Tag Archives: HHS

Regulatory roundup

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

Agencies release final rule on short-rerm, limited duration health insurance
The Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA), the Department of Treasury, and the Department of Health and Human Services (HHS) issued a final rule amending the definition of short-term, limited-duration health insurance that individuals may purchase. The final rule permits insurers to sell policies that cover periods longer than the three-month maximum permitted under the Patient Protection and Affordable Care Act (ACA), allowing for an initial period of 364 days and for renewals of up to 36 months.

To read the entire final rule, click here.

Medicare Part D premiums continue to decline in 2019
The Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a 2019 Medicare Part D prescription drug plan is projected to decline for the second year in a row. Earlier this year, CMS announced several changes in the Part D program aimed at further empowering Part D plans to drive a hard bargain with drug manufacturers and lower the cost of prescription drugs. CMS has been working to ensure that Medicare Part D plans can leverage all of the tools that are available to commercial plans in negotiations.

To learn more, click here.

CBO publishes report on the cost related to employer mandate repeal and Cadillac tax delay
The Congressional Budget Office (CBO) released estimates related to the cost of the “Employer Relief Act” (H.R.4616), which would suspend the collection of penalties on large employers that decline to offer qualifying health insurance coverage for plan years 2015-2018 and delay implementation of the excise (“Cadillac”) tax on high-premium insurance plans by one year. The report assessed the costs based on the legislative text approved by the House Ways and Means Committee on July 11.

To learn more, click here.

Rebate considerations for prescription drug stakeholders

The prescription drug distribution chain is complex and involves several stakeholders. There are generally six in the supply and demand of prescription drugs: pharmaceutical manufacturers, health insurers (including self-insured employers), pharmacy benefit managers (PBMs), pharmacies, wholesalers, and patients.

These stakeholders’ contracts determine how much a patient’s health insurance pays for prescription drugs and the patient’s out-of-pocket costs. Pharmaceutical manufacturer rebates are one of the key drivers that influence how health insurers cover prescription drugs. Rebates affect the finances of all stakeholders involved in the prescription drug distribution chain.

Prescription drug rebates are generally paid by a pharmaceutical manufacturer to a PBM, who then shares a portion with the health insurer. Rebates are mostly used for high-cost brand-name prescription drugs in competitive therapeutic classes where there are interchangeable products (rarely for generics), and aim to incentivize PBMs and health insurers to include the pharmaceutical manufacturer’s products on their formularies and to obtain preferred “tier” placement.

The May 2018 “American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs” from the U.S. Department of Health and Human Services targets rebates as part of its goal to lower prescription drug prices. In this article, Milliman’s Gabriela Dieguez, Maggie Alston, and Samantha Tomicki explain the finances associated with rebates and their impact on health insurer coverage decisions.

Implications of proposed changes to short-term medical plans

In February 2018, the Departments of Health and Human Services (HHS), Labor, and the Treasury released a proposed rule that would change the maximum duration of short-term, limited-duration insurance (STLDI) policies. Under the proposed rule, STLDI plans, or “short-term medical” plans, may emerge as an alternative form of individual health insurance. In this article, Milliman actuaries Jason Karcher and Nick Ortner discuss the proposed changes and the potential effect they might have on the individual health insurance market.

Regulatory roundup

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

IRS releases final and temporary rule on health providers’ fee
The Internal Revenue Service (IRS) released final regulations that provide rules for the definition of a covered entity for purposes of the fee imposed by section 9010 of the Patient Protection and Affordable Care Act (ACA), as amended. The final regulations supersede and adopt the text of temporary regulations that provide rules for the definition of a covered entity. These regulations affect persons engaged in the business of providing health insurance for U.S. health risks.

To read the entire rule, click here.

Federal agencies propose rule on short-term, limited-duration insurance
The U.S. Departments of Treasury, Labor (DOL), and Health and Human Services (HHS) have released a proposed rule that would amend the definition of short-term, limited duration insurance for purposes of its exclusion from the definition of individual health insurance coverage.

The proposed rule would make it easier to obtain coverage through short-term health insurance plans by allowing insurers to sell policies that last under a year. The new rules stem from an executive order the president signed in October aimed at boosting competition, giving consumers more choices, and lowering premiums.

To learn more, click here.

How CBO and JCT analyze major proposals that would affect health insurance coverage
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) released a report that estimates the budgetary effects of most types of major legislative proposals that would affect both spending and revenues using a process that involves many steps and many analysts. The report focuses on the process that the agencies use to analyze proposals affecting health insurance coverage for people under age 65, such as legislation that would make major changes to the ACA.

For more information, click here.

Regulatory roundup

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

Health plan choice and premiums in the 2018 federal health insurance exchange
The U.S. Department of Health and Human Services (HHS) has issued a brief that presents information on qualified health plans (QHPs) available on the federal health insurance exchange for states that use the HealthCare.gov platform. National estimates and summary tables are presented in each section of the text. State-specific estimates are in the appendix.

For more information, click here.

ACA AIR submission composition and reference guide published
The Internal Revenue Service (IRS) has published “Affordable Care Act (ACA) Information Returns (AIR) Submission Composition and Reference Guide.” The document provides details on composing and submitting Forms 1094/1095-B and Forms 1094/1095-C by transmitters to the IRS. The scope of the document addresses the application-to-application (A2A) messages exchanged on a Simple Object Access Protocol (SOAP) basis between client and exposed web service endpoints and the user interface (UI)-browser-based web, requiring human initiation.

For more information, click here.

Guidance on the requirements for providing a qualified small employer health reimbursement arrangement released
The IRS published Notice 2017-67 offering guidance on the requirements for providing a qualified small employer health reimbursement arrangement (QSEHRA) under section 9831(d)—which was added to the Internal Revenue Code by the 21st Century Cures Act (Cures Act)—the tax consequences of the arrangement, and the requirements for providing written notice of the arrangement to eligible employees.

For more information, click here.

IRS updates FAQs on employer-shared responsibility payments
The IRS updated its website listing frequently asked questions (FAQs) on employer-shared responsibility provisions under the Patient Protection and Affordable Care Act (ACA), including questions and answers regarding employer-shared responsibility payments.

For more information, click here.

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.