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Proposed Regulations Implementing 90-Day Waiting Period Limitation under PPACA

The federal Departments of Health and Human Services, Treasury, and Labor (collectively, the ?Ç£Departments?Ç¥) recently issued proposed regulations (the ?Ç£Proposed Regulations?Ç¥) implementing the 90-day waiting period limitation (the ?Ç£90-Day Limit?Ç¥) under the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥) and also proposing amendments to existing portability regulations under the Health Insurance Portability and Accountability Act of 1996 (the ?Ç£HIPAA Regulations?Ç¥) to conform those regulations to PPACA?ÇÖs requirements.?á PPACA provides that, effective for plan years beginning on or after January 1, 2014, grandfathered and non-grandfathered group health plans (both insured and self-funded) and health insurance issuers are prohibited from applying a waiting period for coverage that exceeds the 90-Day Limit.?á The definition of ?Ç£waiting period,?Ç¥ as currently in effect under the HIPAA Regulations and adopted by the Proposed Regulations, is the timeframe imposed by a plan or insurance policy that must pass before coverage for an eligible employee or dependent becomes… Continue Reading

Temporary Standards for State-Administered External Review Processes under PPACA Extended until 2016

The Departments recently issued Technical Release 2013-01, which extended transitional relief that was set to expire on January 1, 2014, permitting the use of temporary standards for state-administered external review processes required under PPACA.?á Until January 1, 2016, the Departments will consider non-grandfathered group health plans and health insurance issuers, in both the group and individual markets, to be compliant with PPACA?ÇÖs state external review process standards, even if the external review process does not include all of the consumer protection standards required by PPACA, if the plans or issuers comply with a state-administered external review process that otherwise complies with the temporary standards established in Technical Release No. 2011-02. Technical Release 2013-01 can be found here. Technical Release 2011-02 can be found here.

DOL Releases Guidance on MAP-21 Required Annual Disclosures

The U.S. Department of Labor (?Ç£DOL?Ç¥) recently released Field Assistance Bulletin No. 2013-01 (the ?Ç£FAB?Ç¥) addressing supplements to the annual funding notices for single-employer defined benefit plans required as a result of the Moving Ahead for Progress in the 21st Century Act (?Ç£MAP-21?Ç¥). ?áThe MAP-21 supplemental notice explains to participants how MAP-21 changed the way their pension plans may calculate plan liabilities.?á The FAB contains a model supplement that plan administrators may attach to the front of the model annual funding notice provided in Field Assistance Bulletin 2009-01.?á The FAB also contains a series of Q&As describing the plans for which the additional MAP-21 disclosures are required, the information required to be set forth in the additional disclosures, and the years in which the additional disclosures are required and no longer required. The FAB can be found here.

Technical Fact Sheet on HHS Notice of Benefit and Payment Parameters for 2014

On March 12, the Centers for Medicare and Medicaid Services released a Technical Fact Sheet summarizing provisions of the Notice of Benefit and Payment Parameters final rule (the ?Ç£Payment Rule?Ç¥) recently issued by the Department of Health and Human Services (?Ç£HHS?Ç¥). Among other things, the Payment Rule (1) expanded on standards defined in prior rules regarding certain risk-shifting programs under PPACA and (2) set standards and provided additional information regarding PPACA?ÇÖs medical loss ratios.?á See our previous blog post on the Payment Rule, available?áhere.?á A copy of the Technical Fact Sheet is available here

FAQ Regarding Expatriate Health Plans under PPACA

In an FAQ released jointly by the Departments of Labor, Treasury, and Health and Human Services (collectively, the ?Ç£Departments?Ç¥), expatriate health plans are granted temporary transitional relief from compliance with the requirements of subtitles A and C of Title I of the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥), including the group health mandates and market reforms such as coverage of preventive care and the restrictions on lifetime and annual limits, for plan years ending on or before December 31, 2015.?á For purposes of this transitional relief, an ?Ç£expatriate health plan?Ç¥ is an insured group health plan with respect to which enrollment is limited to primary-insured individuals who reside outside of their home country for at least six months of the plan year and any covered dependents of such expatriates.?á In order to qualify for the transitional relief, expatriate health plans must comply with the pre-PPACA version of Title XXVII… Continue Reading

