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IRS Releases Proposed Regulations on the Comparable Effectiveness Fee

The Internal Revenue Service (“IRS”) released proposed regulations regarding the “comparable effectiveness fee” applicable to certain health insurers and plan sponsors of self-insured health plans under PPACA. The comparable effectiveness fee will assist in financing the Patient-Centered Outcomes Research Institute (the “Institute”) which was established under PPACA to fund research of the clinical effectiveness of medical treatments, procedures and drugs. PPACA imposes the comparable effectiveness fee on an applicable issuer or plan sponsor for each plan or policy year ending on or after October 1, 2012, and before October 1, 2019, to support the Institute. The fee is $2.00 (for plan or policy years ending before October 1, 2013, the fee is $1.00) multiplied by the average number of lives covered under the plan or policy. The proposed regulations address the health insurers and plan sponsors which will be subject to this fee and explain how to calculate the average… Continue Reading

HHS Issues 2012 List of Counties Requiring Culturally and Linguistically Appropriate Services

The U.S. Department of Health and Human Services (“HHS”) recently released a list of counties that will require culturally and linguistically appropriate services in 2012 under the Patient Protection and Affordable Care Act (“PPACA”). Section 2719 of the Public Health Service Act requires non-grandfathered group health plans and health insurance issuers offering non-grandfathered health insurance coverage to provide relevant notices in a “culturally and linguistically appropriate manner.” Notices subject to the requirement include the (1) additional internal claims and appeals requirements and external review procedures for non-grandfathered plans and (2) summary of benefits and coverage. The regulations implementing Section 2719 require that certain accommodations be made for relevant notices sent to an address in counties in which 10 percent or more of the population is literate in only the same non-English language. For such counties, English versions of the applicable notices must include a statement prominently displayed in the applicable… Continue Reading

April 2012
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