Review & Update HR & Benefit Practices For DOL Proposed Change In FMLA Regs, Other Rules Treating Some Same-Sex Couples As Spouses

July 8, 2014

August 11, 2014 is the deadline for employers and other interested individuals to comment on the  U.S. Department of Labor’s Wage and Hour Division (DOL) June 27, 2014 Notice of Proposed Rulemaking (NPRM), which would amend the definition of spouse under the current Family and Medical Leave Act of 1993 (FMLA) regulations in light of the United States Supreme Court’s decision in United States v. Windsor, which ruled unconstitutional section 3 of the Defense of Marriage Act (DOMA).  The proposed change is one of a series of regulatory changes that the Obama Administration has proposed or adopted since the Windsor decision.

DOL intends that the NPRM will replace the current definition of “spouse” its current FMLA regulations so that eligible employees in legal same-sex marriages will be able to take FMLA leave to care for their spouse or family member, regardless of where they live.

To accomplish this, the NPRM proposes to revise the current definition of spouse in the current FMLA regulations to define spouse as follows: Spouse, as defined in the statute, means a husband or wife. For purposes of this definition, husband or wife refers to the other person with whom an individual entered into marriage as defined or recognized under State law for purposes of marriage in the State in which the marriage was entered into or, in the case of a marriage entered into outside of any State, if the marriage is valid in the place where entered into and could have been entered into in at least one State. This definition includes an individual in a same-sex or common law marriage that either (1) was entered into in a State that recognizes such marriages or, (2) if entered into outside of any State, is valid in the place where entered into and could have been entered into in at least one State.

Among other things, this change will:

  • Replace the current “state of residence” rule with a rule that determines spousal status based on where the marriage was entered into (sometimes referred to as “place of celebration”) rule for determining marital status;
  • Revise the definition of spouse expressly to reference same-sex marriages in addition to common law marriages, and to encompass same-sex marriages entered into abroad that could have been entered into in at least one State.

The expanded definition of spouse will broaden the range of couples that employers and plans may be required to treat as spouses for purposes of the FMLA.  This expansion also may result in the extension of rights with respect to parents or children of a same-sex partner for certain employment or employee benefit purposes.  While the historical determination of parental relationships under the FMLA regulations based on a functional, rather than legalistic, test means that the proposed change will likely have less significance in this regard, employers and plans still should evaluate the potential implications of the expanded definition of spouse on its responsibilities with respect to the employees, their same-sex partners and the parents and children of the same-sex partners.

Also, many employers and employee benefit plans may be concerned about proposed language in the NPRM and other regulations requiring employers to decide if a marriage not valid in the United States could have been valid if performed within the United States.  Likewise, as the number of states where same-sex partners can qualify as spouses continues to evolve as courts and legislatures act to require recognition of these relationships, many employers and plans may feel legitimate concerns about the operational demands of administering their human resources and employee benefit plans and policies with respect to individuals involved in same-sex relationships where the legal status of the relationship may evolve due to changes of law, creating responsibilities for the employer or plan with respect to relationships that it may not know exist or the status of which may change subsequent to a determination of marital status or other relevant decision.  Employers and employee benefit plans should consider adopting practices to address these challenges to minimize the risk of incurring liability as a result of an oversight resulting from evolving status.

 For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 25 years’ experience advising employers, health plan and other employee benefit, insurance, financial services, health and other business clients about these and other matters.   As a part of this involvement, Ms. Stamer has extensive experience advising employers, employee benefit plans, insurers, health care providers and others about the implications of DOMA and other rules impacting the identification of spouses and other family status protections under the FMLA and other Federal and state employment, tax, health care and other laws.  She publishes and speaks extensively on these and other staffing and human resources, compensation and benefits, technology, health care, privacy, public policy, and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer, PC here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile www.cynthiastamer.com or by registering to participate in the distribution of these and other updates on our HR & Employee Benefits Update here including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information concerning this communication click here©2014 Cynthia Marcotte Stamer. Limited, non-exclusive right to republished granted to Solutions Law Press, Inc. All other rights reserved.


Employee & Other Whistleblower Complaints Common Source of HIPAA Privacy & Other Complaints

July 7, 2014

Employer and other health plan sponsors, administrators, insurers and their business associates should heed both the lesson about properly protecting health plan documents with protected health information and the more subtle lesson about the role of employees and other whistleblowers in bringing these violations to the attention of regulators contained in the latest Health Insurance Portability & Accountability Act (HIPAA) resolution agreement as well as act to manage their potential employment related liability to workforce members reporting these violations

HIPAA’s Privacy, Security and Breach Notification Rules generally prohibit  health plans, health care providers, health plans (Covered Entities) and their business associates from creating, using, accessing or disclosing protected health information except as allowed by HIPAA.  In addition, HIPAA requires covered entities both to meet detailed criteria for protecting electronic protected health information and also to take reasonable steps to protect all protected health information, as well as meet other business associate, breach notification, and individual rights requirements.

