Tag Archives: House of Representatives

Regulatory roundup

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

Proposed rule on health insurance premium tax credit
The Internal Revenue Service (IRS) released proposed regulations relating to the health insurance premium tax credit and the individual shared responsibility provision. These proposed 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.

The proposed regulations also affect individuals who are eligible for employer-sponsored health coverage and individuals who seek to claim an exemption from the individual shared responsibility provision because of unaffordable coverage. Although employers are not directly affected by rules governing the premium tax credit, these proposed regulations may indirectly affect employers through the employer shared responsibility provisions and the related information reporting provisions.

To read the entire proposed rule, click here.

House approves bill on health flexible spending, health savings accounts
The U.S. House of Representatives voted 243-164 to approve the Restoring Access to Medication and Improving Health Savings Act (H.R.1270). The bill would repeal the tax code’s provisions that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin, thereby allowing distributions from such accounts for over-the-counter drugs.

The repeal would apply to drug expenses incurred after December 31, 2015. The bill would also reduce the threshold at which individuals must fully repay any excess cost-sharing subsidies they received to help them purchase health insurance on an exchange. The Joint Committee on Taxation estimated that the bill would raise $2.17 billion over 10 years and increase the number of uninsured by 130,000.

CMS: When must 2017 edition of SBC template be used?
The Centers for Medicare and Medicaid Services (CMS) released guidance recently addressing the applicability date of the Summary of Benefits and Coverage (SBC) template and associated documents that were published on April 6, 2016.

For more information, 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.

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.

Regulatory roundup

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

“Doc fix” bill to call for means testing of higher-income Medicare beneficiaries
A bipartisan, bicameral agreement on legislation to permanently repeal the Medicare physician payment formula—the “sustainable growth rate” (SGR)—was introduced in the House and Senate on March 19, with House and Senate leaders hoping to clear the proposal before the April 1 date when doctors would otherwise face a 21% cut to the reimbursements they receive under Medicare. The “doc fix” has been extended numerous times in the past via temporary patches without revenue offsets; the new proposal (unnumbered) reportedly includes some revenue raisers, in the form of “means testing” for more affluent Medicare recipients. The agreement is expected to cost about $200 billion (over 10 years), but only about $70 billion would be offset.

The initial legislative language released does not include the revenue provisions. However, documents released earlier from the bill’s negotiating team indicated that the $70 billion in offsets would be split between Medicare providers and beneficiaries. On the beneficiary side, the documents suggested phasing in a requirement that higher-income beneficiaries (possibly, for example, individuals/families with incomes of $133,000/$260,000) pay more for Medicare Parts B and D benefits and that beneficiaries pay more out-of-pocket expenses before Medigap supplemental policies pay out (i.e., it would prohibit first-dollar Medigap policies).

House approves bill exempting volunteer firefighters from ACA mandate
On March 16, the U.S. House voted 415-0 to approve the Protecting Volunteer Firefighters and Emergency Responders Act (H.R.1191), sending the bill to the Senate.

The bill would amend the tax code to exclude services rendered by bona fide volunteers providing firefighting and prevention services, emergency medical services, or ambulance services to a state or local government or a tax-exempt charitable organization from the category of “employees.” The Patient Protection and Affordable Care Act (ACA) mandates that large employers provide minimum essential healthcare coverage.

The bill defines “bona fide volunteer” as having compensation only in the form of reimbursement for (or reasonable allowance for) reasonable expenses incurred in the performance of volunteer services; or reasonable benefits (including length-of-service awards) and nominal fees customarily paid by similar entities for the services of volunteers.

By regulations, the Internal Revenue Service (IRS) already does not count volunteer fire departments or ambulances as employers under the ACA mandate, so the bill puts into law what the regulations provide.

Treasury, DOL, HHS release final rule on excepted benefits
The U.S. Departments of the Treasury, Labor (DOL), and Health and Human Services (HHS) have issued a final rule on excepted benefits to specify requirements for limited wraparound coverage to qualify as an excepted benefit.

