Feds release rules on essential health benefits

Law expands mental health, substance abuse benefits

BY KATHRYN MAYER

The Department of Health and Human Services on Wednesday finalized a key health reform rule that most notably expands mental health and substance abuse benefits to 62 million Americans.

The rule, to take effect next January, outlines standards for a core package of benefits—called essential health benefits—that health insurance issuers must cover both inside and outside the health insurance exchanges. Through its standards for essential health benefits, the final rule expands coverage of mental health and substance use disorder services, including behavioral health treatment, for millions of Americans.

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Important Dates to Remember

The following checklist provides insurance agents/brokers, employers and benefits and payroll professionals key upcoming dates and deadlines related to health benefits. This reminder list does not constitute all of the deadlines applicable to employers and some deadlines may be different based on variations in plan year or plan design.

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Tip Tuesday! Employee Wellness: Tips for Healthy Living

Sandy Smith

With busy schedules and lifestyles, keeping the mind, body and soul healthy can be a major challenge. Moen, which manufactures kitchen faucets, bathroom faucets, showerheads and stainless steel sinks for residential and commercial applications and offers employees a comprehensive health and wellness program, offers these tips to help you and your employees live a happy, healthy, safe and balanced life:

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Moving beyond baby steps with wellness

By Samuel H. Fleet

Employers want to do the right thing when it comes to health benefits for their employees, not only because it is humane, but also because it makes good business sense to take care of their most important assets. As health benefits have become increasingly costly, employers have struggled to find the key to meeting healthcare needs without breaking the bank. Many have pinned their hopes on wellness initiatives, the most popular offerings including newsletters and websites, weight-loss programs and smoking cessation programs.

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Take FMLA Health Conditions Seriously

A serious health condition is the most common reason for taking FMLA leave, whether it is for the employee or a spouse, son, daughter or parent with a serious health condition.

How does one determine a serious health condition (SHC) for FMLA purposes?

The textbook answer is that an SHC is an illness, injury, impairment or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider.

Inpatient care is easy to determine. It means any overnight stay in a hospital, hospice or residential medical care facility, including any period of incapacity or any subsequent treatment in connection with inpatient care.

What about continuing treatment? That is where the difficulty lies. Continuing treatment includes the following:

·      Incapacity and treatment. The incapacity must exceed three consecutive, full calendar days. The treatment typically must consist either of two doctor visits within 30 days of the start of the incapacity or one doctor visit followed by a regimen of continuing treatment (e.g., physical therapy, taking a prescription). The first visit must occur within the first seven days of incapacity. Examples include pneumonia and minor outpatient surgery.

·      Pregnancy or prenatal care. Expectant moms with any length of incapacity qualify.

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Protect Against Overtime Lawsuits

Since the recession peak in 2008, there has been a marked increase in the number of law suits filed by employees for overdue overtime pay. Some law firms are even actively seeking these types of law suits due to the high rate of settlement which might be a factor in the increase of suits.

According to a USAToday article, the main complaint employees have is they are working more than 40 hours a week without proper compensation due to several factors:

• Required to work off the clock
• Jobs are misclassified as exempt from overtime requirements
• Technology growth, smartphones in particular, has led to work carrying over into personal time

The Fair Labor Standards Act of 1938 was instituted to mandate a maximum hour workweek, establish a minimum wage, guarantee overtime pay for certain jobs and help protect against unlawful child labor. Over the years it has been amended to accommodate the changing workforce. One of the problems facing employers today is following the FLSA as the workplace grows and changes with technology.

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Tip Tuesday! Leptin and Alkaline Foods

By: Dr. Axe

When it comes to dieting, listening to your body’s cues can lead to a successful journey. Knowing when you’re actually hungry and when you’re emotionally eating or just thirsty is essential in long-term weight loss and maintenance. Logically, you know you should stop eating when you are full. However, it can often be more complicated than that. Various hormones in your body trigger you to start and stop eating. What if the hormone that tells you to stop eating could be controlled by the foods you eat?

WHAT IS LEPTIN?

