Tag Archives: Regs and guidance

2020 cost-of-living adjustments for Medicare

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has announced cost-of-living adjustments (COLAs) for Medicare Parts A and B for 2020. In April this year, CMS announced the 2020 amounts for the Medicare Part D standard prescription drug benefit.

For more perspective, read this Milliman Client Action Bulletin.

Regulatory roundup

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

HHS issues final rule on standard unique health plan identifier and other entity identifier
The U.S. Department of Health and Human Services (HHS) released a final rule that rescinds the adopted standard unique health plan identifier (HPID) and the implementation specifications and requirements for its use, and the other entity identifier (OEID) and implementation specifications for its use. The final rule also removes the definitions for the “controlling health plan” and “subhealth plan.”

To learn more, click here.

ACA Information Returns Submission Composition and Reference Guide issued
The Internal Revenue Service (IRS) published the latest version of the ACA Information Returns (AIR) Guide. The AIR Project is responsible for delivering applications, infrastructure, and supporting processes required to process information returns. In January 2016, filing Forms 1094/1095-B and Forms 1094/1095-C became mandatory. The IRS will begin accepting TY2019 Forms 1094/1095-B and Forms 1094/1095-C, as well as original prior year forms and corrections, in January 2020.

To learn more, click here.

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.

Executive Order protecting and improving Medicare issued

President Donald Trump signed an Executive Order stating it would improve private Medicare plans for seniors. The Executive Order is expected to bolster Medicare Advantage, offer more affordable plan options, encourage wider use of telehealth services, promote wellness benefits, and bring payments in Medicare fee-for-service programs in line with payments for Medicare Advantage.

To learn more, click here.

Opportunity for states to participate in a wellness program demonstration project

The Centers for Medicare and Medicaid Services (CMS), in consultation with the U.S. Departments of Labor (DOL) and the Treasury, announced an opportunity for states to apply to participate in a wellness program demonstration project. Participating states may implement nondiscriminatory health-contingent wellness programs in the individual market, as described in section 2705(l) of the Public Health Service Act (PHS Act).

For more information, click here.

An overview of the Prescription Drug Pricing Reduction Act

The Prescription Drug Pricing Reduction Act (PDPRA) of 2019 proposes changes to the Medicare Part D program that could impact all stakeholders beginning as early as 2021. The Senate Finance Committee approved a draft of this Act on July 25, 2019. The key provisions affecting Part D include:

1. Redesigning the Part D benefit, including eliminating the current coverage gap phase, establishing an out-of-pocket maximum for beneficiary cost sharing, and splitting the cost of catastrophic phase claims between plan sponsors, the federal government, and drug manufacturers.

2. Requiring drug manufacturers to pay a rebate directly to the federal government if prices for certain Part D drugs increase faster than inflation.

3. Mandating public disclosure of aggregate rebates, discounts, and other pharmacy benefit manager (PBM) contract provisions.

In this article, Milliman consultants provide an overview of these provisions and the potential effects on Part D stakeholders. The PDPRA also proposes changes to the Medicare Part B and Medicaid programs. However, the authors only focus on the proposed changes relating to Medicare Part D.

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.