Transitional Reinsurance Deadline Extended To December 5, 2014

November 17, 2014 at 2:46 pm | Posted in CMS, Compliance, Uncategorized | Leave a comment
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This past Friday, CMS extended the deadline for contributing entities to submit their 2014 enrollment counts for the transitional reinsurance program contributions.  The deadline has now been extended until 11:59 p.m. on December 5, 2014.  The January 15, 2015 and November 15, 2015 payment deadlines remain the same.

Click Here for the CMS announcement.

Thousands at Risk of Losing Health Insurance Acquired Through Federal Marketplaces

August 18, 2014 at 10:07 am | Posted in Affordable Care Act, Compliance, Health Insurance Exchanges, Health Insurance Marketplace | Leave a comment
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The Washington Post reported on August 14th that Federal health officials are warning hundreds of thousands of people who have bought health plans through the federal insurance exchange that their coverage will be cut off unless they quickly provide proof that their citizenship or immigration status makes them eligible to be insured through the new marketplace.

The warnings were mailed last week to 310,000 people in the three dozen states that rely on the exchange. The letters give the recipients until Sept. 5th to send copies of green cards, citizenship documents or other information showing that they qualify for the coverage. If they miss the deadline, their coverage will end on Sept. 30th.

This move is the first step the administration has taken to hold consumers accountable when information on their applications conflicts with records on file at federal agencies or is missing altogether.

The action will affect only people with lingering eligibility issues involving their citizenship or immigration status. They are included in about 2 million cases of several kinds of application discrepancies involving people who have obtained coverage through the exchange.

Federal health officials announced that they will take separate action soon to resolve an even larger group of cases with discrepancies: those in which the income people listed on their insurance applications is out of sync with their federal tax records. In cases of unresolved income inconsistencies, the government could reduce — or eliminate — people’s federal insurance subsidies but could not end their coverage.

EEOC Issues Employee Pregnancy Discrimination Guidance

July 15, 2014 at 2:28 pm | Posted in Affordable Care Act, Americans with Disabilities Act, Compliance, Employment Law | Leave a comment
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Yesterday the EEOC released comprehensive enforcement guidance on the issue of an employer’s obligations regarding employee pregnancy and discrimination that arises from a past, current or expected future pregnancy. The guidance updates prior EEOC guidance on this subject in light of legal developments over the past thirty years and includes a discussion of:

  • when employer actions may constitute unlawful discrimination on the basis of pregnancy, childbirth, or related medical conditions in violation of Title VII of the Civil Rights Act of 1964 (Title VII), as amended by the Pregnancy Discrimination Act of 1978 (PDA);
  • the obligation of employers under the PDA to provide pregnant workers equal access to benefits of employment such as leave, light duty, and health benefits; and
  • how Title I of the Americans with Disabilities Act (ADA), which went into effect over a decade after the PDA and was amended in 2008 to broaden the definition of disability, applies to individuals with pregnancy-related impairments

In regards to the issue of health insurance, the EEOC addressed the issue in the following FAQS:

Are employers who provide health insurance benefits required to provide insurance that includes coverage of pregnancy, childbirth, or related medical conditions?

Yes. Employers who have health insurance benefit plans must apply the same terms and conditions for pregnancy-related costs as for medical costs unrelated to pregnancy. If the plan covers pre-existing conditions — as all health plans are required to do as of January 1, 2014, under the Patient Protection and Affordable Care Act — then it must cover the costs of an insured employee’s pre-existing pregnancy. If the plan covers a particular percentage of the medical costs incurred for non-pregnancy-related conditions, it must cover the same percentage of recoverable costs for pregnancy-related expenses.

Employers can violate the PDA by providing health insurance that excludes coverage of prescription contraceptives, whether the contraceptives are prescribed for birth control or for medical purposes. To comply with Title VII, an employer’s health insurance plan must cover prescription contraceptives on the same basis as prescription drugs, devices, and services that are used to prevent the occurrence of medical conditions other than pregnancy. For example, if an employer’s health insurance plan covers preventive care for medical conditions other than pregnancy, such as vaccinations, physical examinations, or prescription drugs to prevent high blood pressure or to lower cholesterol levels, then prescription contraceptives also must be covered.

May employers covered by the PDA refuse to provide coverage of prescription contraceptives if they have religious objections to doing so?

In Burwell v. Hobby Lobby Stores, Inc., the Supreme Court recently ruled that the Patient Protection and Affordable Care Act’s contraceptive mandate violated the Religious Freedom Restoration Act (RFRA) as applied to closely held for-profit corporations whose owners had religious objections to providing certain types of contraceptives. EEOC’s Enforcement Guidance explains Title VII’s prohibition of pregnancy discrimination; it does not address whether certain employers might be exempt from Title VII’s requirements under the RFRA or under the Constitution’s First Amendment.

A link to the guidance and EEOC FAQS regarding pregnancy discrimination can be found here:

Enforcement Guidance: Pregnancy Discrimination And Related Issues
Questions and Answers about the EEOC’s Enforcement Guidance on Pregnancy Discrimination and Related Issues

Failure to Secure PHI and Two Stolen Laptops Results in $1,975,220 in HIPAA Violation Fines

April 23, 2014 at 1:25 pm | Posted in Compliance, ePHI, Health and Human Services, HIPAA, Regulations | Leave a comment
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The HHS Office of Civil Rights (OCR) announced that is has levied $1,975,220 in HIPAA fines against Concentra Health Services and QCA Health Plan Inc. for their failure to encrypt PHI stored on two laptops that were stolen.

Both Concentra and QCA, who self reported the stolen laptops, had undergone a HIPAA risk analysis and were aware…but did nothing…to secure the PHI stored on the laptops. The Concentra laptop was stolen from an employee’s office. The QCA laptop was stolen from an employee’s car. Concentra was fined $1,725,220 and QCA was fined $250,000.

