Congress Taking On Health Reform Again: Get Informed & Involved!

December 16, 2016

Congress is getting ready to take on heath care reform again. Americans need to become informed and participate! http://ow.ly/C6bc306V5eT http://ow.ly/i/q1dUA

Comments Off on Congress Taking On Health Reform Again: Get Informed & Involved! | Uncategorized | Permalink
Posted by Cynthia Marcotte Stamer

PBGC Table Shows Present Value  PBGC Maximum Guarantee

December 4, 2016

 On December 02, 2016, PBGC posted a table showing the applicable present values for 2017 plan years. For more information see Technical Update 07-04. (12/02/2016).

Comments Off on PBGC Table Shows Present Value  PBGC Maximum Guarantee | Bankruptcy, Corporate Compliance, corporate governance, defined benefit plan, Employee Benefits, Employment, Retirements | Permalink
Posted by Cynthia Marcotte Stamer

CMS Alert Warns Worker’s Comp & Other Liability Payers To Comply With Medicare Benefit Coordination Rules 

December 4, 2016

The Center for Medicare & Medicaid Services (CMS) is responsible  for protecting the Medicare program’s fiscal integrity and ensuring that it pays only for those services that are its responsibility. Medicare Secondary Payer (MSP) provisions make Medicare a secondary payer to certain non-group health plans (NGHPs), which include liability insurers (including self-insured entities), no-fault insurers, and workers’ compensation entities. CMS has the right to recover Medicare payments made that should have been the responsibility of another payer.

MSP situations involving NGHPs are triggered by unexpected incidents, such as car accidents or work-related injuries, involve Medicare beneficiaries, and result in medical expenses for which an NGHP (rather than Medicare) has primary responsibility for payment. In these situations, Medicare becomes a secondary payer. In some MSP situations involving NGHPs, Medicare will initially pay for related medical expenses in order to ensure that the beneficiary has timely access to needed care and later seek to recover those payments.

The CMS Benefits Coordination & Recovery Center (BCRC) seeks repayment  for any conditional payments it makes related to a liability, no-fault, or workers’ compensation case. A conditional payment is a payment Medicare makes for services another payer may be responsible for. The payment is “conditional” because it must be repaid to Medicare when a beneficiary receives a settlement, judgment, award, or other payment from an NGHP.

When the BCRC learns of an NGHP case, it gathers information about any related conditional payments Medicare made and request repayment. 

A beneficiary or beneficiary’s attorney or other representative may contact the BCRC for any of the following questions/issues:
Questions about Medicare’s recovery rights or the reimbursement process

To obtain conditional payment amounts

To obtain Medicare’s final recovery claim amount

Questions regarding MSP recovery demand letters

Questions with respect to a “Notice of Intent to Refer Debt to the Department of Treasury” letter

Questions regarding repaying Medicare

To request a waiver of recovery with respect to a beneficiary MSP debt. (Note: A waiver of recovery request cannot be accepted or processed until a recovery demand letter is issued.)

To request a first level appeal with respect to the determination contained in a beneficiary MSP recovery demand letter or a determination made on a waiver of recovery request from a beneficiary

Please see the Contacts page for specific contact phone numbers and mailing address information.
Commercial Repayment Center (CRC) Responsibilities  
Effective October 5, 2015, the Commercial Repayment Center (CRC) assumed responsibility for the recovery of conditional payments where an insurer/workers’ compensation entity is the identified debtor. Any NGHP recoveries initiated by the BCRC prior to the October 2015 transition will continue to be the responsibility of the BCRC. To view the process of recovering conditional payments from an insurer/workers’ compensation entity, click the Insurer NGHP Recovery link.
When to Contact the CRC
Insurer/workers’ compensation entities should review their recovery letter for a return address or closing referencing the BCRC or CRC. If the CRC sent the letter, contact the CRC. However, if the BCRC sent the letter, contact the BCRC. The insurer/workers’ compensation entity may contact the BCRC or the CRC, depending on who sent their recovery letter, for any of the following questions/issues:
Questions about Medicare’s recovery rights or the reimbursement process

Questions regarding Conditional Payment Letters/Conditional Payment Notices

Questions regarding MSP recovery demand letters

Questions with respect to a “Notice of Intent to Refer Debt to the Department of Treasury” letter

Questions regarding repaying Medicare

To request a first level appeal with respect to the determination contained in an MSP recovery demand letter

Please see the Contacts page for specific contact phone numbers and mailing address information.
Medicare Secondary Payer Recovery Portal (MSPRP)
The MSPRP is a web-based tool designed to assist in the resolution of liability insurance, no-fault insurance, and workers’ compensation Medicare recovery cases. The MSPRP gives users (attorneys, insurers, beneficiaries, and recovery agents) the ability to access and update certain case specific information online and monitor the recovery process online. For additional information regarding the MSPRP, click the Medicare Secondary Payer Recovery Portal link.
Note: NGHP Recovery related materials previously available as downloads on this page have been moved to the Beneficiary or Insurer Services sections of CMS.gov, as applicable. Click the Medicare’s Recovery Process link to access downloads pertinent to the beneficiary. Downloads pertaining to the insurer/workers’ compensation entity may be accessed by clicking the Insurer NGHP Recovery link.