Parkview Resolution Agreement

Late last month, the Department of Health & Human Services Office of Civil Rights (HHS) announced that complaints of a retiring physician over the mishandling of her patient records by Parkview Health System, Inc. (Parkview) prompted the investigation that lead Parkview to agree to pay $800,000 to settle charges that it violated HIPAA’s Privacy Rule.

The resolution agreement settles charges lodged by HHS based on an OCR investigation into the retiring physician’s allegations that Parkview violated the HIPAA Privacy Rule by failing to properly safeguard the records when it returned them to the physician following her retirement.

As a covered entity under the HIPAA Privacy Rule, HIPAA requires that Parkview appropriately and reasonably safeguard all protected health information in its possession, from  acquisition to disposition.

In an investigation prompted by the physician’s complaint, OCR found that Parkview breached this responsibility in its handling of certain physician patient records in helping the physician to transition to retirement.

According to OCR, in September 2008, Parkview took custody of medical records of approximately 5,000 to 8,000 patients while assisting the retiring physician to transition her patients to new providers, and while considering the possibility of purchasing some of the physician’s practice.

Subsequently on June 4, 2009, Parkview employees, with notice that the physician was not at home, left 71 cardboard boxes of these medical records unattended and accessible to unauthorized persons on the driveway of the physician’s home, within 20 feet of the public road and a short distance away from a heavily trafficked public shopping venue. OCR concluded this conduct violated the Privacy Rule.

To settle OCR’s charges that these actions violated HIPAA, OCR has agreed to pay the $800,000 resolution amount and to adopt and implement a corrective action plan requiring Parkview to revise their policies and procedures, train staff, and provide an implementation report to OCR.

HIPAA Violations Carry Significant Liability

As demonstrated by the Parkview resolution agreement, violation of HIPAA  can carry significant civil and potentially even criminal liability.  The criminal provisions of HIPAA as well as the express terms of the Privacy Rules require that covered entities and their business associates adopt and administer specific compliance programs and practices to provide to compliance with HIPAA and HIPAA’s breach notification rules and the Privacy Regulations may require self-reporting of violations when and if violations occur.  Since HIPAA includes potential criminal liability, violations of its provisions can trigger organizational liability for covered entities and their business associates.  Consequently, HIPAA compliance also generally should be part of the Federal Sentencing Guideline Compliance Program of every covered entity and business associate.

The HITECH Act tightened certain rules applicable to the use, access or disclosure of protected health information by covered entities and their business associates.  In addition, the HITECH Act added breach notification rules, extended direct responsibility for compliance with HIPAA to business associates, increased penalties for noncompliance with HIPAA and made other refinements to HIPAA’s medical privacy rules and made certain other changes.  Furthermore, enforcement of HIPAA and the resulting penalties have increased since the HITECH Act took effect.

With OCR stepping up both audits and enforcement and penalties for violations higher than ever since the HITECH Act amended HIPAA, Covered Entities and business associates should act quickly to review and update their policies, practices and training to implement any adjustments needed to maintain compliance and manage other risks under these ever-evolving HIPAA standards.

When conducting these efforts, Covered Entities and business associates not only carefully watch for and react promptly to new OCR guidance and enforcement actions, but also document their commitment and ongoing compliance and risk management activities to help support their ability to show their organization maintains the necessary “culture of compliance” commitment needed to mitigate risks in the event of a breach or other HIPAA violation and take well-documented, reasonable steps to encourage their business associates to do the same.    When carrying out these activities, most covered entities and business associates also will want to take steps to monitor potential responsibilities and exposures under other federal and state laws like the privacy and data security requirements that often apply to personal financial information, trade secrets or other sensitive data under applicable federal and state laws and judicial precedent.

A series of supplemental guidance issued by the Department of Health & Human Services Office of Civil Rights (OCR) in recent weeks is giving health care providers, health plans, health care clearinghouses (Covered Entities) and their business associates even more to do in reviewing and updating their policies, practices and training for handing protected health information (PHI) beyond bringing their policies and practices into line with OCR’s restatement and update to the Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules; Final Rule (Omnibus Final Rule) OCR published January 25, 2013.

Covered Entities generally have been required to comply with most requirements the Omnibus Final Rule’s restated regulations restating OCR’s regulations implementing the Health Insurance Portability & Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules to reflect HIPAA amendments enacted by the Health Information Technology for Economic and Clinical Health (HITECH) Act since the Omnibus Final Rule took effect on March 26, 2013 and to have updated business associate agreements in place since September 23, 2013.  Meanwhile, the Omnibus Final Rule generally has required business associates have updated business associate agreements in place and otherwise to have come into compliance with all of the applicable requirements of the Omnibus Final Rule since September 23, 2013.  Although these deadlines are long past, many Covered Entities and business associates have yet to complete the policy, process and training updates required to comply with the rule changes implemented in  the Omnibus Final Rule.

