King v Burwell Ruling

Today the Supreme Court ruled (6-3) that the federal health insurance subsidies shall remain available to individuals in the 37 states using www.healthcare.gov. This decision means that the major coverage provisions of the Affordable Care Act will proceed as planned. 

Here are links to recent headlines and resources on the topic:

• CommonWealth Fund Blog: Coverage and Financial Security Preserved for Millions of Americans in the Supreme Court Ruling for the Government
• Wall Street Journal Blog by Drew Altmann: After King v Burwell Ruling, Health Law Issues Involve Implementation
• Modern Healthcare: Guide to King v. Burwell
• Reuters: Supreme Court upholds key Obamacare insurance subsidies

WSJ: More Health-Care Insurers Seek Big Premium Increases

On Monday the Obama administration published more information about hefty premium increases for 2016 sought by large insurers selling plans under the health law.

An article in the Wall Street Journal by Louise Radnofsky and Stephanie Armour reported major carriers from around the country are proposing big increases in the premium rates paid by consumers who buy insurance policies on their own.

Noted in the article which can be found here: 

Blue Cross and Blue Shield of Illinois is looking to raise rates by averages of 29% or more. In Pennsylvania, Highmark Health Insurance Co. is asking for 30%, according to proposals submitted by insurers for the year ahead. Around the country, some of the main market leaders are looking for double digit increases.

The new requests for premiums come at a time when the political and legal future of the law hangs in the balance. The Supreme Court is set to issue a decision later this month on the validity of the law’s tax credits to offset the cost of premiums for lower-income consumers in most states in the country. 

ACA Compliance: A Blueprint from Employers

ADP, a global provider of human capital management solutions, has developed a useful guide for employers, providing a clear explanation of the ACA's employer compliance requirements, with specific instructions on how to avoid penalties.

The brief offers actionable, practical advice and spells out how employers can adopt strategies to make well-informed decisions. By understanding their available options, employers can not only do right by their employees and save money, but also achieve full compliance with the law.

Information covered includes:

• Avoiding the “Catastrophic Tax”
• Avoiding the “Lesser Tax”
• Conducting an Excise Tax Liability Analysis
• Documenting the Offer of Coverage
• Doing Due Diligence on Non-Calendar Year Plan

Download the full report here.

Kaiser Family Foundation: American’s opinion of the health care law closely divided

The Kaiser Health Tracking Poll for April found public opinion of the Affordable Care Act (ACA) continues to be almost evenly split, with 43 percent reporting a favorable view and 42 percent reporting an unfavorable view.

Among the key findings, when asked what the next health care priority should be for the White House and Congress, 76 percent of Americans responded "making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them."

Key takeaways from the Supreme Court’s Obamacare hearing

Oral arguments were heard in the Supreme Court on March 4 for King v. Burwell. The case centers on the constitutionality of IRS regulations that provide federal subsidies to just over 9 million people, totaling $28.8 billion in tax credits and cost-sharing reductions in 2016, in states that did not establish their own health care exchanges.

Several good resources providing an overview of what's at stake include:

The Washington Post offers a guide and an article from Jason Millman on five important takeaways:

1. The vote will be close.
2. Kennedy's skepticism could be good for the Obama administration.
3. The Supreme Court could offer a temporary 'fix' if subsidies are struck down.
4. Court standing likely won't be an issue.
5. No one knows what Chief Justice John Roberts is thinking. 

Jason Adler posted a helpful overview here.

And, the SCOTUS Blog can be found here.

ACA 101: What You Need To Know

**Editing Note: This is an in-person briefing, not a webinar (as previously noted) and registration is closed.**

On Friday, March 6, from 11 a.m.-12:30 p.m. Eastern the Kaiser Family Foundation and the Alliance for Health Reform are hosting a briefing to review the Affordable Care Act (ACA).

Speakers will answer and discuss critical ACA questions, such as:

• What are the key provisions of the ACA? 
• How did the ACA extend coverage to the uninsured? 
• How does the ACA impact private and public insurance coverage, marketplaces and employer-sponsored coverage? 
• What is the role for states? 
• What are the requirements on employers and individuals? 
• How was Medicaid changed by the ACA and then the Supreme Court? 
• How is the Children’s Health Insurance Program (CHIP) affected?

