Tag Archives: White House

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.

Regulatory roundup

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

Medicare Parts A and B cost-of-living adjustments for 2019 published
The Centers for Medicare and Medicaid Services (CMS) has issued the cost-of-living adjustments (COLAs) applicable to components in the Medicare program for 2019.

To view the rates, click here.

Bills prohibiting pharmacy “gag” clauses signed into law
President Trump signed the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act of 2018 into law. The first prohibits health insurers and pharmacy benefit managers from limiting a pharmacy’s ability to discuss cheaper drug options with consumers. These “gag” clauses prevent pharmacists from telling group health plan enrollees, and individual drug plan enrollees, whether the retail price of a drug would be cheaper than the enrollees’ copay amount.

This second prohibits a prescription drug plan under Medicare or Medicare Advantage from restricting a pharmacy from informing an enrollee of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price of the drug without health insurance coverage.

HHS releases annual civil monetary penalties inflation adjustment
The U.S. Department of Health and Human Services (HHS) is updating its regulations to reflect required annual inflation-related increases to the civil monetary penalties in its regulations, pursuant to the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015.

For more information, click here.




Final rule considerations for association health plans

In October 2017, the Trump administration issued the “Executive Order Promoting Healthcare Choice and Competition Across the United States.” This sought to provide additional health insurance coverage options for small groups and individuals outside of the Patient Protection and Affordable Care Act (ACA) market. One option the executive order addressed directly is the association health plan (AHP) for small groups and certain individuals.

In January 2018, the proposed rules for AHPs were issued, and in June 2018, the final rule was released.

Prior to the release of the final rule, associations did not have a well-defined pathway to being determined bona fide. Instead, each association’s facts and circumstances were evaluated against three broad issues:

• Does the association exist for a purpose other than providing benefits?
• Do employer members of the association have a close enough relationship to be essentially a single common entity?
• Do employer members control the health plan in form and substance?

With the new pathway identified in the June final rule, the second criteria is made much more explicit and can be satisfied by demonstrating that association members share a common industry or geography.

Many, if not most, of the currently existing associations, including local and national chambers of commerce, local or national industry groups, professional groups, and regional interest groups, could fairly easily fulfill all the conditions to become a bona fide association under the latest rules and thereby offer a large-group health plan as an employer. This was not the case prior to the president’s executive order.

In this article, Milliman consultants Fritz Busch and Jason Karcher examine the final rule released in June, evaluate considerations for sponsors of AHPs, and briefly assess the final rule’s impact on the small-group health and individual markets.




Regulatory roundup

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

Cost-sharing reduction subsidies to cease
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 U.S. Department of Labor (DOL) to update 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.

President signs bill keeping ACA “small group health plan” definition
President Barack Obama signed the “Protecting Coverage for Employees Act” (P.L.114-60) into law on October 7. The law keeps the current definition of “small group health plans” under the Patient Protection and Affordable Care Act (ACA) at 50 or fewer employees rather than groups of up to 100 employees beginning in 2016.

IRS health tax tip: Reporting requirements for applicable large employers
The Internal Revenue Service (IRS) has released Health Care Tax Tip 2015-62 regarding reporting requirements for applicable large employers. Under the healthcare law, applicable large employers—those with 50 or more full-time employees, including full-time equivalent employees, in the preceding year—are required to report some information regarding health coverage by filing information returns with the IRS and furnishing statements to full-time employees.

For more information, click here.

IRS health tax tip: Understanding minimum essential coverage
The IRS posted Health Care Tax Tip 2015-61 on minimum essential coverage. The ACA requires any person or organization providing minimum essential coverage, including employers that provide self-insured group health plans, to report this coverage to the IRS and furnish statements to the covered individuals. These reporting requirements affect:

• Health insurance issuers or carriers
• The executive department or agency of a governmental unit that provides coverage under a government-sponsored program
• Plan sponsors of self-insured group health plan coverage
• Sponsors of coverage that the U.S. Department of Health and Human Services has designated as minimum essential coverage

For more information, click here.




Regulatory roundup

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

Council of Economic Advisers report: Trends in healthcare cost growth and the role of the ACA
The White House’s Council of Economic Advisers has published a report analyzing recent trends in healthcare costs, the forces driving those trends, and their likely economic benefits. The report includes the following findings about recent trends:

• Healthcare spending growth is the lowest on record. According to the most recent projections, real per capita healthcare spending has grown at an estimated average annual rate of just 1.3% over the three years since 2010. This is the lowest rate on record for any three-year period and less than one-third the long-term historical average stretching back to 1965.
• Healthcare price inflation is at its lowest rate in 50 years. Recent years have also seen exceptionally slow growth in the growth of prices in the healthcare sector, in addition to total spending. Measured using personal consumption expenditure price indices, healthcare inflation is currently running at just 1% on a year-over-year basis, the lowest level since January 1962. (Healthcare inflation measured using the medical Consumer Price Index [CPI] is at levels not seen since September 1972.)
• Recent slow growth in healthcare spending has substantially improved the long-term federal budget outlook. The Congressional Budget Office (CBO) has reduced its projections of future Medicare and Medicaid spending in 2020 by $147 billion (0.6% of GDP) since August 2010. This represents about a 10% reduction in projected spending on these programs. These revisions primarily reflect the recent slow growth in health care spending…

To read the entire report, click here.

IRS updates ACA section 1341 transitional reinsurance program FAQs
The Internal Revenue Service (IRS) has updated its “ACA Section 1341 Transitional Reinsurance Program FAQs” webpage.

Section 1341 of the Patient Protection and Affordable Care Act (ACA) establishes a transitional reinsurance program to help stabilize premiums for coverage in the individual market during the years 2014 through 2016. The statute requires all health insurance issuers and third-party administrators on behalf of self-insured group health plans to make contributions under this program to support payments to individual market issuers that cover high-cost individuals (payment-eligible issuers). Regulations proposed by the U.S. Department of Health and Human Services (HHS) to implement the Reinsurance Program specify that self-insured group health plans are liable for the contributions, although a plan may utilize a third-party administrator or administrative-services-only contractor for transfer of the contributions.

The U.S. Department of Labor has advised that paying required contributions under the Reinsurance Program would constitute a permissible expense of the plan for purposes of Title I of ERISA because the payment is required by the plan under the ACA as interpreted in the proposed rule issued by HHS.

To view the updated webpage, click here.

IRS presentation: Healthcare-related tax provisions that affect businesses
The IRS has published a slide presentation entitled “Healthcare-related tax provisions that affect businesses.” Topics include:

  • Transition relief for 2014 under sections 6056, 6055 and 4980H
  • Applicable large employer (ALE) status
  • Tax provisions for ALEs: Information reporting for ALE (section 6056), employer shared responsibility provisions (Section 4980H)
  • Tax provisions for small employers: Small business healthcare tax credit (section 45R)
  • Tax provisions for all employers that sponsor self-insured plans regardless of size: Reporting of minimum essential coverage (section 6055)

 
To view the entire slide presentation, click here.