Even if a Covered Entity or business associate completed the updates required to comply with the Omnibus Final Rule, however, recent supplemental guidance published by OCR means that most organizations now have even more work to do on HIPAA compliance. This includes the following supplemental guidance on its interpretation and enforcement of HIPAA against Covered Entities and business associates published by OCR since January 1, 2014 alone:

Beyond this 2014 guidance, Covered Entities and their business associates also should look at enforcement actions and data as well as other guidance OCR issued during 2013 after publishing the Omnibus Final Rule such as:

With OCR stepping up both audits and enforcement and penalties for violations higher than ever since the HITECH Act amended HIPAA, Covered Entities and business associates should act quickly to review and update their policies, practices and training to implement any adjustments needed to maintain compliance and manage other risks under these ever-evolving HIPAA standards.

When conducting these efforts, Covered Entities and business associates not only carefully watch for and react promptly to new OCR guidance and enforcement actions, but also document their commitment and ongoing compliance and risk management activities to help support their ability to show their organization maintains the necessary “culture of compliance” commitment needed to mitigate risks in the event of a breach or other HIPAA violation and take well-documented, reasonable steps to encourage their business associates to do the same.    When carrying out these activities, most covered entities and business associates also will want to take steps to monitor potential responsibilities and exposures under other federal and state laws like the privacy and data security requirements that often apply to personal financial information, trade secrets or other sensitive data under applicable federal and state laws and judicial precedent.

Watch & Manage Whistleblower Liability From HIPAA Violations & Compliance

Beyond illustrating the potential HIPAA-associated penalties that can result from failing to comply with HIPAA, the Parkview resolution agreement also illustrates the risks that current or former workforce members and others acting as whistleblowers play in helping OCR to identify HIPAA violations.  HIPAA and most other laws prohibited covered entities from forbidding or retaliating against a person for objecting to or reporting the concern and offer whistleblowers potential participation in the reporting and prosecution of violations.  Beyond these specific federal HIPAA protections, state courts often recognize firing or otherwise retaliating against workforce members or others for exercising rights protected by HIPAA or other federal anti-retaliation statutes as a basis for a state whistleblower or other retaliatory discharge claim.  See, e.g. Faulkner v. Department of State Health Servs., 2009 U.S. Dist. LEXIS 22419 (N.D. Tex. Mar. 19, 2009).  See also Court Recognizes Retaliation For Filing HIPAA Privacy Complaint As Basis For Texas Whistleblower Claim.    With retaliation and other whistleblower complaints becoming increasingly common and judgments from these claims rising, covered entities and their business associates need to include appropriate employment liability risk management processes and procedures in their HIPAA compliance processes and coordinate carefully with their human resources team and qualified employment counsel to manage the employment liability related risks associated with investigations and discipline activities under HIPAA.  Concurrently, Privacy Officers also should ensure that their organization’s human resources team understands the HIPAA rules and spot and properly refers to the privacy officer for investigation statements or other activities that may indicate that a HIPAA compliance or retaliation concern needs investigation or redress to avoid missing potential exposures hidden in the human resources processes that could reflect a practice of tolerance or retaliation unacceptable to OCR.

 For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the ABA JCEB Annual Agency Meeting with the Office of Civil Rights (OCR) for the past several years who has worked on medical and other privacy concerns throughout her career, she regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others, defends covered entities and business associates against OCR, FTC and other privacy and data security investigations, serves as special counsel in litigation arising from these concerns and is the author of several highly regarded publications on HIPAA and other privacy and security concerns.

Ms. Stamer also regularly works with OCR, FTC, USSS, FBI and state and local law enforcement on privacy, data security, health care, benefits and insurance and other matters, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For instance, Ms. Stamer for the third year will serve as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR. Her insights on HIPAA risk management and compliance often appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others.  You can get more information about her HIPAA and other experience here.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer, PC here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile www.cynthiastamer.com or by registering to participate in the distribution of these and other updates on our HR & Employee Benefits Update here including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information concerning this communication click here©2014 Cynthia Marcotte Stamer. Limited, non-exclusive right to republished granted to Solutions Law Press, Inc. All other rights reserved.


Consider Fiduciary & Other Risk Management When Planning For ACA Transitional Reinsurance Costs, Other Plan Design Changes

July 7, 2014

Employer and other plan sponsors should start working now with their insurers, administrators and advisors to understand the implications of and their options for addressing the “Transitional Reinsurance Program” and other new Patient Protection & Affordable Care Act (ACA)-associated cost and plan design changes  so that they are prepared to finalize and implement their health plan design, contracts and arrangements in time to meet the accelerated deadlines for notifying participants of plan changes and otherwise implement their plan changes for the upcoming plan year.

The impending imposition of  Transitional Reinsurance Program assessments are only one of a myriad of new and pre-existing federal health plan rules and associated market changes impacting the design of employer and union-sponsored health plans.  Since ACA now also requires 60 days advance written notice of material health plan changes, .  When making these decisions, employer and other health plan sponsors and their advisors, administrators and insurers  should not only focus on the technically new mandates but also the allocation of fiduciary and other responsibilities, liabilities and other plan and services agreements terms.  Plan sponsors and their fiduciaries historically have underappreciated the significance of these allocations or presumed that their vendor contracts allocate responsibility to the service providers and vendors to match the sales pitch.  Always rarely the case, the changes in the marketplace and the law make it even more likely that sponsoring employers and their leaders of even plans that carefully reviewed and negotiated these responsibilities in their past contracts need to carefully look at these plan and contractual terms carefully.