Moderated by KFF’s Diane Rowland and the Alliance’s Ed Howard, Friday’s discussion will include:

• Jennifer Tolbert, director of state health reform, Kaiser Family Foundation, will provide a broad overview of the key provisions in the ACA, including private and public coverage provisions, quality and delivery system reforms;
• Sabrina Corlette, research professor and project director at the Center on Health Insurance Reforms, Georgetown University’s Health Policy Institute, will address the changes in private insurance, requirements on individuals, the creation of marketplaces and the implications of the King v. Burwell Supreme Court case on subsidies;
• Paul Fronstin, director of the Health Research and Education Program, Employee Benefit Research Institute, will explain employer-sponsored coverage and requirements; and
• Charlene Frizzera, senior advisor, Leavitt Partners, and former CMS acting administrator, will address the Medicaid and CHIP provisions in the ACA

Here's a link to registration information.

House Approves Legislation Marking 40 Hours as 'Full Time' for PPACA Purposes

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. House of Representatives approved a measure on January 8 that would establish 40 hours as the benchmark for "full time" work under the Patient Protection and Affordable Care Act (PPACA). The 252-172 vote included 12 Democrats.

The Save American Workers Act (H.R. 30), introduced by House Ways and Means Committee member Todd C. Young (R-IN), would replace the number 30 (hours per week) with the number 40 (hours per week) for purposes of identifying full-time employees and satisfying the PPACA employer mandate under Internal Revenue Code Section 4980H. H.R. 30 would also modify the calculation of full-time equivalent workers by requiring employers to divide the aggregate number of hours of service of employees who are not full-time employees by 174 rather than 120.

President Obama has issued a Statement of Administration Policy asserting that he would veto H.R. 30 if it reached his desk, noting that the measure would increase the federal budget deficit, reduce the number of people receiving employer-based health insurance coverage and increase the number of individuals who are uninsured. The latest Congressional Budget Office budget score estimates that H.R. 30 would increase the deficit by $53.2 billion over the next ten years. House Minority Leader Nancy Pelosi (D-CA) stated in a January 8 news conference that the measure would add half a million people to the ranks of the uninsured.

Senators Susan Collins (R-ME) and Joe Donnelly (D-IN) have introduced a companion bill in the U.S. Senate, the Forty Hours is Full Time Act (S. 30), but legislative text remains unavailable at this time.

House Passes Bill Exempting Veterans When Determining Employer Mandate Applicability

NBCH thanks the American Benefits Council for the information provided in this post.

On January 6, the U.S. House of Representatives passed the Hire More Heroes Act (H.R. 22) by unanimous, bipartisan vote of 412-0.

The measure, sponsored by Representative Rodney Davis (R-IL), would exempt veterans already enrolled in coverage under TRICARE or the U.S. Department of Veterans Affairs (VA) from being taken into account for the purposes of determining if an employer is subject to the employer mandate under the Patient Protection and Affordable Care Act (PPACA).

The PPACA "shared responsibility" employer mandate under Internal Revenue Code Section 4980H, which took effect on January 1, requires employers with 100 or more full-time (or equivalent) employees to offer health coverage that satisfies affordability and minimum value requirements to their full-time employees or pay a penalty if even one full-time employee receives a premium tax credit for health coverage obtained through a health insurance exchange. (The 100 employee threshold is applicable only under transition relief for 2015; after 2015, the threshold is 50 employees.)

The bill would allow businesses to hire veterans covered by TRICARE or the VA without counting them as full-time employees. Supporters of the measure point out that it will help some small businesses stay below the mandate threshold as well as encourage the hiring of veterans.

The bill was previously introduced in the House in the 113th Congress and approved by a vote of 406-1. The measure was not considered by the Senate.

CMS Announces PPACA Transitional Reinsurance Fee Amount for 2016; Formalizes In-Patient Hospitalization Requirement for Minimum Value Plans

NBCH thanks the American Benefits Council for the information provided in this post.

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including the transitional reinsurance program (TRP) fee and minimum value requirements that were the subject of some recent attention and controversy.

Transitional Reinsurance Program Fee
Under Section 1341 of the Patient Protection and Affordable Care Act (PPACA), during the first three years that state health insurance exchanges are operational (2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance a three-year transitional reinsurance program. The contribution rate for 2015 is $44 per covered life; it was $63 per covered life for 2014.

The proposed regulations set the TRP fee at $27 per enrollee for the 2016 benefit year. The regulations also include additional information on the exception for certain self-administered, self-insured group health plans, clarifications regarding certain counting methods, and guidance regarding the deadline for satisfying reporting requirements where the reporting date does not fall on a business day. Specifically: 

• Self-administered, self-insured plan exception: For the 2015 and 2016 benefit years, a "covered entity" does not include qualifying self-administered, self-insured group health plans. In the preamble to the 2015 Notice of Benefit and Payment Parameters, HHS indicated that it considered a third party administrator to be an entity that is not under common ownership or control with the self-insured group health plan or its plan sponsor. The preamble to the proposed regulations states that principles similar to the controlled group rules of Code sections 414(b) and (c) would apply for purposes of determining whether a third-party administrator is under common ownership or control with a plan or its plan sponsor.
  
