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Federal Departments Issue New FAQ and Model Disclosure Request Form under Mental Health Parity and Addiction Equity Act

On June 16, 2017, a new FAQ, Part 38, was jointly issued by the federal Departments of Labor, Health and Human Services, and the Treasury (collectively, the ?Ç£Departments?Ç¥) regarding the application of certain requirements under the Mental Health Parity and Addiction Equity Act (?Ç£MHPAEA?Ç¥), as amended by the Affordable Care Act and the 21st Century Cures Act. In particular, this new FAQ addresses the question of whether the MHPAEA applies to benefits that a group health plan or health insurance issuer may offer for treatment of an eating disorder. Generally, the MHPAEA prohibits plans and issuers from imposing financial requirements or treatment limitations on ?Ç£mental health benefits?Ç¥ and ?Ç£substance use disorder benefits?Ç¥ (collectively, ?Ç£MH/SUD Benefits?Ç¥) that are more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical and surgical benefits. The FAQ clarifies that eating disorders are mental health conditions; therefore, treatment of an… Continue Reading

Upcoming Deadline for Annual Reporting and Payment of PCORI Fee Under the Affordable Care Act

The deadline for plan sponsors of self-insured health plans to report and remit the Patient-Centered Outcomes Research Institute fee (?Ç£PCORI Fee?Ç¥) due under the Affordable Care Act with respect to the 2016 plan year is July 31, 2017. For this purpose, a plan year that ended during 2016 is considered a 2016 plan year. The PCORI Fee is assessed to fund the Patient-Centered Outcomes Research Institute and applies to plan years ending on or after October 1, 2012, and before October 1, 2019. Plans should report and remit the PCORI Fee, which is based on a flat dollar amount multiplied by the average number of lives covered under the plan for the applicable plan year, via a second quarter IRS Form 720.The applicable covered lives fee amount for plan years that ended after December 31, 2015, and before October 1, 2016 is $2.17. The applicable covered lives fee amount for… Continue Reading

Executive Order Intended to Ease Religious-Based Objections to Women?ÇÖs Contraceptive Services

On April 17, 2017, President Trump signed an executive order (the ?Ç£EO?Ç¥) that includes a request to the Secretaries of Treasury, Labor, and Health and Human Services to consider amending regulations related to a plan sponsor?ÇÖs ability to make a conscience-based objection to, and opt out of, complying with the preventive services mandate under the Affordable Care Act (the ?Ç£ACA?Ç¥). Under the ACA, non-grandfathered group health plans must generally provide coverage for specified preventive services, including women?ÇÖs contraceptive services. Although the EO broadly indicates the entire ACA preventive services mandate, the context of the order suggests the focus is on women?ÇÖs contraceptive services. Religious employers, narrowly defined as houses of worship, are currently exempt from the requirement to cover women?ÇÖs contraceptive services, but there is no exemption for non-profit religiously affiliated employers or any for-profit organization. The EO appears to request the agencies make it easier for religiously-affiliated employers to… Continue Reading

House Republicans Unveil Draft Healthcare Reform Legislation

The House Energy and Commerce and Ways and Means Committees introduced two bills on March 6, 2017, collectively entitled the American Health Care Act (the “Act“). The Energy and Commerce bill primarily addresses Medicaid and other state-based program funding issues, while the Ways and Means bill focuses on the fees and taxes, insurance subsidies, and other provisions that directly affect employer-provided health coverage under the Affordable Care Act (the “ACA“). It is important to note what these bills are and what they are not. The bills do not represent the complete repeal of the ACA or the final word on what the Act may ultimately look like when finished. These are reconciliation bills intended to repeal and replace certain portions of the ACA by a simple majority vote in a way that would not be subject to a filibuster in the Senate if brought to a vote there. The trade-off… Continue Reading

IRS Provides Transition Relief Regarding QSEHRA Notice Deadline

The IRS has provided transition relief under its Notice 2017-20 (the ?Ç£IRS Notice?Ç¥) regarding the employee notice requirement that small employers must meet if they want to provide a ?Ç£qualified small employer health reimbursement arrangement?Ç¥ (?Ç£QSEHRA?Ç¥) to their employees. As background, the 21st Century Cures Act (the ?Ç£Cures Act?Ç¥) permits certain employers who are not ?Ç£applicable large employers?Ç¥ under the Affordable Care Act (i.e., generally, employers with fewer than 50 full-time or full-time equivalent employees) (?Ç£Eligible Employers?Ç¥) to offer QSEHRAs for the reimbursement of substantiated medical care expenses incurred by employees or their family members, effective January 1, 2017. The Cures Act requires Eligible Employers to furnish a written notice to their eligible employees (?Ç£QSEHRA Notice?Ç¥) at least 90 days prior to the beginning of the year in which the QSEHRA will be provided (or in the case of an employee who is not eligible to participate in the QSEHRA… Continue Reading

