CMS Cites Cost Effectiveness of 2018 Obamacare Open Enrollment

The Centers for Medicare and Medicaid Services (CMS) has released its final report on the 2018 open enrollment period for Affordable Care Act (ACA, or Obamacare) policies, touting the cost effectiveness of the new approach.

obamacare-enrollment-reaches-3.6-millionIn 2017, CMS spent $100 million in advertising and promotion for open enrollment, coming out to $11 per enrollee; in 2018, it spent $10 million, or just $1 per enrollee. The agency said it adjusted its budget this year to match that of Medicare promotion.

An estimated 11.8 million consumers enrolled in Affordable Care Act plans for 2018, compared to 12.2 million in 2017 and 12.7 million in 2016, when the numbers were at an all-time high.

Here are the details from the report:

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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HHS Releases Guide on Obtaining One’s Health Records

The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today released the ONC Guide to Getting and Using your Health Records, a new online resource for individuals, patients, and caregivers.

hhs-publishes-guide-to-health-recordsThis new resource supports both the 21st Century Cures Act goal of empowering patients and improving patients’ access to their electronic health information and the recently announced MyHealthEData initiative. The new initiative, led by the White House Office of American Innovation and supported by ONC, empowers patients by giving them control of their healthcare information.  Other participants in the effort include the Centers for Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), and the Department of Veterans Affairs (VA).

“It’s important that patients and their caregivers have access to their own health information so they can make decisions about their care and treatments,” said Don Rucker, M.D., national coordinator for health information technology. “This guide will help answer some of the questions that patients may have when asking for their health information.”

Individuals’ ability to access and use their health information electronically is a measure of interoperability and a cornerstone of ONC’s efforts to increase patient engagement, improve health outcomes, and advance person-centered health.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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OCR Chief to Seek Changes to HIPAA Privacy Rule and Breach Enforcement

Roger Severino, director of the Office for Civil Rights (OCR) with enforcement powers over the HIPAA Privacy Rule and breach enforcement, announced he is looking to make some changes to both and will issue Notices of Proposed Rulemaking (NPRMs) and Requests for Information (RFIs) before proceeding.

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OCR Director Roger Severino

Specifically, he told a HIPAA meeting in Arlington, Va., on March 27 that he would:

  • Issue a Request for Information regarding sharing some of the proceeds from data breach violations with the victims themselves
  • Issue a Notice of Proposed Rulemaking to suggest dropping the requirement that health care providers issue and patients sign notices of HIPAA privacy practices
  • Issue another NPRM so health care providers can act in “good faith” and disclose private health information, under certain circumstances as when the patient is incapacitated, to the patient’s family

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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PAID Wage Resolution Program Launches

With little fanfare (i.e., no announcement on its website), the Department of Labor (DOL) has launched its Payroll Audit Independent Determination (PAID) program, a voluntary initiative where companies can seek assistance in resolving wage-and-hour issues including back pay and overtime.

DOL-launches-voluntary-FLSA-violation-reporting-programPolitico, the online magazine, claims a DOL spokesperson confirmed that PAID is launching today, April 3, and in accordance with the original announcement about the program, will then run for six months for evaluation.

PAID allows employers without prior violations to self-report suspected wage-and-hour violations and then resolve them without penalty, provided the businesses vow to remain in full compliance with the Fair Labor Standards Act (FLSA) going forward.

DOL Secretary Alexander Acosta told Congress, when announcing the program, “If an employer currently sees that they made a mistake, right now there is little incentive for them to come forward.”

Liberal critics claim it is nothing more than a get-out-of-jail-free card for transgressing employers.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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SCOTUS Rejects Obama DOL Overtime Interpretation

In a win for auto dealerships, the Supreme Court has ruled 5-4 that “service advisers” — those individuals who advise customers on which type of servicing or repair is needed on their car — are exempt from overtime.

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The U.S. Supreme Court building, completed in 1935.

The Department of Labor (DOL) in 2011 ruled that they are overtime eligible, even though the Fair Labor Standards Act (FLSA) clearly excludes from overtime “any salesman, partsman or mechanic” who is “primarily engaged in selling or servicing automobiles.”

Today’s ruling hinged on the word or — “selling or servicing” rather than “selling and servicing.”

“[T]he use of ‘or’ to join ‘selling’ and ‘servicing’ suggests that the exemption covers a salesman primarily engaged in either activity,” Justice Clarence Thomas wrote for the majority in the case, Encino Motorcars v. Navarro.

Thomas was joined by Chief Justice John Roberts and Justices Anthony Kennedy, Samuel Alito and Neil Gorsuch, the most-of-the-time conservative wing of the court.

The liberals disagreed. “Because service advisers neither sell nor repair automobiles, they should remain outside the exemption and within the act’s coverage,” Justice Ruth Bader Ginsburg wrote in an opinion joined by Justices Elena Kagan, Sonia Sotomayor and Stephen Breyer.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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New Rule on Disability Benefit Claims Goes into Effect Today

Following a 90-day delay to solicit comments, today (April 1, 2018) is the applicability date for employee benefit plans to comply with a final rule under the Employee Retirement Income Security Act (ERISA) that will give America’s workers new procedural protections when dealing with plan fiduciaries and insurance providers who deny their claims for disability benefits.

new-rule-on-disability-claims-takes-effectThe new rule ensures, for example, that disability claimants receive a clear explanation of why their claim was denied as well as their rights to appeal a denial of a benefit claim, and to review and respond to new information developed by the plan during the course of an appeal. The rule also requires that a claims adjudicator could not be hired, promoted, terminated, or compensated based on the likelihood of denying claims.