The Transitional Reinsurance Program is one of a series of new ACA-imposed assessments that can impact the plan design and costs.    Proper understanding of these rules is critical for plan sponsors and their fiduciaries to ensure that they don’t unintentionally assume significantly greater liability for their self-insured health plans in an attempt to design around a relatively small by comparison ACA assessment.

Section 1341 of the Patient Protection & Affordable Care Act (ACA) requires the establishment of the reinsurance program to provide for stabilization of funding for exchanges.  Funding for the costs of the program is accomplished through amounts assessed upon insurers and self-insured plan third party administrators.  ACA § 1341 accomplishes this by providing for:

  • The establishment for each State of a transitional reinsurance program stabilize premiums for coverage in the individual market from 2014 through 2016;
  • Requiring all health insurance issuers and third party administrators on behalf of self-insured group health plans, to pay contributions to support reinsurance payments that cover high-cost individuals in non-grandfathered plans in the individual market.

Registration is now open for a series of webinars that the Department of Health & Human Services will host on “The Transitional Reinsurance Program: Contributing Entities and Counting Methods” on July 14, July 18 and July 23, 2014 from 2:00 p.m. – 3:30 p.m. EST.  The upcoming HHS webinars will cover the same information.  They will focus on reinsurance contributions including who is a contributing entity and how a contributing entity can calculate its annual enrollment count to determine reinsurance contribution amounts. The intended audience for this webinar is health insurance issuers, self-insured group health plans, third party administrators (TPAs) and administrative services-only (ASO) contractors.  To register for the HHS webinar and to obtain additional information see here.

Understanding how the Transitional Reinsurance Program assessments will be calculated is one of many critical steps in making plan design changes.  When considering whether to take advantage of options for minimizing these assessments, however, employer, union and other plan sponsors need to consider whether the liability and other consequences of meeting requirements for avoidance of the assessments is warranted by the anticipated savings.  With superficially it might seem desirable to avoid the payment of a few dollars per covered lives associated with the assessment, employers and other sponsoring organizations and the officers or other leadership employees involved in plan design or administration should critically review the effect of meeting these requirements specifically, as well as their proposed vendor contracts and associated plan documents and communications on their personal and organizations’ fiduciary and other liabilities.  To the extent that existing or expanded fiduciary liability cannot be avoided, it will be critical that the sponsor and its leadership ensure that proper steps are taken to select, credential, bond, and appoint the persons who will be or help carry out fiduciary or other plan-related responsibilities.  Additionally, most plan sponsors will want to consider exploring the availability of fiduciary liability insurance coverage to help mitigate the potential liability risks associated with plan sponsorship.

For Advice, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The author of the “Managed Care Contracting Guide” and a multitude of other highly-regarded publications on health plan and other fiduciary liability risk management, Ms. Stamer has advised plan sponsors, administrators, insurers and others about these and other health plan liabilities and their risk management throughout her more than 25 year career. You can get more information about her HIPAA and other experience here.

If you need assistance with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

You can review other recent publications and resources and additional information about the other experience of Ms. Stamer here. Examples of some recent publications that may be of interest include:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information about this communication click here.

©2014 Cynthia Marcotte Stamer.  Non-exclusive right to republish granted to Solutions Law Press, Inc.   All rights reserved.


HHS Claims Average $69/Month Cost for Subsidized Coverage Shows ACA Success Challenged

June 18, 2014

The Department of Health & Human Services (HHS) is touting a new report available here released today that it says people who qualified for tax credits to buy health insurance coverage through the health insurance exchange who selected silver plans, the most popular plan type in the federal Marketplace, paid an average premium of $69 per month. In the federal Marketplace, 69 percent of enrollees who selected Marketplace plans with tax credits had premiums of $100 a month or less, and 46 percent of $50 a month or less after tax credits.   The balance of the cost of the coverage is covered via subsidies.  Other sources, however, say the data in the report raises concerns about the overall cost of the health care reform law and its impact on the total cost of coverage.

HHS says the report also looks at competition and choice nationwide among health insurance plans in 2013-2014.  HHS claims that the report shows most individuals shopping in the Marketplace had a wide range of health plans from which to choose. On average, consumers could choose from five health insurers and 47 Marketplace plans. An increase of one issuer in a rating area is associated with 4 percent decline in the second-lowest cost silver plan premium, on average.

While the HHS report by focusing on what subsidized individuals pay out of pocket spins the data to give the impression that the health care reform law is bringing down health care costs as promised, other sources say the data in the Report raises serious concerns about the overall cost of the health care reform law and the total cost of coverage.  While acknowledging that “the generous subsidies” helped consumers receiving subsidies, the Los Angeles Times reports these subsidies coupled with the massive enrollment by individuals qualifying for subsidies raise budgetary concerns.  According to the Los Angeles Times article, the reports shows the federal government is on track to spend at least $11 billion on subsidies for consumers who bought health plans on marketplaces run by the federal government, even accounting for the fact that many consumers signed up for coverage in late March and will only receive subsidies for part of the year.  However, this total does not count the additional cost of providing coverage to the 1/3 of the 8 million new people who signed up for coverage who bought coverage in states that ran their own marketplaces, including California, Connecticut, Maryland and New York.   While Federal officials said subsidy data for these consumers were not available, the Los Angeles Times estimated that if these state consumers received roughly comparable government assistance for their insurance premiums, the total cost of subsidies could top $16.5 billion this year, resulting in budgetary costs “far higher”  than the $10 million budgetary cost that the Congressional Budget Office projected subsidies would cost U.S. taxpayers in 2014. See  Obamacare subsidies push cost of health law above projections.