Comments Off on CMS Alert Warns Worker’s Comp & Other Liability Payers To Comply With Medicare Benefit Coordination Rules  | Claims, health benefit, Health Benefits, health Care, health insurance, health insurance marketplace | Permalink
Posted by Cynthia Marcotte Stamer

DOL Appeals Preliminary Injunction Blocking White Collar Exemption Salary Threshhold Change

December 2, 2016

The US Department of Labor (DOL) is appealing the November 22 Nevada v US Department of Labor ruling preliminarily enjoining DOL from implementing or enforcing a modification to the DOL Fair Labor Standards Act (FLSA) White Collar Exemption Regulations that would have nearly doubled the minimum salary that an employer must pay an employee on a salaried basis in reliance on the White Collar Exemption.

The Department of Justice on behalf of the Department of Labor filed a notice to appeal the preliminary injunction to the U.S. Circuit Court of Appeals for the Fifth Circuit yesterday.  

The November 22 Nevada preliminary injunction order barred DOL nationwide from implementing a change to its White Collar Regulations on  December 1, 2016 that would automatically excluded any employee earning a salary of less than $913 per week ($47,476 per year) from coverage by the most commonly relied upon FLSA exemption, White Collar Exemption,  pending a future ruling on the merits lifting the injunction.  

The Obama Administration’s final rule change published in the Federal Register on May 23, 2016, increases the threshold salary for the exemption from $455 per week to $913 per week ($47,476 per year) effective December 1, 2016 and provides for automatic adjustments to this amount every three years beginning January 1, 2020

DOL’s full statement regarding the litigation is here.

The appeal likely surprises many who assumed that the impending change in Administration would put an end to the Obama Administration’s change.  It remains to be seen how quickly the Fifth Circuit will hear the appeal as well as the fate of the rule change and the litigation after President-Elect Trump takes office. Either way, however, zealous and often successful private plaintiff and DOL enforcement of other elements of the While Collar Exemption and other FLSA requirements makes it imperative that employers be prepared to produce the necessary proof to defend their payment of any worker on a salaried basis as well as.compliance with all minimum wage, overtime, record keeping and other FLSA requirements.

About The Author
Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,”“Tax: Erisa & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney and management consultant, author, public policy advocate and lecturer widely known for work, teachings and publications.

Ms. Stamer works with businesses and their management, employee benefit plans, governments and other organizations deal with all aspects of human resources and workforce, internal controls and regulatory compliance, change management and other performance and operations management and compliance. She supports her clients both on a real-time, “on demand” basis and with longer term basis to deal with daily performance management and operations, emerging crises, strategic planning, process improvement and change management, investigations, defending litigation, audits, investigations or other enforcement challenges, government affairs and public policy.
A Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares shared her thought leadership, experience and advocacy on these and other concerns by her service in the leadership of a broad range of other professional and civic organization including her involvement as the Vice Chair of the North Texas Healthcare Compliance Association, Executive Director of the Coalition on Responsible Health Policy and its PROJECT COPE: Coalition on Patient Empowerment, a founding Board Member and past President of the Alliance for Healthcare Excellence, past Board Member and Board Compliance Committee Chair for the National Kidney Foundation of North Texas; former Board President of the early childhood development intervention agency, The Richardson Development Center for Children; former Board Compliance Chair and Board member of the National Kidney Foundation of North Texas, current Vice Chair of the ABA Tort & Insurance Practice Section Employee Benefits Committee, current Vice Chair of Policy for the Life Sciences Committee of the ABA International Section, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, a current Defined Contribution Plan Committee Co-Chair, former Group Chair and Co-Chair of the ABA RPTE Section Employee Benefits Group, immediate past RPTE Representative to ABA Joint Committee on Employee Benefits Council Representative and current RPTE Representative to the ABA Health Law Coordinating Council, former Coordinator and a Vice-Chair of the Gulf Coast TEGE Council TE Division, past Chair of the Dallas Bar Association Employee Benefits & Executive Compensation Committee, a former member of the Board of Directors of the Southwest Benefits Association and others.