The final rules permit group health plan sponsors, in limited circumstances, to offer wraparound coverage to employees who are purchasing individual health insurance in the private market, including in the health insurance marketplace. The rule sets forth two pilot programs for limited wraparound coverage. One pilot allows wraparound benefits only for multistate plans in the health insurance marketplace. The other allows wraparound benefits for part-time workers who enroll in an individual health insurance policy or in basic health plan coverage for low-income individuals established under the ACA. These workers could, under existing excepted benefit rules, qualify for a flexible spending arrangement (FSA) alternative to this wraparound coverage.

The final rules give employees who otherwise may not be able to get employer-based benefits access to high-level benefits.

To read the entire final rule, click here.

Regulatory roundup

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

House passes ACA exemption for volunteer responders from employee count
On January 12, the U.S. House of Representatives voted to approve the Protecting Volunteer Firefighters and Emergency Responders Act (H.R.33). This bill would exclude volunteer firefighters from the definition in the Patient Protection and Affordable Care Act (ACA) of full-time employees, thereby exempting volunteer fire companies from the law’s health insurance mandate.

The bill would amend tax code Section 4980H(c) to exempt bona fide volunteers of government and nonprofit organizations from counting toward the employer mandate threshold. The bill requires Senate action.

IRS issues guidance for filing Form 8922 regarding third-party sick pay recap
The Internal Revenue Service (IRS) has released Notice 2015-06. The notice describes the rules for filing Form 8922, Third-Party Sick Pay Recap, an annual form filed with the IRS, which replaces third-party sick pay recaps that were filed with the Social Security Administration.

Form 8922 is used to report total amounts of certain sick pay paid to employees by a third party (an entity other than the employee’s employer). Form 8922, which applies to sick pay paid on or after January 1, 2014, must be filed if liability for the payment and reporting of Federal Insurance Contributions Act (FICA) taxes with respect to third-party sick pay is split between the employer and a third party under applicable regulations. The notice also describes the requirements for payment and reporting of FICA taxes, Federal Unemployment Tax Act (FUTA) taxes, and income tax withholding with respect to sick pay.

Notice 2015-06 will be published in Internal Revenue Bulletin 2015-05 on February 2, 2015. To read the entire notice, click here.

Regulatory roundup

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

House passes bill increasing full-time work threshold to 40 hours under the ACA
The House has voted to approve the Save American Workers Act (H.R. 30), which would raise the threshold for full-time employment under the Patient Protection and Affordable Care Act (ACA) from 30 hours to 40 hours per week. A comparable Senate bill (S. 30) has been introduced.

House approves bill exempting veterans from ACA count by private employers
The U.S. House of Representatives recently voted to approve the Hire More Heroes Act (H.R.22), which would exempt employees with health coverage under TRICARE or the Veterans Administration from being counted by employers under the ACA’s employer mandate. The bill excludes such individuals from the employee count when an employer determines whether it is an applicable large employer subject to the requirement to provide affordable healthcare coverage. The bill calls for an effective date of months beginning after December 31, 2013. The bill must be approved by the Senate to advance.

IRS updates publication on medical and dental expenses
The Internal Revenue Service (IRS) has updated Publication 502, Medical and Dental Expenses. The publication explains itemized deductions for medical and dental expenses, including the Health Coverage Tax Credit.

To read the updated publication, click here.

Updates to HIPAA exemption election guidance
The Center for Consumer Information and Insurance Oversight (CCIIO) has announced procedures and requirements regarding a plan sponsor’s election to exempt its group health plan from certain requirements of Title XXVII of the Public Health Service (PHS) Act. This guidance follows up on the final regulation for the HIPAA opt-out election process.

After December 31, 2014, opt-out elections must be submitted electronically. For electronic submission of elections, plan sponsors will need to register for access to the Non-Federal Governmental Plans Module (Non-Fed Module) in the Health Insurance Oversight System (HIOS).

To read the entire user manual, click here. For more information, click here.