 For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the ABA JCEB Annual Agency Meeting with the Office of Civil Rights (OCR) for the past several years who has worked on medical and other privacy concerns throughout her career, she regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others, defends covered entities and business associates against OCR, FTC and other privacy and data security investigations, serves as special counsel in litigation arising from these concerns and is the author of several highly regarded publications on HIPAA and other privacy and security concerns.

Ms. Stamer also regularly works with OCR, FTC, USSS, FBI and state and local law enforcement on privacy, data security, health care, benefits and insurance and other matters, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For instance, Ms. Stamer for the third year will serve as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR. Her insights on HIPAA risk management and compliance frequently appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others.  You can get more information about her HIPAA and other experience here.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer, PC here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile www.cynthiastamer.com or by registering to participate in the distribution of these and other updates on our HR & Employee Benefits Update distributions here including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information concerning this communication click here©2014 Cynthia Marcotte Stamer. Limited, non-exclusive right to republished granted to Solutions Law Press, Inc. All other rights reserved.


HIPAA Compliance & Breach Data Shares Helpful Lessons For Health Plans, Providers and Business Associates

June 11, 2014

Health care providers, health plans and insurers, health care clearinghouses (collectively “Covered Entities”), their business associates, and others concerned about medical privacy regulations or protections should check out two new reports to Congress about breach notifications reported and other compliance data under the Health Insurance Portability & Accountability Act (HIPAA) by the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).   Reviewing this data can help Covered Entities and their business associates identify potential areas of exposures and enforcement that can be helpful to minimize their HIPAA liability as well as to expect OCR enforcement and audit inquiries.  Smart covered entities and business associates will include review of these and other reports about compliance and enforcement by OCR and assessment of their processes against this information as a part of their HIPAA compliance and risk management practices.

Required by the Health Information Technology for Economic and Clinical Health (HITECH) Act, the two new reports discuss various details about HIPAA compliance for calendar years 2011 and 2012.  They include the following:

  • Report to Congress on Breach Notifications, discussing the breach notification requirements and reports OCR received as a result of these breach notification requirements; and
  • Report to Congress on Compliance with the HIPAA Privacy and Security Rules, summarizing complaints received by OCR of alleged violations of the provisions of Subtitle D of the HITECH Act, as well as of the HIPAA Privacy and Security Rules at 45 CFR Parts 160 and 164 .
  • Covered entities and their business associates should review the finding reported as part of their compliance practices. Others concerned about medical or other privacy or data security regulations or events also may find the information in the reports of interest.

Under HIPAA, covered entities generally are prohibited from using, accessing or disclosing protected health information about individuals except as specifically allowed by HIPAA,  In addition, HIPAA also requires Covered Entities to establish safeguards to protect protected health information against improper access, use or destruction, to afford certain rights to individuals who are the subjects of protected information, to obtain certain written assurances from service providers who are business associates before allowing those service providers to use, access or disclose protected health information when carrying out covered functions for the Covered Entity, and meet other requirements.

The HITECH Act tightened certain rules applicable to the use, access or disclosure of protected health information by covered entities and their business associates.  In addition, the HITECH Act added breach notification rules, extended direct responsibility for compliance with HIPAA to business associates, increased penalties for noncompliance with HIPAA and made other refinements to HIPAA’s medical privacy rules and made certain other changes.

Enforcement of HIPAA and the resulting penalties have increased since the HITECH Act took effect.

Covered Entities generally have been required to comply with most requirements the Omnibus Final Rule’s restated regulations restating OCR’s regulations implementing the Health Insurance Portability & Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules to reflect HIPAA amendments enacted by the HITECH Act since March 26, 2013 and to have updated business associate agreements in place since September 23, 2013.  Although these deadlines are long past, many Covered Entities and business associates have yet to complete the policy, process and training updates required to comply with the rule changes implemented in  the Omnibus Final Rule.

Even if a Covered Entity or business associate completed the updates required to comply with the Omnibus Final Rule, however, recent supplemental guidance published by OCR means that most organizations now have even more work to do on HIPAA compliance. This includes the following supplemental guidance on its interpretation and enforcement of HIPAA against Covered Entities and business associates published by OCR since January 1, 2014 alone:

Beyond this 2014 guidance, Covered Entities and their business associates also should look at enforcement actions and data as well as other guidance OCR issued during 2013 after publishing the Omnibus Final Rule such as:

With OCR stepping up both audits and enforcement and penalties for violations higher than ever since the HITECH Act amended HIPAA, Covered Entities and business associates should act quickly to review and update their policies, practices and training to implement any adjustments needed to maintain compliance and manage other risks under these ever-evolving HIPAA standards.