Ms. Stamer also is a highly popular lecturer, symposia chair and author, who publishes and speaks extensively on health and managed care industry, human resources, employment, employee benefits, compensation, and other regulatory and operational risk management. Examples of her many highly regarded publications on these matters include the “Texas Payday Law” Chapter of Texas Employment Law, as well as thousands of other publications, programs and workshops these and other concerns for the American Bar Association, ALI-ABA, American Health Lawyers, Society of Human Resources Professionals, the Southwest Benefits Association, the Society of Employee Benefits Administrators, the American Law Institute, Lexis-Nexis, Atlantic Information Services, The Bureau of National Affairs (BNA), InsuranceThoughtLeaders.com, Benefits Magazine, Employee Benefit News, Texas CEO Magazine, HealthLeaders, the HCCA, ISSA, HIMSS, Modern Healthcare, Managed Healthcare, Institute of Internal Auditors, Society of CPAs, Business Insurance, Employee Benefits News, World At Work, Benefits Magazine, the Wall Street Journal, the Dallas Morning News, the Dallas Business Journal, the Houston Business Journal, and many other symposia and publications. She also has served as an Editorial Advisory Board Member for human resources, employee benefit and other management focused publications of BNA, HR.com, Employee Benefit News, InsuranceThoughtLeadership.com and many other prominent publications and speaks and conducts training for a broad range of professional organizations and for clients on the Advisory Boards of InsuranceThoughtLeadership.com, HR.com, Employee Benefit News, and many other publications. For additional information about Ms. Stamer, see CynthiaStamer.com or contact Ms. Stamer via email here or via telephone to (469) 767-8872.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press, Inc.™ resources at SolutionsLawPress.com such as:

  • DOL Aggressively Targeting Restaurants For Wage & Hour & Child Labor Law Violations
  • Stop Bullying Month Opportunity to Strengthen Workplace Anti-Harassment Efforts
  • Health Plans, Other Covered Entities Have Continuing Duty To Reevaluate HIPAA Enterprise Risk To PHI & Address Security Risks & Other Compliance Concern On Ongoing Basis
  • New ACA Student Health Insurance Guidance Allows College Payment Of Working Students’ Student Health Insurance Premiums Post 2016
  • ERISA Violations Cost More Now
  • IRS Qualified Plan Correction Procedures Changing 1/1/17
  • DOL Invites FLSA Section 14(c) Certificateholders Test Prototype Application
  • Private Exchanges: Employer Health Program Panacea or Problem? Consider Carefully!
  • New DOL, IRS & HHS FAQ Confirms Employers Can’t Pay, Use HRAs to Reimburse Employees For Individual Policy Premiums
  • Review Health Plans With Reference-Based Reimbursement Designs Under New Agency FAQ Guidance
  • IRS Guidance Raises Concerns For Many Employers Offering “Skinny” & Other Limited Coverage Health Plans
  • Plan’s Purchase of Company Stock Triggers $6.48 Million Award Against ESOP Sponsor, Shareholder, Board Members & Trustees
  • Encourage Workers To Review Withholding As Part Of Annual Enrollment
  • Making Wellness Work On A Shoestring Budget
  • Brace For OCR HIPAA Audits
  • Check Health Plan Privacy For New Guidance Compliance
  • Health Benefit Still Top Employer Benefit Cost
  • Congress Passess Joint Resolution Overturning NLRB “Quickie Election Rule”
  • U.S. Businesses & Their Leaders Face Rising FLSA Collective Action Liability Risks
  • Improve HR Value To Company By Making HR A Performance Rather Than People Department
  • Sponsoring Employers Face Excise Taxes, Other Liabilities Unless Health Plans Comply With ACA Out-Of-Pocket & Other Federal Rules
  • Legal Review Of Health Plan Documents, Processes Needed To Mitigate Employer’s Excise Tax & Other Health Plan Risks
  • EEOC ADA Suit Against Magnolia Health Highlights US Employer’s Growing Disability Discrimination Risks
  • 10 Practical Pointers To Use Law To Better Strengthen The Legal Defensibility Of Your Business & Its Leaders
  • Health Insurer/Vendor’s Claims & Appeals Deficiencies Could Trigger Significant Employer Excise Tax Liability
  • EEOC Charges Employer Violated ADA By Terminating Employment At FMLA Leave End
  • Businesses Should Verify Proper Tracking, Withholding & Reporting On Tips & Gratuities

If you or someone else you know would like to receive future updates about developments on these and other concerns, please provide your current contact information and preferences including your preferred e-mail by creating or updating your profile here.

©2016 Cynthia Marcotte Stamer. Non-exclusive right to republish granted to Solutions Law Press, Inc. All other rights reserved.

Comments Off on DOL Appeals Preliminary Injunction Blocking White Collar Exemption Salary Threshhold Change | Appeals, board of directors, compensation, compliance, Corporate Compliance, corporate governance, directors, employee, Employer, Employers, Employment, Fair Labor Standards Act, Labor Management Relations, Non-Exempt, OFCCP, Risk Management, Salaried, Uncategorized, Worker Classification, Workforce | Permalink
Posted by Cynthia Marcotte Stamer