Tag Archives: HHS

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.

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.