When conducting these efforts, Covered Entities and business associates not only carefully watch for and react promptly to new OCR guidance and enforcement actions, but also document their commitment and ongoing compliance and risk management activities to help support their ability to show their organization maintains the necessary “culture of compliance” commitment needed to mitigate risks in the event of a breach or other HIPAA violation and take well-documented, reasonable steps to encourage their business associates to do the same.    When carrying out these activities, most covered entities and business associates also will want to take steps to monitor potential responsibilities and exposures under other federal and state laws like the privacy and data security requirements that often apply to personal financial information, trade secrets or other sensitive data under applicable federal and state laws and judicial precedent.

 For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 25 years’ experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. The scribe for the ABA JCEB Annual Agency Meeting with the Office of Civil Rights (OCR) for the past several years who has worked on medical and other privacy concerns throughout her career, she regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others, defends covered entities and business associates against OCR, FTC and other privacy and data security investigations, serves as special counsel in litigation arising from these concerns and is the author of several highly regarded publications on HIPAA and other privacy and security concerns.

Ms. Stamer also regularly works with OCR, FTC, USSS, FBI and state and local law enforcement on privacy, data security, health care, benefits and insurance and other matters, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For instance, Ms. Stamer for the third year will serve as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR. Her insights on HIPAA risk management and compliance frequently appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others.  You can get more information about her HIPAA and other experience here.

You can review other recent human resources, employee benefits and internal controls publications and resources and additional information about the employment, employee benefits and other experience of the Cynthia Marcotte Stamer, PC here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile www.cynthiastamer.com or by registering to participate in the distribution of these and other updates on our HR & Employee Benefits Update distributions here including:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information concerning this communication click here©2014 Cynthia Marcotte Stamer. Limited, non-exclusive right to republished granted to Solutions Law Press, Inc. All other rights reserved.


Review & Update Health Plan Notices, Language & Process For New Guidance On COBRA, Other Key Health Plan Rules

June 2, 2014

Add reviewing and updating your plan language, notices and processes for administering the coverage continuation requirements to the ever-growing list of items that employers and other group health plan sponsors, insurers, administrators and fiduciaries need to handle this year.

The most recently emerging guidance published by federal regulators to implement the Patient Protection & Affordability Act (ACA) and other health care reforms is a package of new guidance on COBRA and its interface with COBRA published in early May.  This guidance includes a new HHS Bulletin Allowing COBRA Qualified Beneficiaries to Enroll in the Health Insurance Marketplace,  as well as a series of updated model COBRA and CHIP Notices and related documents.

The HHS Bulletin on COBRA allows individuals who previously elected COBRA rather than enrolling in coverage through one of the new health insurance exchanges created under ACA a special extended enrollment opportunity to enroll in coverage under these exchanges.  Many employers and health plans may want to communicate this new option to help minimize their COBRA exposures.

Beyond  the extended exchange enrollment period for COBRA enrolled or eligible persons, the new guidance also may merit updates and changes to group health plan’s existing COBRA plan language, notices and election forms and procedures.  Labor Department guidance several years ago significantly expanded the number of notifications required under COBRA as well as the required content.  In connection with that guidance, the Labor Department published various model notices and other materials.  As part of new guidance published in May, 2014, the Labor Department has revised and published updated versions of many of these model documents.  The updated materials include:

In addition to the updated COBRA guidance, employers, health plans and their insurers, administrators and fiduciaries also will want to review and update their plan language, processes, budgets, notices and other materials in response to updated guidance in Affordable Care Act Implementation FAQs Part XIX on Department of Labor model notices, limitations on cost-sharing, coverage of preventive services, health flexible spending account (FSA) carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.  Employers and others involved in the design or administration of group health plans  also will want to review this new guidance as part of their continuing health plan compliance, cost forecasting and planning efforts.

Catch Up On Latest, Get Practical Health Plan Insights At June 17  Texas CEO Briefing

Texas CEO Magazine invites Solutions Law Press Readers to catch up on new developments and strategies to help employers prepare for and cope with the ever-evolving stream of health plan developments enacted under the Patient Protection & Affordable Care Act by participating in a practical briefing on:

Tuesday, June 17

7:30 – 9:00 a.m.

Park City Club

5956 Sherry Lane, Dallas

Register: https://texasceomagazine.com/events

Two of Texas CEO’s  “Top 10 Most Read” articles in 2013 were authored by Dallas attorney and benefit specialist Cynthia Stamer who will anchor a panel of benefit experts that will explore new developments and their practical implications on:

  • Benefit Plan Design
  • Workforce Classification
  • Data Collection
  • Cost Projections
  • Private Exchanges
  • New Reporting Requirements (IRC 6055 & 6056)
  • Noncompliance Penalties
  • Avoiding the Tax
  • The New Care Delivery Dynamic

Featured Speakers include Cynthia Stamer, Managing Partner, Solutions Lawyer Publisher and Author, Eric Bassett, Senior Partner & Central Market Leader, Mercer Health & Benefits Consulting, Scott Gibbs, Senior Vice President, McGriff, Seibels & Williams, Inc., and Becky Parker, Health Reform Director, MHBT Inc.

