Tag Archives: House of Representatives

Overview of proposed Value in HealthCare Act

At the end of July, a bipartisan bill entitled “Value in HealthCare Act of 2020” was introduced to the U.S. House of Representatives proposing a number of significant changes to the Centers for Medicare and Medicaid Services Medicare Shared Savings Program (MSSP) and the Advanced Alternative Payment Model feature of the Medicare Access and CHIP Reauthorization Act of 2015.

Given the timing of this bill, there is uncertainty about whether (or when) the bill will be passed into law. However, the introduction of it is a significant step towards encouraging value-based care and signifies an appetite for change in the MSSP in order to encourage additional participation of Accountable Care Organizations (ACOs).

In this paper, Milliman actuaries Noah Champagne and Andrew Yang discuss the proposed changes in this bill as well as the implications of each change on ACOs—in particular those under the Pathways to Success model.

Regulatory roundup

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

House committees approve bill on prescription drug price negotiation

The House Education and Labor Committee approved the Lower Drug Costs Now Act (H.R.3), a bill that would require the federal government to directly negotiate prices for certain high-cost drugs that have little or no competition in the market.

Negotiated prices would apply to individuals enrolled in Medicare, as well as group or individual health insurance. Group health plans and health insurers could elect not to participate in the program for a drug, but would have to publicly disclose their elections.

To learn more, click here.

Regulatory roundup

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

House approves “Cadillac” tax repeal

The U.S. House of Representatives voted to repeal the “Cadillac” tax on “high-cost” employer health plans from the Patient Protection and Affordable Care Act (ACA). The application of the 40% tax on employer-sponsored health plans costing more than an estimated $11,200/$30,100 for individuals/families in 2022 (when the tax would be in effect under current law) has been delayed several times since its 2018 initial application date.

For more information, click here.

House panel advances legislation to stop surprised medical bills

The U.S. House’s Energy and Commerce Committee approved a bill (H.R. 2328) that includes provisions to address “surprise” medical bills that patients encounter when healthcare providers charge for services or items that insurers will not cover or when they receive care from an out-of-network provider at an otherwise in-network facility. The bill protects patients from surprise bills in emergency situations, patients who didn’t specifically choose to see an out-of-network physician for scheduled care, and patients in situations where no in-network provider is available to treat them.

To learn more, click here.

IRS expands list of preventive care for HDHP participants

The Internal Revenue Service (IRS) added care for a range of chronic conditions to the list of preventive care benefits that may be provided by a high-deductible health plan (HDHP). Notice 2019-45 lists the new types of medical care that may be treated as preventive care for this purpose.

To learn more, click here.

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.