Tag Archives: Regs and guidance

Regulatory roundup

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

Cost-sharing reduction subsidies to seize
The Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma issued a memorandum stating cost-sharing reduction (CSR) payments made to issuers of qualified health plans will stop. The decision is based on a legal opinion provided by the Office of the Attorney General.

Executive order on healthcare allows the purchase of insurance across state lines
President Donald Trump signed an executive order on healthcare directing the Department of Labor (DOL) to updated rules allowing small employers to create association health plans. Small businesses will be able to band together if they are within the same state, in the same line of business, or are in the same trade association.

For more information, click here.

Proposed extension of information collection request submitted for public comment
The DOL released a notice providing the general public and federal agencies the opportunity to comment on a revision of the “Coverage of certain preventive services under the Affordable Care Act—private sector” information collection request (ICR). The notice was issued to align the ICR with the executive order signed on May 4, 2017, “Executive order promoting free speech and religious liberty.”

For more information, click here.

Regulatory roundup

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

Medicare offers more health coverage choices and decreased premiums in 2018
The Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. CMS estimates that the Medicare Advantage average monthly premium will decrease by $1.91 (about 6 percent) in 2018. More than three-fourths (77 percent) of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium for 2018.

For more information, click here.

Fee funding the Patient-Centered Outcomes Research Trust Fund issued
The IRS released Notice 2017-61 which provides the adjusted applicable dollar amount to be multiplied by the average number of covered lives for purposes of the fee imposed by §§ 4375 and 4376 of the Internal Revenue Code for policy years and plan years that end on or after October 1, 2017, and before October 1, 2018.

The fee imposed by §§ 4375 and 4376 helps to fund the Patient-Centered Outcomes Research Trust Fund (PCORTF) and is calculated using the average number of lives covered under the policy or plan and the applicable dollar amount for that policy year or plan year.

The applicable dollar amount that must be used to calculate the fee imposed by §§ 4375 and 4376 for policy years and plan years that end on or after October 1, 2017, and before October 1, 2018, is $2.39. The increase from the prior amount is calculated by multiplying the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year, $2.26, by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on February 14, 2017.

For more information, click here.

Regulatory roundup

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

CMS announces special enrollment periods for Americans impacted by recent hurricanes
As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare and Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This important step gives these individuals and families who have been impacted by the hurricanes the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the exchange immediately if eligible for a special enrollment period.

To learn more, click here.

Regulatory roundup

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

IRS issues guide on ACA information returns
The Internal Revenue Service (IRS) released Publication 5258, “Affordable Care Act (ACA) Information Returns (AIR) Submission Composition and Reference Guide.” The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to the IRS.

To download the guide, click here.

IRS issues guide on electronic filing of ACA information returns
The IRS released Publication 5165, “Guide for Electronically Filing Affordable Care Act (ACA) Information Returns for Software Developers and Transmitters.” The guide outlines the communication procedures, transmission formats, business rules, and validation procedures for information returns transmitted electronically through the AIR system.

To download the guide, click here.

Regulatory roundup

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

New report on the ACA’s transitional reinsurance program
The Congressional Research Service has published the report “The Patient Protection and Affordable Care Act’s (ACA’s) Transitional Reinsurance Program.” The report provides an overview of the risk mitigation program. The first section of the report provides background information on reinsurance and the ACA risk-mitigation programs. The second section describes the components of the transitional reinsurance program, as well as implementation of and experience with the program. The third section discusses questions regarding the scope of the authority of the U.S. Department of Health and Human Services (HHS) to administer the transitional reinsurance program, including those raised by a 2016 Government Accountability Office report.

To download the entire report, click here.

CDC report on health insurance coverage
The Centers for Disease Control and Prevention (CDC) published a report providing health insurance estimates from the first quarter of the 2017 National Health Interview Survey. Highlights from the report include:

• In the first three months of 2017, 28.1 million (8.8%) persons of all ages were uninsured at the time of interview—0.5 million fewer persons than in 2016 (a nonsignificant difference) and 20.5 million fewer persons than in 2010.
• Among adults aged 18 to 64, 70.5% (138.8 million) were covered by private health insurance plans at the time of interview in the first three months of 2017. This includes 4.8% (9.4 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
• The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan (HDHP) increased, from 39.4% in 2016 to 42.3% in the first three months of 2017.

To download the entire CDC report, click here.

Regulatory roundup

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

Draft ACA substitute Forms 1094 and 1095 published
The Internal Revenue Service (IRS) released a draft of Publication 5223 specifying general rules and specifications for Patient Protection and Affordable Care Act (ACA) Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C, if you will not be using the official IRS Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C, to furnish statements to recipients.

To download a copy of the draft, click here.