Cynthia is a Dallas-based attorney who has spent more than 25 years helping private and public employers and health and employee benefit planners develop, implement, administer and defend creative, legally compliant and operationally effective health plans and policies.

Cynthia’s Texas CEO Magazine article, “Benefit Plan Triage: 12 STEPS EVERY EMPLOYER WITH A HEALTH PLAN SHOULD DO NOW,” was one of the Top 10 most-read articles of 2012. And in 2013, “Getting Ready for ACA Reform: 13 Steps to Take Now,” and “Affordable Care Act Update,” were both Top 10 most read articles.

Cynthia, among other things,  is:

  • Past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group
  • Immediate Past Chair of the ABA’s RPTE Employee Benefit & Compensation Committee
  • Marketing Committee Chair of the ABA Joint Committee on Employee Benefits
  • Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee
  • Current Vice-Chair of the Gulf States TEGE Council – Exempt Organizations Group

Eric works with clients in all areas of health care and group benefits with particular emphasis on health care strategies, delivery system capabilities, defined contribution, and consumerism. Eric began his 28-year health care career working for health care vendors. He has led cross-functional teams involved in the development of rural managed care strategies, integration of legacy networks and systems, physician profiling and implementation of open access networks and systems. Eric’s consulting experience includes:

  • Developing and managing health improvement, disease and demand management programs.
  • Chronic PCMH program design and development.
  • Working with management and labor during collective bargaining.
  • Integrating and consolidating benefit plans for mergers and acquisitions.
  • Working closely with corporate committees to facilitate decision-making.
  • Active and retiree exchange strategy and design.

Scott Gibbs works with large employers on long term strategies to make corporate benefit plans consistent with the company’s goals and budgets, working with both fully-insured and self-funded plans.

Scott is a member of:

  • Society for Human Resource Management (SHRM)
  • Texas Public Risk Management Association
  • International Foundation of Employee Benefit Plans
  • State and Local Government Benefit Association
  • Scott has an undergraduate degree from Baylor University and a Master’s in Health Care Administration from Trinity University.

Becky directs all corporate strategy and communication on the Affordable Care Act for MHBT and its clients. She has worked as an employee benefits advisor since 1992 and was one of the first employee benefits professionals to have earned a Certification in Health Care Reform Studies from The American College.

Becky is an active member of the Austin Association of Health Underwriters where she was president in 2003 and also served on the Texas Association of Health Underwriters board as their liaison to the Texas Department of Insurance and was honored nationally for her work.

Becky is an advocate for employee benefits in the legislative arena regularly testifying at the Texas State Capitol and engaging our federal elected officials on insurance related matters. Becky has even advised Texas Congressmen on the employer aspects of the Affordable Care Act.

Becky holds a Bachelor of Arts degree from The University of Texas at Austin.

For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. She regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others.

For the past two years, Ms. Stamer has served as the  scribe for the ABA Joint Committee on Employee Benefits agency meeting with OCR.   Ms. Stamer also regularly works with OCR, FTC, USSS, FBI and state and local law enforcement on privacy, data security, health care, benefits and insurance and other matters, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For instance, Ms. Stamer for the second year will serve as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR. Her insights on HIPAA risk management and compliance frequently appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others.  You can get more information about her HIPAA and other experience here.

If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

You can review other recent publications and resources and additional information about the other experience of Ms. Stamer here. Examples of some recent publications that may be of interest include:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information about this communication click here.

©2014 Cynthia Marcotte Stamer.  Non-exclusive right to republish granted to Solutions Law Press, Inc.   All rights reserved.


6/17 Workshop Helps Businesses Get Ready for Latest Affordable Care Act Rollout

May 31, 2014

Texas CEO Magazine invites Solutions Law Press Readers to catch up on new developments and strategies to help employers prepare for and cope with the ever-evolving stream of health plan developments enacted under the Patient Protection & Affordable Care Act by participating in a practical workshop

Tuesday, June 17

7:30 – 9:00 a.m.

Park City Club

5956 Sherry Lane, Dallas

Register: https://texasceomagazine.com/events

The Affordable Care Act continues to hit the business world with successive waves of reform. To make sure your company is ready, we’ve assembled a panel of experts to update you about the current and impending legal terrain and share their benefit plan design and compliance tips to help your business cope with these changes.

Two of Texas CEO’s  “Top 10 Most Read” articles in 2013 were authored by Dallas attorney and benefit specialist Cynthia Stamer who will anchor our panel of benefit experts as we take you through:

  • Benefit Plan Design
  • Workforce Classification
  • Data Collection
  • Cost Projections
  • Private Exchanges
  • New Reporting Requirements (IRC 6055 & 6056)
  • Noncompliance Penalties
  • Avoiding the Tax
  • The New Care Delivery Dynamic

Featured Speakers Include:

Cynthia Stamer, Managing Partner, Solutions Lawyer

Cynthia is a Dallas-based attorney who has spent more than 25 years helping private and public employers and health and employee benefit planners develop, implement, administer and defend creative, legally compliant and operationally effective health plans and policies.

