Tag Archives: HHS

Regulatory roundup

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

Technical guidance for self-insured health plans on federal external review process
The U.S. Department of Health and Human Services issued “Technical Guidance – Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Coverage.” This release replaces the technical guidance issued June 22, 2011, with standards adopted in the final regulation at 76 FR 37208 that further define requirements under Public Health Service Act (PHS Act) section 2719(b)(1).

For more information, click here.

Agencies issue ACA FAQs, Part 37
The U.S. Departments of Treasury, Labor (DoL), and Health and Human Services released frequently asked questions (FAQs) Part 37 regarding Patient Protection and Affordable Care Act (ACA) implementation. The FAQs highlight: health reimbursement arrangements (HRAs); integration of HRAs with group health plans sponsored by the employer of a spouse of an employee; Code Section 162(m)(6); and more.

To read the FAQs, click here.

DoL issues FY 2016 MHPAEA enforcement fact sheet
The Employee Benefits Security Administration (EBSA) enforces the law governing 2.2 million private employment-based group health plans, which cover 130.8 million participants and beneficiaries. EBSA relies on its 460 investigators to review plans for compliance with ERISA, including the Mental Health Parity and Addiction Equity Act (MHPAEA). EBSA released its first annual MHPAEA enforcement fact sheet, summarizing its enforcement activity in fiscal year (FY) 2015.

To read the fact sheet, click here.

Regulatory roundup

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

Final rule on health insurance premium tax credit
The Internal Revenue Service (IRS) released a final rule relating to the health insurance premium tax credit (premium tax credit). These final regulations affect individuals who enroll in qualified health plans through health insurance exchanges and claim the premium tax credit, and exchanges that make qualified health plans available to individuals and employers.

These final regulations also affect individuals who are eligible for employer-sponsored health coverage.

To read the entire rule, click here.

New HHS report details impact of the Affordable Care Act
The U.S. Department of Health and Human Services (HHS) released an extensive compilation of national and state-level data illustrating the substantial improvements in healthcare for all Americans in the last six years. According to the HHS data, the uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Patient Protection and Affordable Care Act (ACA). But beyond those people who would otherwise be uninsured, millions of Americans with employer, Medicaid, Medicare, or individual market coverage have benefited from new protections as a result of the law.

To access the report, click here.

Guide for electronically filing ACA Information Returns (AIR) for software developers and transmitters
A new IRS publication outlines the communication procedures, transmission formats, business rules, and validation procedures for information returns transmitted electronically through the AIR system.

For more information, click here.

DoL issues final rule on claims procedures for disability benefits
The U.S. Department of Labor (DoL) released a final regulation revising the claims procedure regulations under ERISA for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the ACA. This rule affects plan administrators, participants, and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

To read the final rule, click here.

2017 COLAs for Medicare benefits

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) has announced cost-of-living adjustment (COLA) figures for Medicare Part A and Part B for 2017. In April this year, CMS announced the updated amounts for the Medicare Part D standard prescription drug benefit for 2017. This Client Action Bulletin provides perspective.

Regulatory roundup

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

Agencies release mental health and substance use disorder parity guidance
The Mental Health and Substance Use Disorder Parity Task Force published its final report highlighting the progress to date on parity implementation, summaries of comments from stakeholders, and actions taken during the Task Force’s tenure. The report offers the following recommendations on how to support consumers, improve parity implementation, and enhance parity compliance and enforcement.

Parity aims to eliminate restrictions on mental health and substance use coverage—like annual visit limits, higher copayments, or different rules on how care is managed, such as frequent preauthorization requirements or medical necessity reviews—if comparable restrictions are not placed on medical and surgical benefits.

To download the entire report, click here.

IRS general rules and specifications for ACA substitute forms
The Internal Revenue Service (IRS) issued Publication 5223 setting forth 2016 requirements for using official IRS forms to file information returns with the IRS, preparing acceptable substitutes of the official IRS forms to file information returns with the IRS, and using official or acceptable substitute forms to furnish information to recipients.

To download the entire publication, click here.

Agencies release final rule on excepted benefits, lifetime and annual limits, and more
The IRS, the Department of Labor (DOL), and the Department of Health and Human Services (HHS) have released a final rule regarding the definition of short-term, limited-duration insurance for purposes of the exclusion from the definition of individual health insurance coverage, and standards for travel insurance and supplemental health insurance coverage to be considered excepted benefits. The document also amends a reference in the final regulations relating to the prohibition on lifetime and annual dollar limits.

To read the entire final rule, click here.

Regulatory roundup

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

Early release of estimates from the National Health Interview Survey
A new report from the National Center for Health Statistics (NCHS) presents selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the January–March 2016 National Health Interview Survey (NHIS), along with comparable estimates from previous calendar years.

Estimates for 2016 are based on data for 24,317 persons. Estimates of public and private coverage, coverage through exchanges, and enrollment in high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs) are also presented. Detailed appendix tables at the end of this report show estimates by selected demographics.

To read the entire report, click here.

IRS schedules two ACA webinars
The Internal Revenue Service (IRS) scheduled two free webinars on issues related to the Patient Protection and Affordable Care Act (ACA): Determining full-time status; and overview of requirements for charitable hospitals.

I. Overview of Requirements for Charitable Hospitals Under ACA (September 19 at 2 p.m. ET)

The ACA added additional requirements that affect tax-exempt hospitals. Learn about:

• Community benefit standard for 501(c)(3) hospitals
• Community health needs assessment and implementation strategy
• Financial assistance and emergency medical care policy
• Limitation on charge requirements
• Billing and collection requirements

To register for this webinar, click here.

II. Determining full-time employees for purposes of the Employer Shared Responsibility Provisions (September 22 at 2 p.m. ET)

• Determining full-time employees for purposes of the Employer Shared Responsibility Provisions
• How to determine full-time status for employees who are seasonal, part-time, or who work nontraditional schedules
• Using the look-back method and the monthly measurement method
• Initial measurement, stability, standard measurement, and administrative periods

To register for this webinar, click here.

Regulatory roundup

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

HHS sends report to Congress on telemedicine and e-health
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report that responds to the Congressional request for the U.S. Department of Health and Human Services (HHS) to provide an update on the current telehealth efforts.

The report addresses congressional interest in federal telehealth policy and coordination. While the report discusses various aspects of telehealth activities and challenges that apply in some cases to both federal government programs and the private sector, the authors focus the report primarily on activity occurring within HHS and discuss how delivery system reform initiatives may increase the use of telehealth. The report closes with a budget proposal related to telehealth in the Department’s FY2017 budget request.

To read the entire report, click here.

CCIIO issues information for FFM user fee adjustment submission requirements
The Center for Consumer Information and Insurance Oversight (CCIIO) released a web-based form through which third-party administrators (TPAs), including pharmacy benefit managers (PBMs) that provide services to self-insured group health plans offered by eligible organizations, and Federally-facilitated Marketplace (FFM) issuers that have entered into an agreement with these TPAs (including PBMs), can report contraceptive claims costs incurred by plan participants and beneficiaries.

For more information, click here and here.