During the 90-day delay, The Department of Labor (DOL) received approximately 200 comment letters from the insurance industry, employer groups, consumer advocates, and lawyers representing disability benefit claimants, all of which are posted on the department’s website.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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New Law: Must Work for Food Stamps in West Virginia

First it was Medicaid, and now it’s food stamps, at least in West Virginia.

West-Virginia-you-must-work-for-food-stamps-SNAPWith no fanfare or public announcement, that state’s governor, Jim Justice, just signed a measure requiring able-bodied adults, 18-49 who are without dependents, to work, volunteer or participate in workforce training programs for 20 hours per week to receive benefits through the Supplemental Nutrition Assistance Program (SNAP). The requirement kicks in Oct. 1.

Under guidance announced by the Trump administration, other states — notably Kentucky and Indiana — are likewise now requiring the able-bodied to work, volunteer or be trained for work to participate in the Medicaid program.

What the West Virginia legislation actually does is restrict and eventually rescind the state’s ability to issue waivers from the federal work requirement for SNAP, which are traditionally handled by the state Department of Health and Human Resources (DHHR). However, exceptions abound based on the unemployment rate in each county. Even with the exceptions, though, waivers will cease entirely on Oct. 1, 2022.

SNAP was created in 2008 as a replacement for what was originally the Food Stamp Program (FSP), as recounted by the U.S. Department of Agriculture (USDA) in its “Short History of SNAP“: (more…)


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Iowa to Launch Association Health Plans: Will Others Follow?

A bill has landed on Iowa Gov. Kim Reynolds’s desk that will enable small businesses to band together to form association health plans that are exempt from the requirements of the Affordable Care Act (ACA). She is expected to sign it.

iowa-to-offer-association-health-plansThe bill merges two legislative efforts to sidetrack the ACA and provide less expensive health plans to Iowans. One is generic in that it allows small businesses and civic groups to form associations to create insurance plans that fall outside the normal regulatory process. The other effort is to allow the Iowa Farm Bureau Federation to create an association health plan with Wellmark Blue Cross & Blue Shield.

Because the plans fall outside the reach of the ACA, they don’t have to insure people with pre-existing conditions, and if they do, they can charge vastly more for the coverage. Maternity, substance abuse and hospitalization may also be excluded from the plans.

“I can tell you that actually, this is how it was before the Affordable Care Act,” said Sen. Mark Chelgren, R.-Ottumwa. “So we have tried this before. This is how the system worked. In the past, we gave choice to Iowans.”

Supporters predict the new plans could cover up to 30,000 Iowans currently without insurance. However, the only insurer in the state to offer plans on the ACA exchange, Medica, says it may file a lawsuit to stop the process, fearful that the plans will dry up its pool of healthy people and leave only the oldest and sickest on its rolls.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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‘Death by Overwork’ Continues to Plague Japan

Drones flying through the office blaring music to force employees to leave work; workers being forced to don purple “shame capes” for working late — such are the latest strategies in Japan’s continuing struggle against karoshi, or “death by overwork.”

japan-faces-crisis-of-death-by-overtime

The City of Tokyo.

That nation’s Labor Standards Act allows employers to set their own standards for overtime, meaning most of the work is “off the clock” and uncompensated. Also, the Japanese culture prides itself on a work ethic that equates to long hours on the job, whatever and wherever it may be.

This work ethic has its roots in struggling postwar Japan, when Prime Minister Shigeru Yoshida arm twisted major companies into promising lifelong employment in return for “worker loyalty.” (Such loyalty led a European Economic Community director in the 1970s to dub the Japanese “workaholics who live in rabbit hutches.”)

Two recent cases of karoshi have gotten the attention of Prime Minister Shinzo Abe, who has promised a skeptical nation that he’ll come up with “work balance” laws to prevent further tragedies.

In 2013, NHK television journalist Miwa Sado, 31, logged 159 hours of overtime in one month, then collapsed and died of heart failure in July. In 2015, a 24-year-old employee of advertising giant Dentsu put in 100 hours of overtime one month before jumping to her death from her balcony — in her company dormitory!

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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DOL Touts Benefits from Federal Budget Reconciliation Measure

The $1.3 trillion federal budget (good till the end of the fiscal year on Sept. 30), signed by President Trump on March 23, includes targeted spending for the Department of Labor (DOL).

Key Provisions in Omnibus Appropriations Bill:

Apprenticeships:

dol-announces-funding-for-fy-2018Apprenticeship is a proven workforce development strategy that helps Americans both earn wages and learn skills. The omnibus appropriations bill includes a 53 percent increase above the Fiscal Year 2017 funding level for apprenticeship programs that will help to expand opportunities for family sustaining jobs.

Office of Labor Management Standards:

The omnibus appropriations bill includes a 5.2 percent increase in funding for the Department of Labor’s Office of Labor Management Standards, which promotes democratic rights of rank-and-file labor union members and labor-management transparency through reporting and disclosure requirements for labor unions and their officials, employers, and labor relations consultants. (more…)


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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