Benefits Update - September 2010

From the editors of CCH's BENE and BAN products, here are hot topics from recent Employee Benefits Management Directions newsletters as well as recent explanatory updates in Employee Benefits Management. Also included are recent explanatory updates to the Benefits Answers Now product.

If you have any comments/suggestions concerning the information provided or the format used, we'd like to hear from you. Please contact me at Tulay.Turan@wolterskluwer.com.

Attorney answers questions on current status of lawsuits against government under health care reform, Employee Benefits Management Directions newsletter, Issue No. 473, August 10, 2010 – The glut of state lawsuits over health care reform can leave some employers wondering what effect the Patient Protection and Affordable Care Act (PPACA) will have on their health care plans and on their employees. CCH, a Wolters Kluwer business, discussed some of these concerns with Jonathan W. Emord, principle of Emord and Associates. Mr. Emord is currently involved in litigation in the Northern District of Ohio, Eastern Division, challenging the constitutionality of the PPACA (U.S. Citizens Association, et al. v. Barack H. Obama, et al.).

Guidelines issued by IRS, EBSA, HHS, for internal, external claims review, Employee Benefits Management Directions newsletter, Issue No. 473, August 10, 2010 – Interim final regulations implementing new requirements for internal claims procedures and appeals, including a 24-hour notice requirement for benefit determinations, have been issued jointly by the IRS, the EBSA, and the Department of Health and Human Services’ Office of Consumer Information and Insurance Oversight (OCIIO).

HHS provides relief for incomplete applications to the Early Retiree Reinsurance Program, Employee Benefits Management Directions newsletter, Issue No. 474, August 24, 2010 – The Department of Health and Human Services has provided additional guidance regarding the application for the Early Retiree Reinsurance Program (ERRP) to help the sponsors who submitted incorrect or incomplete applications.

Nine out of ten U.S. companies anticipate losing grandfather status under health care reform, Hewitt says, Employee Benefits Management Directions newsletter, Issue No. 474, August 24, 2010 – While many U.S. companies initially hoped they could preserve much of their existing group health plans under the new grandfather provision, a new survey by Hewitt Associates shows that almost all now believe they will not.

Claims appeals regulations – The PPACA-related claims appeals regulations are discussed at ¶10,425.

Nursing breaks – The DOL has issued a fact sheet providing general information on break time requirements that employers must provide to employees who are nursing mothers. Break time requirements are set forth in the Patient Protection and Affordable Care Act, which amended Section 7 of the FLSA. The DOL guidance is discussed at ¶50,035.

HIPAA proposed regulations – Proposed regulations regarding the privacy of health information are discussed at ¶10,085 and ¶10,095.

State laws – Various state laws have been updated at ¶10,760.

HIPAA nondiscrimination rules – The nondiscrimination rules regarding health status-related factors have been updated to reflect the Patient Protection and Affordable Care Act (PPACA) at ¶10,075.

PBGC proposed regulations – The PBGC has issued proposed rules for changing ERISA Reg. §4062, regarding when a plan sponsor ceases operations at a facility. The regulations are at ¶560,112.

Guidelines issued by IRS, EBSA, HHS, for internal, external claims review. Interim final regulations implementing new requirements for internal claims procedures and appeals, including a 24-hour notice requirement for benefit determinations, have been issued jointly by the IRS, the EBSA, and the Department of Health and Human Services' Office of Consumer Information and Insurance Oversight (OCIIO). The rules implement the claims appeals requirements in the Patient Protection and Affordable Care Act. More information about the internal and external claims review requirements can be found at ¶20,057.

PBGC proposes clarifications involving cessation of operations at a facility. The Pension Benefit Guaranty Corporation has issued proposed rules regarding when a plan sponsor ceases operations at a facility. The changes are being proposed in order to "reduce uncertainty about PBGC's interpretation of the statute, thereby permitting more rapid resolution of cases." See the discussion at ¶14,600 for more information about these PBGC requirements.

PPACA will have impact on cancer prevention. The Patient Protection and Affordable Care Act (PPACA) contains provisions that are a step forward in the fight against cancer, according to Dan Smith, the Majority Staff Director of the U.S. Senate Committee on Health, Education, Labor and Pensions. Find out more about how the PPACA impacts cancer prevention at ¶23,140.

Nine out of ten U.S. companies anticipate losing grandfather status under health care reform. While many U.S. companies initially hoped they could preserve much of their existing group health plans under the new grandfather provision, a new survey by Hewitt Associates shows that almost all now believe they will not. Ninety percent of companies said they anticipate losing grandfathered status by 2014, with the majority expecting to do so in the next two years. To find out more about employer’s expectations about their grandfathered status, see ¶20,053.

DOL issues clarification of break time requirements for nursing mothers. The U.S. Labor Department's Wage and Hour Division has issued a fact sheet providing general information on break time requirements that employers must provide to employees who are nursing mothers. Break time requirements are set forth in the Patient Protection and Affordable Care Act, which amended the Fair Labor Standards Act (FLSA). To learn more about these break time requirements, see the discussion at ¶73,930.