“Covered entities and business associates must understand that mobile device security is their obligation,” said Susan McAndrew, OCR’s deputy director of health information privacy. “Our message to these organizations is simple: encryption is your best defense against these incidents.”

A copy of the HHS OCR press release is here:
http://www.hhs.gov/news/press/2014pres/04/20140422b.html

HHS Announces New Round of 2014 HIPAA Compliance Audits: Are You Ready?

March 25, 2014 at 9:18 am | Posted in Compliance, Federal Laws, Health and Human Services, Health Care, HIPAA, Medical, Regulations | Leave a comment
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Last month, the HHS Office of Civil Rights (OCR) announced that there will be a more vigorous HIPAA audit effort in 2014 of HIPAA covered entities, including health plans, and their business associates. Speaking at a February 24th health care technology conference, Susan McAndrew, OCR deputy director for health information privacy said: “Hopefully in coming months you’ll see actual activity that will start up on the audit process.” OCR soon will launch a survey of 1,200 organizations as a first step toward selecting those to be audited. McAndrew also stated that the organizations to be surveyed were selected from “a large database,” and the survey seeks to verify if the entity is a suitable candidate for a HIPAA audit.

In a February 24th notice published in the Federal Register, OCR announced that it will survey “up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program.” According to the notice, the survey “will gather information about respondents to enable OCR to assess the size, complexity and fitness of a respondent for an audit.” An OCR spokesperson says the survey will target approximately 800 covered entities and 400 business associates.

If you have not done so already, at a minimum, a plan sponsor should start to self assess: (1) whether it is a HIPAA covered entity; (2) whether it receives protected health information (PHI); and (3) assuming it receives PHI, has it taken timely and reasonable steps to secure the PHI in a manner consistent with HIPAA’s regulations?

Happy 40th Birthday, ERISA!

March 7, 2014 at 1:00 pm | Posted in Compliance, Department of Labor, ERISA, Federal Laws, Regulations | Leave a comment
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Protections for employee benefits moved forward 40 years ago this week with the March 4, 1974, Senate passage of the Employee Retirement Income Security Act. While it would be nearly six months until President Gerald Ford signed ERISA into law in September of that year, the bill marks congressional recognition of the sanctity of retirement, health care, and other employee benefits. ERISA also calls for the DOL to play the role of chief regulator and enforcer of the new protections. The DOL’s divisions…the Employee Benefits Security Administration…performs that important task.

ACA Exchange Enrollment Hits 4 Million

February 26, 2014 at 2:09 pm | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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HHS announced Tuesday that approximately 4 million Americans have enrolled through the end of January for coverage through the Affordable Care Act Exchanges. A full enrollment report for February will be released in mid-March.

“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Centers for Medicare & Medicaid Services administrator Marilyn Tavenner wrote in a blog post Tuesday. “Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage,” she continued.

Only five weeks remain in the open enrollment period.

Affordable Care Act Update: Final Regulations for 90-Day Waiting Period Released

February 21, 2014 at 11:19 am | Posted in Affordable Care Act, Compliance, Creditable Coverage, Department of Labor, Employment Law, Federal Taxes, Health and Human Services, Health Care, PPACA, Regulations | Leave a comment
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On February 20th, The U.S. Departments of Labor, Treasury, and Health and Human Services published final regulations (85 pages) implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.

To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.

Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The rules also address situations in which it cannot be determined that a new employee will be working full-time.

The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment.

A link to the final rule is here: http://www.dol.gov/opa/media/press/ebsa/20140220-redfeg1.pdf.

HHS Announces 53% Increase in Federal Exchange/Marketplace Enrollment

February 14, 2014 at 9:21 am | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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HHS Secretary Kathleen Sebelius announced on February 12 that enrollment in the Health Insurance Marketplace continued to rise in January, with a 53 percent increase in overall enrollment over the prior three-month reporting period, with young adult enrollment outpacing all other age groups combined.

Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by February 1, 2014 (the end of the fourth reporting period for open enrollment), with January alone accounting for 1.1 million plan selections in state and federal marketplaces. In January, 27 percent of those who selected plans in the Federally-facilitated Marketplace are between the ages of 18 and 34, a three percentage point increase over the figure reported for the previous three-month period. Young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of February 1, while all other age groups combined grew by 55 percent.

A copy of the HHS press release is here: http://www.hhs.gov/news/press/2014pres/02/20140212a.html

 

Employer Pays $25,000 to Settle Employee FMLA Claims Arising Out of Care for the Employee’s Niece

February 7, 2014 at 1:54 pm | Posted in Compliance, Department of Labor, Employment Law, FMLA, Human Resources, Regulations | Leave a comment
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Ohio based DNA Diagnostics Center Inc. has agreed to pay $25,000 in lost wages and liquidated damages to an employee  for unlawfully denying her FMLA leave. The company  fired the employee for exercising her rights under the FMLA to care for her seriously ill 12-year-old niece, for whom the employee was standing “in loco parentis,” or in the place of a parent. Under terms of the settlement agreement, the company must expunge the employee’s record of any disciplinary references. In June 2010, the DOL issued an Administrator Interpretation clarifying the definition of son and daughter under the FMLA includes not only a biological or adopted child, but also a foster child, a stepchild, a legal ward, or a child of a person standing in loco parentis. This definition ensures that an employee who assumes the role of caring for a child receives parental rights to family leave, regardless of the legal or biological relationship.

A copy of the DOL press release is here: http://www.dol.gov/whd/media/press/whdpressVB3.asp?pressdoc=Midwest/20140204.xml

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