Leptin is a hormone that plays a role in various parts of the body, including the brain, lungs, kidneys, spleen, heart and liver. Primarily, leptin tells your body when you are full. It signals the brain to stop eating based on the expansion of your stomach. The more food in your stomach, the harder leptin signals you to put down the fork.

WHAT EFFECTS LEPTIN LEVELS?

Weight and food consumption are two controllable factors that affect the amount of leptin in your body. Since fat cells produce leptin, body mass index (BMI) has been linked to high levels of leptin in the blood. The more you weigh, the more leptin in your body. Thus, obesity (BMI >30) leads to increased leptin levels.

Also, diet has been shown to affect the levels of leptin in the body. Since leptin and the immune system work together, consuming anti-inflammatory alkaline foods make you more sensitive to leptin levels. This can potentially lead to weight loss and a healthier body.

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DOL Announces Final FMLA Regulations

On the twentieth anniversary of FMLA’s enactment, the DOL issued finalregulations that clarify amendments made in the past few years.

The regulations focus on two areas of FMLA:  military leave (created by the National Defense Authorization Act for Fiscal Year 2010) and special rules for airline and flight crew employees (created by the Airline Flight Crew Technical Corrections Act). The regulations take effect 30 days after they are published in the Federal Register.

Here is a summary of changes for military qualifying exigency leaves:

·      Employees are now eligible if they have family members serving in the regular armed forces

·      Eligible family members may take leave for purposes of rest and recuperation for up to 15 days, instead of just five days

·      There is a new qualifying exigency leave category for parental care

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Three ways to keep love alive

By Arleen Fitzgerald, L.I.C.S.W.


A loving relationship can be one of the great joys of life. You have mutual affection — and feel at ease with each other.

That's not to say it comes easy. Growing and maintaining a healthy partnership requires tender, loving care.

While each couple is different, there are some basic ways to nurture and strengthen your connection. Remember these three T's:

Talk
When couples don't communicate regularly, it can create distance. Maybe you believe your partner should just know what you're thinking — or what would make you happy. But remember, no one — not even someone who knows you best — can read your mind.

Maybe you want your partner to help more around the house. Or, you'd like more time together. Say so. Speak directly and honestly — so that your partner knows what you need.

Be a loving listener, too. You may not always like what you hear. But, responding in a positive way can keep the conversation going. As you talk, avoid hurtful words and actions. You want your relationship to be a safe place to express needs, desires and differences.

That said, not all communication is verbal. For instance, make eye contact when you talk — and don't underestimate the power of a smile.

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Blood pressure: Know where you stand

By William Weese, M.D.


                       Your heart is like a trusted friend who rarely complains. That can make it easy to miss the signals that it's under stress.

Checking your blood pressure is one important — and easy — way to learn how well your heart is working.

Do you know your numbers?
Many people don't realize they have high blood pressure, also called hypertension. That's because it usually has no symptoms. You can have it and feel fine — for years, in fact.

In the meantime, it can silently be making your heart work harder to pump blood. This can damage your blood vessels and organs.

Left untreated, high blood pressure is a dangerous condition. It can raise your risk of serious health concerns, including:

• Heart attack
• Stroke
• Heart failure
• Chronic kidney disease
• Blindness

You won't know whether your blood pressure is OK unless you have it checked regularly — as often as your doctor advises.

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Tip Tuesday! Weight Loss: Are you ready to get serious?

By Arleen Fitzgerald, L.I.C.S.W., and Melanie Polk, M.M.Sc., R.D., F.A.D.A.


The best-kept weight-loss secret isn't a fad diet or a pill. It's a lifestyle — and a solid plan.

If you've made up your mind to drop those extra pounds — for good — don't jump in without a course of action. That's because in this case, "ready" and "set" are just as important as "go!"

Step 1: Let your doctor weigh in
A smart place to start is to talk with your doctor. He or she can help you set a healthy target weight — and suggest reliable ways to trim down.

Your doctor might also refer you to a registered dietitian or weight-loss program for extra guidance and support.*

Don't be surprised if your doctor cautions you not to peel off the pounds too quickly. Slow, steady weight loss — 1 to 2 pounds each week — is the best way to have lasting results.