Cynthia’s Texas CEO Magazine article, “Benefit Plan Triage: 12 STEPS EVERY EMPLOYER WITH A HEALTH PLAN SHOULD DO NOW,” was one of the Top 10 most-read articles of 2012. And in 2013, “Getting Ready for ACA Reform: 13 Steps to Take Now,” and “Affordable Care Act Update,” were both Top 10 most read articles.

Ms. Stamer is:

  • Past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group
  • Immediate Past Chair of the ABA’s RPTE Employee Benefit & Compensation Committee
  • Marketing Committee Chair of the ABA Joint Committee on Employee Benefits
  • Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee
  • Current Vice-Chair of the Gulf States TEGE Council – Exempt Organizations Group

Eric Bassett, Senior Partner & Central Market Leader, Mercer Health & Benefits Consulting

Eric works with clients in all areas of health care and group benefits with particular emphasis on health care strategies, delivery system capabilities, defined contribution, and consumerism. Eric began his 28-year health care career working for health care vendors. He has led cross-functional teams involved in the development of rural managed care strategies, integration of legacy networks and systems, physician profiling and implementation of open access networks and systems. Eric’s consulting experience includes:

  • Developing and managing health improvement, disease and demand management programs.
  • Chronic PCMH program design and development.
  • Working with management and labor during collective bargaining.
  • Integrating and consolidating benefit plans for mergers and acquisitions.
  • Working closely with corporate committees to facilitate decision-making.
  • Active and retiree exchange strategy and design.

Scott Gibbs, Senior Vice President, McGriff, Seibels & Williams, Inc.

Scott Gibbs works with large employers on long term strategies to make corporate benefit plans consistent with the company’s goals and budgets, working with both fully-insured and self-funded plans.

Scott is a member of:

  • Society for Human Resource Management (SHRM)
  • Texas Public Risk Management Association
  • International Foundation of Employee Benefit Plans
  • State and Local Government Benefit Association
  • Scott has an undergraduate degree from Baylor University and a Master’s in Health Care Administration from Trinity University.

Becky Parker, Health Reform Director, MHBT Inc.

Becky directs all corporate strategy and communication pertaining to the Affordable Care Act for MHBT and its clients. She has worked as an employee benefits advisor since 1992 and was one of the first employee benefits professionals to have earned a Certification in Health Care Reform Studies from The American College.

Becky is an active member of the Austin Association of Health Underwriters where she was president in 2003 and also served on the Texas Association of Health Underwriters board as their liaison to the Texas Department of Insurance and was honored nationally for her work.

Becky is an advocate for employee benefits in the legislative arena regularly testifying at the Texas State Capitol and engaging our federal elected officials on insurance related matters. Becky has even advised Texas Congressmen on the employer aspects of the Affordable Care Act.

Becky holds a Bachelor of Arts degree from The University of Texas at Austin.

For Representation, Training & Other Resources

If you need assistance monitoring these and other regulatory policy, enforcement, litigation or other developments, or to review or respond to these or other workforce, benefits and compensation, performance and risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer may be able to help.

Board Certified in Labor & Employment Law, Past Chair of the ABA RPTE Employee Benefit & Other Compensation Arrangements Group, Co-Chair and Past Chair of the ABA RPTE Welfare Plan Committee, Vice Chair of the ABA TIPS Employee Benefit Plans Committee, Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health plan and employee benefit, insurance, financial services, employer and health industry clients about these and other matters. Ms. Stamer has extensive experience advising and assisting health care providers, health plans, their business associates and other health industry clients to establish and administer medical privacy and other compliance and risk management policies, to health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. She regularly designs and presents HIPAA and other risk management, compliance and other training for health plans, employers, health care providers, professional associations and others.

For the past two years, Ms. Stamer has served as the  scribe for the ABA Joint Committee on Employee Benefits agency meeting with OCR.   Ms. Stamer also regularly works with OCR, FTC, USSS, FBI and state and local law enforcement on privacy, data security, health care, benefits and insurance and other matters, publishes and speaks extensively on medical and other privacy and data security, health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her publications and insights appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. For instance, Ms. Stamer for the second year will serve as the appointed scribe for the ABA Joint Committee on Employee Benefits Agency meeting with OCR. Her insights on HIPAA risk management and compliance frequently appear in medical privacy related publications of a broad range of health care, health plan and other industry publications Among others, she has conducted privacy training for the Association of State & Territorial Health Plans (ASTHO), the Los Angeles Health Department, the American Bar Association, the Health Care Compliance Association, a multitude of health industry, health plan, insurance and financial services, education, employer employee benefit and other clients, trade and professional associations and others.  You can get more information about her HIPAA and other experience here.

If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here.

You can review other recent publications and resources and additional information about the other experience of Ms. Stamer here. Examples of some recent publications that may be of interest include:

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating or updating your profile here. For important information about this communication click here.

©2014 Cynthia Marcotte Stamer.  Non-exclusive right to republish granted to Solutions Law Press, Inc.   All rights reserved.


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