State Court Order to Turn Over ERISA Plan Benefits Not Preempted by ERISA

A participant in two employer-sponsored ERISA plans divorced her husband. ?áIn the marital settlement agreement, her husband waived his interest and future rights in the plans. ?áThe participant neglected to update the plans?ÇÖ beneficiary designation forms.?á They still designated her ex-husband as beneficiary when she died.?á The plan administrators for each plan initially determined that her benefit under the plans should be paid to the ex-husband. ?áThe participant?ÇÖs parents, as administrators of her estate, appealed the decisions.?á After the claims appeal process, the ex-husband filed for declaratory relief in federal district court, which stayed its decision pending the outcome of the estate?ÇÖs state court suit. ?áThe state court found the ex-husband in contempt of the marital settlement agreement and ordered him to waive his interest in the benefits.?á The federal district court then ordered the plan administrators to pay the funds to the ex-husband and the ex-husband to then waive… Continue Reading

DOL Issues Final Rules on Multiple Employer Welfare Arrangements

The U.S. Department of Labor (?Ç£DOL?Ç¥) recently released final rules intended to curb abuses of some multiple employer welfare arrangements (?Ç£MEWAs?Ç¥) by imposing additional reporting requirements on MEWAs and by enhancing DOL?ÇÖs enforcement authority. ?áUnder the final rules, all MEWAs that provide medical benefits, even if not a group health plan, must electronically file a Form M-1 annually, which now requires more extensive financial information than the prior version.?á Additionally, all employee welfare plans that file a Form M-1 must also file a Form 5500, even if the plan would otherwise be exempt, to demonstrate the plan?ÇÖs compliance with the Form M-1 filing requirement.?á Failure to answer the Form M-1 compliance question will cause the Form 5500 to be rejected as incomplete, which may subject the filer to civil penalties.?á The deadline for filing this year?ÇÖs Form M-1 has been extended to May 1, 2013.?á The final rules also enhance… Continue Reading

HHS Final Rule Regarding Notice of Benefit and Payment Parameters for 2014

The U.S. Department of Health and Human Services (?Ç£HHS?Ç¥) recently issued the Notice of Benefit and Payment Parameters, a final rule which (1) expands on standards defined in prior rules regarding the permanent risk adjustment, transitional reinsurance, and temporary risk corridors programs under the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥) (collectively, the ?Ç£Risk Programs?Ç¥) and (2) sets out payment parameters for the Risk Programs. The Risk Programs become effective in 2014 and are intended to reduce the incentives for health insurance issuers to avoid enrolling higher-risk individuals, such as those with pre-existing medical conditions, by transferring funds from insurers with lower-risk enrollees to insurers who cover higher-risk populations. Notably for group health plan sponsors, this final rule (i) confirms which types of health insurance coverage and self-funded health plans are excluded from making contributions under the transitional reinsurance program (the ?Ç£TRP?Ç¥) (which is effective only for 2014, 2015, and… Continue Reading

State Supreme Court Decision Offers First Amendment Guidance for Attorney-Bloggers

A February 28, 2013 decision issued by the Virginia Supreme Court, which arose out of a disciplinary action instituted by the Virginia State Bar, contains a groundbreaking discussion of the application of First Amendment protections to attorney-generated blogs. Horace Hunter, an attorney with the Richmond firm Hunter & Lipton, authors the blog in question, ?Ç£This Week in Richmond Criminal Defense.?Ç¥ At the time of the state bar?ÇÖs disciplinary hearing, the blog included 30 posts written by Hunter, 25 of which discussed cases and were scrutinized in this matter.?á Of the 25 posts: 22 discussed cases in which Hunter represented either a criminal defendant or a plaintiff in a wrongful death action. Hunter referred to his law firm in 19 posts. Most posts relayed some measure of victory for Hunter and his firm. No post contained a disclaimer stating that the results discussed did not guarantee or predict similar results in… Continue Reading

Second Circuit Reaffirms that Moench Presumption Applies Only When Plan Terms Require Investment in Employer Stock

The U.S. Court of Appeals for the Second Circuit affirmed, in part, and vacated, in part, a fiduciary breach lawsuit against the investment committees of two eligible individual account plans. Participants sued the investment committees claiming that the decision to offer an employer stock fund was imprudent. The Second Circuit recognizes the Moench presumption?Çöthe presumption of prudence when a plan fiduciary retains employer securities as an investment option as required by the terms of the plan document. Although the district court applied the Moench presumption to both plans, the terms of only one plan required investment in employer stock; the other plan merely permitted investment in employer stock. Thus, with respect to the second plan, the Second Circuit vacated the dismissal and reinstated the claims and the derivative claims against the investment committee. McKevitt v. UBS AG, No. 12-1662 (2d Cir. Feb. 27, 2013).

March 2013