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HHS Issues Final Regulations Expanding Medical Loss Ratio Notice Requirements

The U.S. Department of Health and Human Services issued final regulations requiring health insurers that meet or exceed the medical loss ratio (MLR) standards established under the Affordable Care Act to provide enrollees with a notice describing the MLR standards and explaining that the insurer met or exceeded those standards. Previously, the notice requirements only applied to insurers who owed rebates because they failed to meet the MLR standards. This notice must be provided with the first plan document provided to enrollees on or after July 1, 2012. A copy of the regulations is available here.

Departments Release Additional FAQs on Summary of Benefits Coverage Requirement

On May 11, 2012, the U.S. Departments of Labor, Health and Human Services and the Treasury issued Part IX in the set of FAQs addressing implementation of the Affordable Care Act. The latest FAQs answer additional questions that were raised in connection with the Final Rules regarding the Summary of Benefits and Coverage (?Ç£SBC?Ç¥). For group health plan coverage, the Final Rules provide that, for disclosures concerning participants who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the SBC must be provided beginning on the first day of the first open enrollment period that begins on or after September 23, 2012. For disclosures with respect to participants who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of the first plan year that… Continue Reading

IRS Updates Informational Webpage on W-2 Reporting of Health Coverage

The IRS updated its informational webpage on the Patient Protection and Affordable Care Act (“PPACA”) W-2 reporting requirement for the value of health coverage. The webpage includes a useful chart presenting various types of coverage and whether or not such coverage is required to be reported on the Form W-2. The chart can be accessed here.

Guidance Clarifies that Self-Funded Group Health Plans are Not Subject to Medical Loss Ratio Rules

An informational bulletin published by the Center for Consumer Information and Insurance Oversight clarified, among other things, that self-funded group health plans are not subject to the medical loss ratio (MLR) reporting and rebate requirements. The bulletin explained that the MLR requirements apply to health insurance issuers offering group or individual health coverage, and that a self-funded group health plan did not fit within the Public Health Service Act?ÇÖs definition of health insurance issuer. The bulletin also provided guidance on the applicability of the MLR rules to employer groups of one, counting employees for determining market size, individual association policies, reinsurance and reporting, exchange user fees, and ?Ç£mini-med?Ç¥ experience. A copy of the bulletin is available here.

IRS Releases Proposed Regulations on the Comparable Effectiveness Fee

The Internal Revenue Service (?Ç£IRS?Ç¥) released proposed regulations regarding the ?Ç£comparable effectiveness fee?Ç¥ 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 ?Ç£Institute?Ç¥) 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 (?Ç£HHS?Ç¥) recently released a list of counties that will require culturally and linguistically appropriate services in 2012 under the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥). 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 ?Ç£culturally and linguistically appropriate manner.?Ç¥ 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

Supreme Court Hears Oral Arguments on the Constitutionality of the Individual Mandate under Health Reform

On March 26th through the 28th, the Supreme Court heard six hours of oral argument on cases addressing the Patient Protection and Affordable Care Act (the ?Ç£Act?Ç¥), the longest scheduled argument in the Court?ÇÖs modern history. The oral argument included challenges to the constitutionality of the Act?ÇÖs individual mandate. On day one, the Court heard argument on whether the case is ripe for consideration. On day two, the oral argument focused on whether the individual mandate in the Act violates the Commerce Clause of the Constitution. On day three, the Court heard argument regarding whether the individual mandate is severable from the entire Act. The Court?ÇÖs decision is expected in June 2012. Links to audio of the oral argument and the transcripts can be found?áhere on the Court?ÇÖs Affordable Care Act website.

Agencies Request Comments on Proposed Exemption for Certain Religious Employers from providing Contraception Coverage

The U.S. Departments of Labor, Health and Human Services, and the Treasury issued an advance notice of proposed rulemaking soliciting comments for proposed amendments to a recently-issued rule exempting certain religious employers from having to provide contraception coverage. Other non-exempt religious-affiliated employers?Çösuch as religious schools and hospitals?Çöthat provide health coverage to their employees have been given an additional year to comply with the requirement that their plans include contraception coverage. The proposed rule for which the agencies seek input will outline potential accommodations for non-exempt religious organizations while also ?Ç£ensuring contraceptive coverage for plan participants and beneficiaries covered under their plans (or, in the case of student health insurance plans, student enrollees and their dependents) without cost sharing.?Ç¥ A copy of the notice is available here.

Departments Release FAQs on Summary of Benefits Coverage Requirement

On March 19, 2012, the U.S. Departments of Labor, Health and Human Services and the Treasury issued Part VIII in the set of FAQs addressing implementation of the Affordable Care Act. The FAQs answer questions that were raised in connection with the Final Rules regarding the Summary of Benefits and Coverage (?Ç£SBC?Ç¥) that were published on February 14, 2012. For group health plan coverage, the Final Rules provide that, for disclosures concerning participants who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the SBC must be provided beginning on the first day of the first open enrollment period that begins on or after September 23, 2012. For disclosures with respect to participants who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of… Continue Reading

HHS Issues Final Regulations on State Health Insurance Exchanges under Health Reform

The U.S. Department of Health and Human Services (?Ç£HHS?Ç¥) issued final and interim final regulations addressing, among other items, (1) how the state health insurance exchanges which are required under the health reform legislation will be established and operated and (2) how individuals and small businesses can participate in the exchanges. The regulations, which combine policies from the two sets of proposed regulations that were issued last summer, offer additional flexibility regarding the eligibility determination process. The regulations are scheduled to be published in the Federal Register on March 27, 2012, but a pre-publication copy of the regulations is available here. Additionally, a copy of the regulatory impact analysis issued by HHS is available here.

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