Tag Archives: GAO

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Q&A issued following final rule on association health plans case
The U.S. Department of Labor (DOL) released questions and answers (Q&As) regarding the federal district court case ruling in State of New York v. United States Department of Labor concerning the department’s final rule on association health plans (AHPs).

The DOL published the Q&A to address questions that may arise in relation to the District Court’s decision. The Q&A will be updated as this matter evolves. The questions are:

• I get my benefits through an AHP. Does the court decision mean that my healthcare claims will not be paid?
• Will the Department appeal the decision?
• Do state insurance departments still have regulatory oversight of AHPs?
• May I contact the Department of Labor if I have more questions or concerns about the impact of the court ruling on my AHP?

To read the entire Q&A, click here.

New resource to help employers understand mental health issues
The DOL, in coordination with the Office of Disability Employment Policy (ODEP) and its Employer Assistance and Resource Network on Disability Inclusion (EARN), has launched a new resource to help employers better understand mental health issues and to provide guidance on how to cultivate a supportive workplace.

The Mental Health Toolkit is an online resource providing background, tools, and resources for employers seeking to offer a mental health-friendly workplace. It presents a framework for fostering a supportive workplace built around awareness, accommodations, assistance, and access.

To read the toolkit, click here.

New report focuses on healthcare costs of untreated behavioral health conditions
The Government Accountability Office (GAO) released “Behavioral Health: Research on Health Care Costs of Untreated Conditions is Limited.” GAO was asked to describe what is known about adults with untreated behavioral health conditions. This report examines (1) reasons why some adults with behavioral health conditions do not receive treatment for their condition, and (2) what is known about the healthcare costs associated with untreated behavioral health conditions in adults.

To download the report, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

CBO releases analysis on specialty drugs in Medicare Part D and Medicaid
The Congressional Budget Office (CBO) published “Prices for and Spending on Specialty Drugs in Medicare Part D and Medicaid: An In-Depth Analysis.” The report examines the net prices paid for specialty drugs and spending on those drugs in Medicare Part D and Medicaid over the 2010–2015 period. In each program, the net price for many drugs is lower than the amount paid to pharmacies, also referred to as the retail price, because of manufacturers’ rebates and other discounts.

For more information, click here.

Private health insurance enrollment report published
The Government Accountability Office (GAO) released “Private Health Insurance: Enrollment Remains Concentrated Among Few Issuers, Including Exchanges.” The report found that enrollment in private health insurance plans continued to be concentrated among a small number of issuers in 2015 and 2016.

In the overall large group market (coverage offered by large employers), small group market (coverage offered by small employers), and individual market (coverage sold directly to individuals), the three largest issuers held 80% of the market or more in at least 37 of 51 states. This is similar to what GAO previously reported for 2011 through 2014.

For more information, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS releases Draft 2018 IRS Form 1095-C and Form 1094-C
The Internal Revenue Service (IRS) has released Draft 2018 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage and Draft 2018 Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. The instructions have not been released that contain the due dates of the forms.

GAO-defined “employer” under Section 3(5) of ERISA
The Government Accountability Office (GAO) reviewed the new rule from the Employee Benefits Security Administration of the U.S. Department of Labor (DOL) on the definition of “employer” under section 3(5) of ERISA—Association Health Plans. The GAO found that (1) the final rule (a) establishes under Title I of ERISA additional criteria under ERISA section 3(5) for determining when employers may join together in a group or association of employers that will be treated as the “employer” sponsor of a single multiemployer “employee welfare benefit plan” and “group health plan,” as those terms are defined in Title I of ERISA; (b) states that, by establishing a more flexible commonality of interest test for the employer members than DOL had adopted in sub-regulatory interpretive rulings under ERISA section 3(5) and otherwise removing undue restrictions on the establishment and maintenance of Association Health Plans (AHPs) under ERISA, the regulation facilitates the adoption and administration of AHPs and expands access to affordable health coverage, especially for employees of small employers and certain self-employed individuals; and (c) sets out the criteria that would permit, solely for purposes of Title I of ERISA, certain working owners of an incorporated or unincorporated trade or business, including partners in a partnership, without any common-law employees, to qualify as employers for purposes of participating in a bona fide group or association of employers sponsoring an AHP and also to be treated as employees with respect to a trade, business, or partnership for purposes of being covered by the AHP; and (2) DOL complied with the applicable requirements in promulgating the rule.

For more information, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

Results of GAO study on undercover testing for ACA coverage
The Government Accountability Office (GAO) recently released “Results of recent undercover testing for Patient Protection and Affordable Care Act coverage, and review of market concentration in the private insurance markets” (GAO-16-882T).

