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August 2017 Newsletter

McCain Votes No, Derails ‘Skinny Repeal’ In Marathon Session

Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

The entire article can be read at: http://khn.org/news/mccain-votes-no-derails-skinny-repeal-in-marathon-session/

Currently, the regulations of the Affordable Care Act will remain in force.

Do You Speak "Repeal and Replace"?

President Donald Trump and many congressional Republicans campaigned on repealing the Affordable Care Act and replacing it with their own plan to overhaul the nation’s health care system. As the GOP develops its offering, its representatives are tossing around wonky health policy terms to describe their core strategies. Below you’ll find some brief definitions.

MEDICAID BLOCK GRANTS AND PERCAPITA CAPS: The federal government gives states a set amount of money to pay for coverage for Medicaid recipients. This would be a shift from the current Medicaid program, where the federal government matches state Medicaid spending on a percentage basis.

HEALTH SAVINGS ACCOUNTS: Also known as HSAs, these allow consumers to put money away on a tax-free basis as long as they use it for medical expenses.

BUDGET RECONCILIATION: Legislative process that allows measures to pass with a simple majority in Congress. Budget reconciliation bills can’t be filibustered but must focus on provisions that have a budgetary impact.

ESSENTIAL HEALTH BENEFITS: ACA mandated categories of benefits that health plans must cover. They include emergency services, hospitalization and maternity care.

INDIVIDUAL MARKET: Where people who do not have health coverage through the government or their employer purchase a plan directly from an insurer. It is sometimes called the nongroup market.

TAX CREDITS/SUBSIDIES: Financial assistance to help consumers purchase health insurance.

HIGHRISK POOLS: Insurance groups that cover individuals with high health insurance costs, such as people who have a past serious illness or a chronic condition.

Kaiser Health News, March 17, 2017 http://khn.org/news/do-you-speak-repeal-and-replace/Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Recent Mental Health Parity Guidance:

A Good Reminder To Review Your Health Plan For Compliancemental-health-parity1.png

The Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA") generally requires that the financial requirements and treatment limitations that apply to mental health and substance use disorder ("MH/SUD") benefits cannot be more restrictive than the financial requirements and treatment limitations that apply to medical and surgical ("M/S") benefits. Financial requirements include, for example, deductibles and coinsurance.

Treatment limitations can be:

  • quantitative (e.g., limits on the number of days or visits covered under the plan) or
  • nonquantitative ("NQTL") (e.g., requiring participants to obtain prior authorization before treatment).

The MHPAEA and its implementing regulations also require plan administrators to provide various disclosures upon request regarding MH/SUD benefits. For example, a plan must provide: (1) criteria for medical necessity determinations made with respect to MH/SUD benefits to current or potential participants, beneficiaries, or contracting providers, (2) the reason for any denial under a group health plan of reimbursement or payment for services with respect to MH/SUD benefits to participants or beneficiaries, and (3) information about the processes, strategies, evidentiary standards, and other factors used to apply a NQTL with respect to M/S benefits and MH/SUD benefits under the plan to participants.

Recently, the Centers of Medicare and Medicaid Services (CMS) issued FAQ 38 clarified, consistent with the Cures Act, that eating disorders are a mental health condition, and therefore treatment of an eating disorder is a "mental health benefit" under MHPAEA.

In response, on June 16, 2017, the Departments released ACA Implementation FAQs Part 38, a Paperwork Reduction Act Notice, and a Draft Model Form, and solicited comments. The model form could be used by participants, enrollees, or their authorized representatives, to request relevant MHPAEA disclosures. FAQs Part 38 also clarified, consistent with the Cures Act, that eating disorders are a mental health condition and therefore treatment of an eating disorder is a "mental health benefit" under the MHPAEA.

International Foundation of Employee Benefits (IFEB), Today's Headlines, Mondaq Business Briefing, July 18, 2017 author: Ms Allison B. Bans, Snell ; Wilmer L.L.P. https://www.ifebp.org


Disability Insurance: The Ugly Duckling Syndrome

The definition of an Ugly Duckling is something that is unattractive or awkward now, but develops into something attractive and successful in the future. Disability benefits fit the bill.  When weighing the employee benefits package of a new job, candidates definitely consider the health care benefits, probably read over the retirement plan and will no doubt investigate the number of vacation days—But few new hires take time to consider the disability benefits offered.

Disability benefits aren’t on most employees’ radar. Most assume they will never have to use disability benefits, but the reality is that one in four 20-year olds will become disabled before reaching retirement age. The International Foundation of Employee Benefits (IFEB) recently released its Employee Benefits Survey, and found that disability benefits remain a steady inclusion in employer benefit packages, whether employees are aware of the benefit or not.

One in four 20-year olds will become disabled before reaching retirement age.

Employers offer disability benefits to help employees through unforeseen illnesses or accidents that would prevent an employee from working. The benefit allows employees to continue to receive a paycheck, while focusing fully on their recovery.

Short-Term Disability (STD)- provides protection from loss of income for illnesses or accidents that are not work-related and typically keep an employee out of the workforce for a short period of time. and is offered by 78% of the employers in the survey.

Long-Term Disability (LTD)-provides protection from loss of income due to illness, injury or accidents that prevent the employee from working for an extended period of time, and is offered by 63% of the employers in the survey.

Don’t let your disability benefits continue on as the ugly duckling of employee benefits—ignored by employees for the flashier, more immediate benefits and perks. If your organization offers short- or long-term disability, educate your employees on the benefit. It’s a great way to illustrate the value of your overall benefits package, and it can
build loyalty and peace of mind among your workforce.

International Foundation of Employee Benefits (IFEB) Disability Benefits: An Overlooked Piece of the Employee Benefits Package, Brenda Hofmann July 20, 2017



Employer Pulse Check: The Future of ACA

The International Foundation of Employee Benefit Plans (IFEB) published a survey in July, 2017 regarding how employers viewed the future of the ACA.  This was done before the Senate failed to pass the “Skinny Repeal” on July 28, 2017. 

Survey responses for the Employer Pulse Check were received from 727 human resources/benefits professionals and trustees representing all sectors: public employers, corporate/single employers and multiemployer plans. The surveyed organizations represent a wide base of U.S. employers from nearly 20 different industries and range in size from fewer than 50 to more than 10,000 workers. Respondents answered survey questions from the perspective of their roles as plan sponsors/fiduciaries.

Latest News in Employee Benefits

Kaiser Health News
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Innovative CareMaps tool helps caregivers understand their roles and take steps to improve their lives.
Sep 21, 2017
A shift in dental guidelines encourages first dental visits for infants as young as 6 months, or when the first baby teeth emerge. That makes some dentists uncomfortable.
Sep 20, 2017
In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times discuss Senate Republicans’ last-ditch effort to upend the Affordable Care Act ahead of a Sept. 30 deadline.
Benefits News
When developing a plan to offset the potential shortfall of Social Security benefits in the long term, annual rebalancing is one step clients should take.
Iowa’s proposed plan could spiral into a ‘Medicaid for all’ scenario fairly quickly, says adviser Craig Hasday.

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