Tag Archives: HHS

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.

Regulatory roundup

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

Employer shared responsibility appeal form released
The U.S. Department of Health and Human Services (HHS) issued a health insurance marketplace appeal request form for employers.

To download a copy of the form, click here.

Spending for Social Security and major healthcare programs
The Congressional Budget Office (CBO) published the report “The 2016 Long-Term Budget Outlook,” which describes the agency’s projections of federal spending, revenues, deficits, and debt over the next 30 years.

The CBO projects that spending for Social Security would increase noticeably as a share of the economy—from 4.9% of gross domestic product (GDP) in 2016 to 6.3% in 2046—if current laws generally remained unchanged. Spending for the major healthcare programs is projected to grow even faster—net outlays for those programs would increase from 5.5% of GDP now to 8.9% in 2046. The major healthcare programs include Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), as well as spending on subsidies for health insurance purchased through the marketplaces established by the Patient Protection and Affordable Care Act (ACA) and related spending. About three-quarters of the increase in spending for the major healthcare programs would be for Medicare.

To download the report, click here.

Regulatory roundup

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

Drafts of ACA 2016 reporting Forms 1095-C, 1094-C released
The Internal Revenue Service (IRS) released drafts of two forms for reporting 2016 health coverage information under the Patient Protection and Affordable Care Act (ACA).

Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, are to be filed in early 2017. The draft forms are for employer planning purposes and may change before their final release later in 2016.

For more information about Form 1095-C, click here.
For more information about Form 1094-C, click here.

ACA-HIPAA grandfathered and non-grandfathered group health plan checklists
The Center for Consumer Information and Insurance Oversight of the Centers for Medicare and Medicaid Services (CMS) released two checklists containing summaries of certain provisions applicable to grandfathered and non-grandfathered, self-funded, non-federal governmental group health plans.

For a summary of certain provisions applicable to grandfathered plans, click here.
For a summary of certain provisions applicable to non-grandfathered plans, click here.

Overview of health insurance exchanges
The Congressional Research Service released “Overview of Health Insurance Exchanges,” which provides a summary of the various components of the health insurance exchanges. The report includes information about how exchanges are structured, the intended consumers for health insurance exchange plans, and consumer assistance available in the exchanges, as specified in the ACA. The report also describes the availability of financial assistance for certain exchange consumers and small businesses and outlines the range of plans offered through exchanges. Moreover, the report provides a brief summary of the implementation and operation of exchanges since 2014.

To read the entire report, click here.

Regulatory roundup

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

House panel advances health bills
The House Ways and Means Committee approved seven healthcare bills recently, including the following that would apply to employer-sponsored plans:

• H.R.5445 (the “Health Care Security Act”), which would increase the annual contribution limits for health savings accounts (HSAs), allow for catch-up contributions by both spouses to a single account, and permit the payment of expenses incurred 60 days before an account is established.
• H.R.5447 (the “Small Business Health Care Relief Act”), which would permit qualified small employers that do not offer a group health plan to reimburse up to $5,130 annually/employee ($10,260/family) for the cost of buying health insurance.
• H.R.210 (the “Student Worker Exemption Act”), which would exclude full-time students who are employed by an institution of higher education from being counted as full-time employees in calculating the institution’s shared responsibility coverage requirement under the Patient Protection and Affordable Care Act (ACA).
• H.R.3080 (the “Tribal Employment and Jobs Protection Act”), which would eliminate the ACA’s employer mandate for businesses owned by Indian tribes.

House panel approves mental health bill with group health plan implications
The House Energy and Commerce Committee voted 53-0 to approve a substitute mental health bill (H.R.2646) called the “Helping Families in Mental Health Crisis Act.” The full House is not expected to act on the measure until sometime in September.

The bill generally calls for improving oversight of certain mental health and substance abuse programs. There are, however, some provisions that affect employer-sponsored plans, including a directive for the Departments of Health and Human Services, Labor, and Treasury to coordinate and issue a “compliance program guidance” document relating to mental health parity that provides examples/illustrations of informative disclosures and nonquantitative treatment limitations, as well as descriptions of the violations uncovered during the course of compliance investigations.

In addition, if a group health plan or group insurance provides coverage for eating disorder benefits, then the plan/insurance, under the bill, must provide such benefits consistent with the mental health/substance use disorder benefits parity requirements.

Regulatory roundup

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

Treasury, DOL, HHS issue proposed rule on expatriate health plans
The Departments of Treasury, Labor (DOL), and Health and Human Services (HHS) have released a proposed regulation on the rules for expatriate health plans, expatriate health plan issuers, and qualified expatriates under the Expatriate Health Coverage Clarification Act of 2014 (EHCCA).

The proposed rule affects expatriates with health coverage under expatriate health plans and sponsors, issuers and administrators of expatriate health plans, individuals with and plan sponsors of travel insurance and supplemental health insurance coverage, and individuals with short-term, limited-duration insurance.

For more information, click here.

Regulatory roundup

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

New ACA implementation FAQs: Preventive services, mental health parity, and women’s health
The U.S. Departments of Treasury, Labor (DOL), and Health and Human Services (HHS) published frequently asked questions (FAQs) about the Patient Protection and Affordable Care Act (ACA) implementation (Part 31). The FAQ covers:

• Coverage of Food and Drug Administration (FDA)-approved contraceptives
• Rescissions
• Out-of-network emergency services
• Coverage for individuals participating in approved clinical trials
• Limitations on cost-sharing under the ACA
• Mental Health Parity and Addiction Equity Act of 2008
• The Women’s Health and Cancer Rights Act

To read the entire FAQ, click here.