For its undercover testing of the 2015 coverage year, GAO submitted fictitious applications for subsidized coverage through the federal marketplaces in New Jersey and North Dakota, and through state-based marketplaces in Kentucky and California.

For the 2016 coverage year, GAO submitted fictitious applications through the federal marketplaces in Virginia and West Virginia, and through the state-based marketplace in California. The results of these undercover tests, while illustrative, cannot be generalized to the full population of enrollees.

To review market concentration, GAO examined data reported by issuers to the Centers for Medicare and Medicaid Services (CMS) for fiscal years 2011 through 2014, the latest data available.

To download the entire report, click here.

Health insurance coverage in the United States
The U.S. Census Bureau report “Health insurance coverage in the United States: 2015” presents statistics on health insurance coverage in the United States based on information collected in the 2014, 2015, and 2016 Current Population Survey Annual Social and Economic Supplements (CPS ASEC) and the American Community Survey (ACS).

Here are some of the report’s highlights:

• The percentage of people with health insurance coverage for all or part of 2015 was 90.9%, higher than the rate in 2014 (89.6%).
• In 2015, private health insurance coverage continued to be more prevalent than public coverage, at 67.2% and 37.1%, respectively. Of the subtypes of health insurance, employer-based insurance covered 55.7% of the population for some or all of the calendar year, followed by Medicaid (19.6%), Medicare (16.3%), direct-purchase (16.3%), and military coverage (4.7%).
• Increases in both private health insurance coverage and government coverage contributed to the overall increase in coverage between 2014 and 2015. The rate of private coverage increased by 1.2 percentage points to 67.2% in 2015 (up from 66.0% in 2014), and the government coverage rate increased by 0.6 percentage points to 37.1% (up from 36.5% in 2014).

To read the entire report, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

GAO observations of ACA’s enrollment controls for coverage and subsidies
The U.S. Government Accountability Office (GAO) has issued a report entitled “Patient Protection and Affordable Care Act: Observations on 18 undercover tests of enrollment controls for health-care coverage and consumer subsidies provided under the Act.” The GAO was asked to examine controls for application and enrollment for coverage through the federal marketplace.

To read the entire report, click here.

JCT issues present law and background information on federal excise taxes
The U.S. Joint Committee on Taxation (JCT) released a report entitled “Present law and background information on federal excise taxes” (JCT Report JCX-99-15). The document provides a description of present-law federal excise taxes and, when applicable, background information on trust funds financed with excise tax revenues.

The document contains information on excise taxes related to employee pension and benefit plans and excise taxes related to healthcare.

The entire report can be downloaded here.

IRS issues answers regarding PCORI fee
The Internal Revenue Service (IRS) has issued 16 questions and answers regarding the Patient-Centered Outcomes Research Institute (PCORI) trust fund fee.

To read the questions and answers, click here.

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

House passes “doc fix” bill with means testing of higher-income Medicare beneficiaries
The House voted to approve the Medicare Access and CHIP Reauthorization Act of 2015 (H.R.2). The bill has been sent to the Senate. A short-term extension—to be approved by the House and the Senate—will be necessary to keep physician payments from being reduced by 21% starting April 1.

Early evidence finds premium tax credit likely contributed to expanded coverage
The U.S. Government Accountability Office (GAO) has released a study entitled “Private health insurance: Early evidence finds premium tax credit likely contributed to expanded coverage, but some lack access to affordable plans” (GAO-15-312). The study came about as a result of a mandate by the Patient Protection and Affordable Care Act (ACA) for the GAO to review the affordability of health insurance coverage. The GAO examined: (1) what is known about the effects of the advance premium tax credit (APTC), and (2) the extent to which affordable health benefits plans are available and individuals are able to maintain minimum essential coverage.

To download the entire study, click here.

IRS issues private letter ruling on VEBA income used to pay benefits
The Internal Revenue Service (IRS) released a private letter ruling on the treatment of income received by a voluntary employees’ beneficiary association (VEBA) to pay plan benefits. The IRS ruled that a VEBA established by an earlier collective bargaining agreement between a union and a liquidating company to provide health insurance for retired union members is maintained pursuant to a collective bargaining agreement for the purposes of Section 419A(f)(5) of the tax code. Also, employer contributions and any income received by the VEBA and set aside to pay plan benefits is exempt function income under Section 512 and therefore won’t constitute unrelated business taxable income within the meaning of that section.

To read the entire private letter ruling, click here.