House Republicans Unveil Draft Healthcare Reform Legislation

The House Energy and Commerce and Ways and Means Committees introduced two bills on March 6, 2017, collectively entitled the American Health Care Act.?á The Energy and Commerce bill primarily addresses Medicaid and other state-based program funding issues while the Ways and Means bill focuses on the Affordable Care Act?ÇÖs (?Ç£ACA?Ç¥) fees and taxes, insurance subsidies, and other provisions that directly affect employer-provided health coverage. It?ÇÖs important to note what these bills are and what they aren?ÇÖt.?á The bills do not represent the complete repeal of the ACA or the final word on what the American Health Care Act may look like when finished.?á These are reconciliation bills intended to repeal and replace portions of the ACA by a simple majority vote in a way that would not be subject to a blocking filibuster in the Senate if brought to a vote.?á The trade-off is reconciliation bills are limited to… Continue Reading

IRS Proposed Regulations Clarify the Definition of Tax ?Ç£Dependent?Ç¥

The IRS recently issued proposed regulations regarding the definition of ?Ç£dependent?Ç¥ under the Internal Revenue Code (?Ç£Code?Ç¥). The proposed regulations generally update existing regulations to conform to amendments previously made to Code Section 152 and other Code sections by the Working Families Tax Relief Act of 2004 (?Ç£WFTRA?Ç¥) and subsequent legislation. Under WFTRA, Code Section 152 was amended to provide that a federal income tax dependent is either a taxpayer?ÇÖs ?Ç£qualifying child?Ç¥ or ?Ç£qualifying relative.?Ç¥ These definitions are relevant for employers that sponsor (i) group health plans if such plans provide coverage for an employee?ÇÖs dependent who is not his or her spouse or child under age 27, but who is the employee?ÇÖs federal income tax dependent, and (ii) dependent care assistance programs which reimburse covered employees for qualifying dependent care expenses of qualifying children and certain other federal income tax dependents. The proposed regulations also provide new guidance with… Continue Reading

Employers Should Continue to Comply with the ACA

President Trump signed an executive order on January 20, 2017, generally directing the heads of government agencies to halt enforcement of Affordable Care Act (?Ç£ACA?Ç¥) provisions that cause financial or regulatory burdens on a host of entities, to the extent permitted by law. While this executive order did not specifically use the word ?Ç£employer?Ç¥ in the list of entities, the list can be construed to include employers providing health coverage to employees. The executive order itself does not relieve employers of any obligations to comply with the ACA, and this action should not occur until the various federal agencies issue guidance delaying or halting the enforcement of specific ACA provisions. The Departments of HHS, Labor, and the Treasury are unlikely to take any action until their new Secretaries are confirmed. In the meantime, employers should continue to comply with the ACA pending issuance of future guidance. View the executive order.

Federal District Court Issues Preliminary Injunction Blocking Enforcement of ACA Section 1557

The U.S. District Court for the Northern District of Texas issued a preliminary nationwide injunction December 31, 2016, blocking HHS from enforcing Section 1557 of the Affordable Care Act in Franciscan Alliance, Inc. et. al. v. Burwell. We previously reported on Section 1557 (which prohibits discrimination in certain healthcare programs and activities for Title IX reasons, e.g., race, color, national origin, sex, age, or disability), the final Section 1557 regulations issued by HHS, and the potential effects on healthcare providers, insurers, and employer-provided health care coverage here. The Franciscan Alliance plaintiffs are three religiously affiliated healthcare providers (later joined by five states) that claimed (i) HHS impermissibly extended Title IX to include gender identity and termination of pregnancy as forms of sex discrimination contrary to Title IX?ÇÖs history and legislative intent, (ii) Section 1557 requires covered entities to perform and/or provide insurance coverage for abortion and transition-related procedures, and (iii)… Continue Reading

Federal Agencies Release Additional Frequently Asked Questions on Special Enrollment Opportunities, Preventive Services, and Qualified Small Employer HRAs

On December 20, 2016, the federal Departments of Health and Human Services, Labor, and the Treasury issued a set of three frequently asked questions (?Ç£FAQs?Ç¥) addressing issues under the Affordable Care Act (the ?Ç£ACA?Ç¥). These FAQs confirm that: (i) an individual who loses eligibility for individual coverage purchased through the public health insurance marketplace is entitled to a HIPAA special enrollment opportunity in employer group health plan coverage, if eligible, even if other coverage in the marketplace or in the individual market remains available; (ii) for non-grandfathered group health plans subject to the ACA, the effective date for the revised Women?ÇÖs Preventive Services Guidelines released on December 20, 2016, is the first plan year beginning on or after December 20, 2017 (e.g., January 1, 2018 for calendar year plans); and (iii) the Qualified Small Employer Health Reimbursement Arrangement introduced in the 21st Century Cures Act and available to small employers… Continue Reading

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