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Business Associate Agreements May Require Amendment

The Omnibus Final Rule (the "Omnibus Rule") under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), was issued in January, 2013 effective March 26, 2013, but with a general compliance deadline of September 23, 2013. Compliance with the Omnibus Rule required changes to many HIPAA compliance practices and related documents, including business associate agreements, the HIPAA notice of privacy practices and breach assessment policies and procedures.

IRS Releases Draft ACA Reporting Form Instructions

On August 28, the Internal Revenue Service (IRS) released draft instructions for completing health insurance reporting forms required under the Affordable Care Act (ACA). The release of the instructions comes a month after the IRS released the draft forms employers and insurers must use to report information regarding health care coverage.

Happy 40th Birthday, ERISA!

Today, ERISA turns 40! It is hard to believe that the Employee Retirement Income Security Act (ERISA), the law that ignited pension reform in the United States, has been around for four decades. To celebrate the law’s long, lively journey since its birth on Labor Day 1974, we have compiled some employee benefits trivia that may surprise even the most ardent ERISA-watchers (and you know who you are!).

Monthly Benefits Update - August 2014

On August 8, President Obama signed legislation that extends certain “pension smoothing” provisions in the Moving Ahead for Progress in the 21st Century (MAP-21) Act that was signed in 2012. This pension funding relief will continue to allow plan sponsors to make lower contributions to their single-employer defined benefit plans in upcoming years by delaying the phase out of MAP-21 until 2017.

Agencies Issue New Regulations Governing ACAs Contraception Mandate

On August 27, 2014, new interim final regulations were published by several administrative agencies entitled "Coverage of Certain Preventive Services Under the Affordable Care Act." On the same day, the agencies released a Notice of Proposed Rulemaking with the same title. As we have previously written, the Patient Protection and Affordable Care Act (ACA) imposes insurance coverage obligations on both non-profit and for-profit religious organizations. These coverage mandates have been the subject of extensive litigation.

DOJ Demonstrates Continued Focus on FCA Claims against Healthcare Entities

In 2009, Attorney General Eric Holder and Former U.S. Department of Health and Human Services Secretary Kathleen Sebelius created an interagency task force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to increase coordination and optimize criminal and civil enforcement. According to the U.S. Department of Justice, the task force yielded historic results resulting in the recovery of $12.1 billion from January 2009 through September 2013. Of that amount, the DOJ claims it recovered more than $2 billion each year for healthcare fraud, reaching $2.6 billion in 2013. In 2014, this trend has continued with two Florida hospitals settling FCA claims with the DOJ last spring for $85 million and $7 million and another two healthcare entities recently settling with the DOJ for $2.2 million and $35 million.

Resistance WAS Futile—California Conforms to ACA Waiting Period Requirement

After wandering in the wilderness for a year, California has now come in from the cold and conformed its requirements for eligibility waiting periods to the federal standard adopted in the Affordable Care Act (ACA). Effective January 1, 2015, SB 1034 imposes a 90-day limit on eligibility waiting periods for insured health benefits issued by insurers subject to regulation by the California Department of Insurance and/or the California Department of Managed Health Care.

Need Help Finding Your Plan's Missing Participants?

The Department of Labor (DOL) recently issued a new Field Assistance Bulletin (FAB 2014-01) that provides guidance regarding the steps a plan administrator should take to fulfill his or her fiduciary duty to locate and distribute account balances to missing participants in terminated defined contribution plans. FAB 2014-01 replaces the 10-year-old Field Assistance Bulletin 2004-02 (FAB 2004-02). Since FAB 2004-02, many changes have occurred that warranted updated guidance. These changes include the discontinuance of the letter-forwarding services by the Internal Revenue Service (IRS) and the Social Security Administration, and the expansion in internet search technologies.

Federal Contractors See Hike in SCA Health & Welfare Rates

Executive Summary: On July 22, 2014, the U.S. Department of Labor (DOL) issued its annual memorandum announcing that, pursuant to 29 C.F.R. Section 4.52, the prevailing hourly health and welfare fringe benefit rates under the McNamara-O'Hara Service Contract Act (SCA) were increasing from $3.81 per hour to $4.02 per hour. The increase took effect immediately, and the new rate is posted on the DOL's Wage Determinations ( and Wage and Hour Division ( websites. A special reduced rate of $1.66 per hour will apply to Hawaii because, under state law, most Hawaii employers are already obligated to provide their employees with health insurance. The new benefit rate was derived from the latest Bureau of Labor Statistics Employment Cost Index, summary of Employer Cost for Employee Compensation.

Health Care Reform: Employers Should Prepare Now for 2015 to Avoid Penalties

Under the Patient Protection and Affordable Care Act, beginning in 2015, certain large employers who do not offer affordable health insurance that provides minimum value to their full-time employees may be subject to significant penalties. These penalties are explained below.