Tag Archives: Regs and guidance

Regulatory roundup

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

Technical guidance for self-insured health plans on federal external review process
The U.S. Department of Health and Human Services issued “Technical Guidance – Standards for Self-Insured Non-Federal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Coverage.” This release replaces the technical guidance issued June 22, 2011, with standards adopted in the final regulation at 76 FR 37208 that further define requirements under Public Health Service Act (PHS Act) section 2719(b)(1).

For more information, click here.

Agencies issue ACA FAQs, Part 37
The U.S. Departments of Treasury, Labor (DoL), and Health and Human Services released frequently asked questions (FAQs) Part 37 regarding Patient Protection and Affordable Care Act (ACA) implementation. The FAQs highlight: health reimbursement arrangements (HRAs); integration of HRAs with group health plans sponsored by the employer of a spouse of an employee; Code Section 162(m)(6); and more.

To read the FAQs, click here.

DoL issues FY 2016 MHPAEA enforcement fact sheet
The Employee Benefits Security Administration (EBSA) enforces the law governing 2.2 million private employment-based group health plans, which cover 130.8 million participants and beneficiaries. EBSA relies on its 460 investigators to review plans for compliance with ERISA, including the Mental Health Parity and Addiction Equity Act (MHPAEA). EBSA released its first annual MHPAEA enforcement fact sheet, summarizing its enforcement activity in fiscal year (FY) 2015.

To read the fact sheet, click here.

Regulatory roundup

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

IRS updates Q&As about ACA information reporting
The Internal Revenue Service (IRS) has updated the following three question and answer (Q&A) documents regarding Patient Protection and Accountable Care Act (ACA) information reporting by employers.

Q&A about Information Reporting by Employers on Form 1094-C and Form 1095-C

Q&A on Reporting of Offers of Health Insurance Coverage by Employers (Section 6056)

Q&A on Employer Shared Responsibility Provisions Under the Affordable Care Act

Employers and coverage providers: 11 facts about healthcare information forms
Under the ACA, businesses that provide health insurance to their employees must submit information returns to the IRS and individuals reporting on health coverage. Taxpayers can use the information on these forms when they file their tax returns to verify the months that they had minimum essential coverage and determine if they satisfied the individual shared responsibility provision of the healthcare law. The IRS will use the information on the statements to verify the months of the individual’s coverage. The IRS’s “Health Care Tax Tip 2016-82” provides some information about these information return forms, the purpose of each, and noteworthy dates.

For more information, click here.

Regulatory roundup

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

Final rule on health insurance premium tax credit
The Internal Revenue Service (IRS) released a final rule relating to the health insurance premium tax credit (premium tax credit). These final 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.

These final regulations also affect individuals who are eligible for employer-sponsored health coverage.

To read the entire rule, click here.

New HHS report details impact of the Affordable Care Act
The U.S. Department of Health and Human Services (HHS) released an extensive compilation of national and state-level data illustrating the substantial improvements in healthcare for all Americans in the last six years. According to the HHS data, the uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Patient Protection and Affordable Care Act (ACA). But beyond those people who would otherwise be uninsured, millions of Americans with employer, Medicaid, Medicare, or individual market coverage have benefited from new protections as a result of the law.

To access the report, click here.

Guide for electronically filing ACA Information Returns (AIR) for software developers and transmitters
A new IRS publication outlines the communication procedures, transmission formats, business rules, and validation procedures for information returns transmitted electronically through the AIR system.

For more information, click here.

DoL issues final rule on claims procedures for disability benefits
The U.S. Department of Labor (DoL) released a final regulation revising the claims procedure regulations under ERISA for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the ACA. This rule affects plan administrators, participants, and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

To read the final rule, click here.

Regulatory roundup

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

IRS extends due dates for furnishing to individuals with 2016 Form 1095-B and Form 1095-C
The Internal Revenue Service (IRS) released Notice 2016-70, which extends the due dates for certain information reporting requirements for 2016 imposed by the Patient Protection and Affordable Care Act (ACA) under section 6055 and 6056 of the Internal Revenue Code.

Specifically, this notice extends the due date for furnishing to individuals the 2016 Form 1095-B, Health Coverage, and the 2016 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from January 31, 2017, to March 2, 2017. This notice also provides for transitional good-faith relief from the penalties imposed by sections 6721 and 6722 of the Internal Revenue Code relating to the 2016 information reporting requirements under sections 6055 and 6056.

To read the entire notice, click here.

The ACA transitional reinsurance program
The Congressional Research Service (CRS) released “The Patient Protection and Affordable Care Act’s Transitional Reinsurance 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 the amounts currently collected and remitted through the program. The third section discusses questions, including those raised by a recent Government Accountability Office (GAO) report, regarding the scope of the authority of the Department of Health and Human Services to administer the transitional reinsurance program. The last section briefly summarizes relevant legislation regarding the transitional reinsurance program.

To read the entire report, click here.

Registration now open for 2017 advance monthly payments of the Health Coverage Tax Credit
The IRS opened the new registration and enrollment process for qualified taxpayers to receive the benefit of the Health Coverage Tax Credit (HCTC) on an advance monthly basis during 2017.

Eligible taxpayers can have 72.5% of their qualified health insurance premiums paid in advance directly to their health plan administrators each month. Each payment made on their behalf to the health plan administrators lowers their out-of-pocket premium costs.

To learn more, click here.

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.

IRS announces PCORI fee
The Internal Revenue Service (IRS) released Notice 2016-64, which provides that the adjusted applicable dollar amount that applies for determining the Patient-Centered Outcomes Research Institute (PCORI) fee for policy years and plan years ending on or after October 1, 2016, and before October 1, 2017, is equal to $2.26. This adjusted applicable dollar amount has been determined using the percentage increase in the projected per capita amount of the National Health Expenditures published by the U.S. Department of Health and Human Services (HHS) in July 2016.

To read the entire notice, click here.

Report issued on expiring healthcare provisions
The Congressional Research Service (CRS) released “Health care-related expiring provisions of the 115th Congress, first session.” The report provides descriptions of selected healthcare provisions that are scheduled to expire during the 115th Congress and calendar year 2017.

The expiring provisions included in the report are those related to Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), and private health insurance programs and activities. The report also includes other healthcare provisions that were last extended under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

To read the entire report, click here.