Step 2: Set the stage for success
Here are some more wise preparations:

Get psyched. Think about why shedding pounds matters to you. Do you want to feel your best? Play with your kids without getting winded? Lower your blood pressure? Prevent future health problems?

Stock up. Fill your fridge and pantry with healthy foods. That way you'll have good choices on hand for meals and snacks.

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Agencies Issue More ACA Regulations

Some seven months after the U.S. Supreme Court validated the individual mandate as a tax, the IRS issuedproposed regulations on the individual penalty tax, which takes effect in 2014.

In addition to the IRS regulations, HHS issued proposed regulations on what constitutes minimum essential coverage. Both sets of regulations clarify provisions of the Affordable Care Act (ACA).

The IRS regulations address §1501 of the ACA. The section contains the individual mandate and adds §5000A to the Internal Revenue Code. These regulations clarify that minimum essential coverage includes COBRA and retiree coverage.

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HIPPA Fine Signals Higher Level of Enforcement

In the past, “500” was the magic number for HIPAA settlements of breaches of unsecured protected health information (PHI). All reported fines occurred where more than 500 individuals were affected.

That is no longer the case.

The Department of Health and Human Services (HHS) recently announced a$50,000 fine against an Idaho hospice after the theft of a single unencrypted laptop containing unsecured PHI. In fact, the Hospice of Northern Idaho (HONI) had not even conducted a risk analysis of the major security threats. As a result, 441 patients had their data stolen.

The HITECH Act requires two types of reporting to HHS when a breach of unsecured PHI occurs:

·         Immediately, if the breach affects 500 or more individuals

·         Annually, for all other breaches

HONI’s fine and settlement agreement were a result of the second type of HHS reporting. Employers must face certain realities related to health information in the 21^st Century. Much of it is stored, accessible or transmitted on devices that are not stationary in the workplace. The risks with mobile devices (e.g., cell phones, tablets, laptops) are many. HHS has made available several useful resources in this area.

What types of precautions have you taken to mitigate risk for your mobile devices? How often do you update your HIPAA risk analysis? Please comment below.

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Don’t overlook the threat of the Paycheck Fairness Act

By Tim Gould

The Paycheck Fairness Act has reared its ugly head again — and while it’s not likely to make it through this session of Congress, it’s definitely something employers need to keep an eye on.

Employment attorney Ilyse Schuman of the law firm Littler Mendelson calls the PFA a “message piece” — and if it ever does become law, it’ll mean some “significant and adverse” consequences for employers.

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Tip Tuesday! A sure-fire way to reduce employee stress

By: Rich Henson

Who’s likely to be more stressed: The CFO preparing to explain less-than-stellar quarterly earnings to his Board of Directors?  Or the clerk in accounting, trying to get the proper signature on a weekly travel expense form?

Believe it or not, it’s probably the clerk, according to a study out of Stanford and Harvard.

Researchers found that higher-level leaders had less stress than non-leaders or lower-level leaders, turning on its head the common notion that C-level execs experience the most anxiety.

In other words, climbing the corporate ladder is a good way to manage your stress.

The study measured levels of the stress-related hormone cortisol while asking participants a series of questions.

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DOL Delays Exchange Notice, Promises HRA Guidance

On January 24, 2013, the DOL published Part XI of the FAQs about Affordable Care Act (ACA) Implementation, delaying the March 1, 2013, deadline for employers to send an Exchange Notice. 

The DOL provided two reasons for delaying the Exchange Notice. First, the notice will be coordinated with educational efforts by the IRS and HHS on the subject of minimum value. Second, a later deadline will ensure that individuals receive a notice with meaningful information. The new deadline will be in the late summer or early fall of this year. Open enrollment for the Exchange – now known as the Health Insurance Marketplace – begins on October 1, 2013.

The DOL also addressed several pending issues for Health Reimbursement Arrangements (HRAs) related to when they are considered to be integratedwith other coverage. Further guidance will be forthcoming.

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