that the plan could not recover the full cost of the participant’s medical expenses when the participant recovered less from a third party.
Category: 3rd, ERISA, Reimbursement |
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cmonfils | November 30, 2011
The U.S. Department of Health and Human Services’ Office for Civil Rights released plans to audit 150 covered entities under its pilot HIPAA audit program. Covered entities should review HIPAA compliance policies and complete a security risk assessment to ready themselves for potential audit.
On November 8, 2011, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) published on its
website the details of its pilot program to perform up to 150 audits of compliance with the privacy, security and breach notification standards (collectively, the Standards) adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act) between November 2011 and December 2012 (the Pilot Audit Program).
Category: HHS, HIPAA |
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cmonfils | November 30, 2011
On November 17, 2011, the Department of Labor (DOL) issued responses to frequently asked questions (FAQs) on health care reform and the Mental Health Parity and Addiction Equity Act of 2008. The FAQs provide guidance on the health plan benefits summary requirement under health care reform, and they also clarify the permissible nonquantitative limitations that health plans may apply to mental health and substance abuse benefits.
Category: DOL, Health Care Legislation, Mental Health Parity |
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cmonfils | November 30, 2011
WASHINGTON — The Supreme Court on Friday made two prominent Washington lawyers very happy and very busy, appointing them to argue on behalf of positions that neither side in the challenges to the 2010 health care law has chosen to embrace.
Category: Health Care Legislation, Supreme Court |
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cmonfils | November 30, 2011
St. Louis – August 2011 – How can employers and governments encourage individuals to practice healthier behaviors? How can companies get their workers to stop smoking, watch what they eat, consume less alcohol, take their medicine and change their diet? One of the most promising methods is to offer incentives within corporate sponsored wellness programs, according to a new study from the Incentive Research Foundation (IRF). The study affirms the role and success of wellness incentive programs – important findings in light of the forthcoming 2014 implementation of the Patient Protection and Affordable Care Act’s provisions that increases the potential funding of wellness incentives to equal as much as 50 percent of the per worker total health care premium.
Category: Health Insurance, Wellness |
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cmonfils | November 30, 2011
WASHINGTON — A dispute has erupted between President Obama and Democrats in Congress over a proposal to broaden the exemption from new rules that require health insurance plans to cover contraceptives for women free of charge.
Category: Health Care Legislation |
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cmonfils | November 30, 2011
In a case of significant importance for plan sponsors and fiduciaries, the U.S. Court of Appeals for the Third Circuit held in US Airways, Inc. v. McCutchen, No. 10-3836 (3d Cir. Nov. 16, 2011), that an employee benefit plan was not entitled to full reimbursement of medical expenses it paid to a participant even though the plan provided that the participant was required to reimburse the plan for all amounts paid “out of any monies recovered from a third party.” The Court found that, because the participant had not received a complete recovery for his injuries in collateral litigation, full reimbursement to the plan would not be consistent with the terms of Section 502(a)(3) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(a)(3), which limits recovery to “appropriate equitable relief.”
Category: 3rd, ERISA, Reimbursement |
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cmonfils | November 30, 2011
Jonathan Gruber, an M.I.T. professor and a key intellectual architect of President Obama’s overhaul of the American health care system, said, “You know, I think basically, what they’ve constructed, the Affordable Health Act, is the best possible private-sector
Category: Health Care Legislation, Supreme Court |
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cmonfils | November 30, 2011
The U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) announced last week that it has begun formal auditing of covered entities under HIPAA. The action is not unexpected; the American Recovery and Reinvestment Act of 2009 (“ARRA”) required OCR to conduct the audits. However, the announcement, along with ARRA’s increased penalties for not complying with HIPAA, may cause covered entities and business associates to refocus on HIPAA’s requirements.
Category: HHS, HIPAA |
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cmonfils | November 30, 2011
from Spencer’s Benefits Reports: The Equal Employment Opportunity Commission’s (EEOC) Age Discrimination in Employment Act (ADEA) exemption for coordination with Medicare applies only to retiree benefits, not the benefits of current employees, the EEOC Office of Legal Counsel staff confirmed in an informal discussion letter in response to an inquiry from a member of the public.
Category: Medicare |
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cmonfils | November 30, 2011
Sen. Orrin Hatch, R-Utah, and Sen. John Barrasso, R-Wyo., are battling to undo this annual fee, which is expected to raise $8 billion in 2014 and $14.3 billion by 2018. Also, some Senate Democrats are warning that a provision in the health law could undermine farmers’ ability to obtain health insurance and some consumer advocates are warning that a tax rule needs to be re-written.
CQ HealthBeat: Republican Senators Want To Kill Health Care Law Insurance Fee
Two Republican senators have joined the battle against the health care overhaul law’s annual fee on insurers, a provision of the measure that the White House will likely fight hard to retain. John Barrasso of Wyoming and Orin G. Hatch of Utah have introduced a bill to repeal the fee, expected to raise $8 billion in 2014 and $14.3 billion by 2018. In remarks on the Senate floor on Wednesday, Hatch said the fee, which insurers and GOP lawmakers call a tax, “is going to hurt employers and employees. It is
Category: Health Insurance |
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cmonfils | November 30, 2011
A Towers Watson survey found that the percentage of employer-sponsored policies that impose lifestyle-related financial penalities have doubled in the last two years.
The New York Times: The Smokers’ Surcharge
More and more employers are demanding that workers who smoke, are overweight or have high cholesterol shoulder a greater share of their health care costs, a shift toward penalizing employees with unhealthy lifestyles rather than rewarding good habits. … In addition, another survey released on Wednesday by Mercer, which advises companies, showed that about a third of employers with 500 or more workers were trying to coax them into wellness programs by offering financial incentives, like discounts on their insurance (Abelson, 11/16).
Category: Health Insurance |
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cmonfils | November 30, 2011
Opponents of the Affordable Care Act who believe the Supreme Court will declare the law unconstitutional are going to be disappointed next year when a majority of the nine justices vote to uphold it. It will likely be a 5-4 decision, but moderate conservative Anthony Kennedy will, I’m confident, recognize that without the law, the free-market system of health insurance, so highly valued by conservatives, will implode, sooner rather than later.
The high court announced earlier this week that it will hear oral arguments on the constitutionality of the law next March. A decision is expected in June, just a few weeks before the parties hold their conventions. Regardless of which way the justices go, the decision will ensure that health care reform will be as contentious a campaign issue as it was in 2008.
Category: Health Care Legislation, Supreme Court |
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cmonfils | November 30, 2011
Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of the market reform provisions of the Affordable Care Act, as well as FAQs regarding implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). These FAQs have been prepared jointly by the Departments of Health and Human Services (HHS), Labor and the Treasury (the Departments). Like previously issued FAQs (available at www.dol.gov/ebsa/healthreform/), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.
The Departments anticipate issuing further responses to questions and issuing other guidance in the future. We hope these publications will provide additional clarity and assistance.
Category: Health Care Legislation, Health Insurance, Mental Health Parity |
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