• Clarification to Snapshot Count and Snapshot Factor Counting Methods: The proposed regulations clarify the application of the snapshot count and snapshot factor counting methods to a health insurance plan or coverage that is established or terminated, or that changes funding mechanisms, in the middle of a quarter. The proposed regulations provide that, if the plan or coverage in question had enrollees on any day during a quarter and if the contributing entity uses either the snapshot count or snapshot factor method, it must choose a set of counting dates for the counting period such that the plan or coverage has enrollees on each of the dates, if possible. However, the enrollment count for a date during a quarter in which the plan or coverage was in existence for only part of the quarter can be reduced by a factor reflecting the amount of time during the quarter for which the plan or coverage was not in existence.
  
• Clarification to Reporting Deadlines: The proposed regulations would require a contributing entity to submit its annual enrollment count for the applicable benefit year to HHS no later than November 15 of benefit year 2014, 2015, or 2016, or, if such date is not a business day, the next business day. 

In-Patient Hospitalization Requirement for Minimum Value Plans
The proposed regulations formalize guidance provided in IRS Notice 2014-69 (released on November 4) addressing the glitch in the HHS minimum value (MV) calculator that generated a fair amount of media attention earlier this year. The calculator is intended to be used to determine whether an employer-sponsored plan provides 60 percent minimum value. According to HHS and Treasury, the online MV calculator was improperly qualifying certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services.

The proposed regulations formalize the guidance provided in Notice 2014-69. The proposed regulations would require that, in order to satisfy minimum value, an employer-sponsored plan must provide substantial coverage of both in-patient hospital services and physician services. The proposed regulations would apply to employer-sponsored plans, including plans that are in the middle of a plan year, immediately on the effective date of the final regulations. However, the proposed regulations provide that the final regulations will not apply before the end of the plan year for plans that, before November 4, 2014, entered into a binding written commitment to adopt, or began enrolling employees into, the plan, so long as that plan year begins no later than March 1, 2015.

EBSA Issues Updated Guidance for Compliance with PPACA, Mental Health Parity Rules

NBCH thanks the American Benefits Council for the information provided in this post.

The Employee Benefit Security Administration (EBSA) of the U.S. Department of Labor (DOL) released an updated version of its Compliance Assistance Guide – Health Benefits Coverage Under Federal Law on November 19. This document, designed to help sponsors and issuers of health insurance coverage comply with current law, was updated to reflect changes attributable to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

The MHPAEA prohibits large employer and group health plans that provide medical and surgical benefits and mental health or substance use disorder benefits from applying financial requirements or quantitative treatment limitations (such as a limit on the number of outpatient visits or inpatient days covered) that are more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical and surgical benefits. Final regulations, released in November 2013, apply to plan and policy years (for grandfathered and non-grandfathered plans) beginning on and after July 1, 2014 (January 1, 2015, for most calendar year plans).

The guide includes general descriptions of the various health care laws and frequently asked questions, self-compliance tools and tips, charts summarizing the notices a plan must provide and model notices. The November 19 update reflects changes to the mental health parity portion of the self-compliance tool section and the mental health parity provisions "questions and answers" section.

HHS Extends Deadline for Submitting Enrollment Counts for PPACA Transitional Reinsurance Program

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. Department of Health and Human Services announced late on November 16 that it is extending the deadline for contributing entities to submit their 2014 enrollment counts for transitional reinsurance program contributions until 11:59 p.m. on December 5, 2014. The deadline was originally set for November 15, 2014.

Section 1341 of the PPACA established a transitional reinsurance program (2014 through 2016) intended to stabilize premiums in the individual insurance market. Health insurance issuers and certain self-insured group health plans are assessed a per-enrollee contribution to fund this transitional reinsurance program. The HHS Centers for Medicare and Medicaid Services (CMS) recently released the form for submitting the TRP annual enrollment count.

The current deadlines for remitting the first (or combined) contribution amount (January 15, 2015) and the second contribution amount (November 15, 2015) remain the same. Additional information on the TRP is available on the dedicated CMS website.

IRS Issues FAQs on Transitional Reinsurance Program

NBCH thanks the American Benefits Council for the information provided in this post.

On October 31, the Internal Revenue Service (IRS) updated a set of frequently asked questions (FAQs) on the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (PPACA) with two questions regarding the treatment of contributions made under the reinsurance program as ordinary and necessary business expenses.

Section 1341 of the PPACA established a transitional reinsurance program (2014 through 2016) intended to stabilize premiums in the individual insurance market. Health insurance issuers and certain self-insured group health plans will be assessed a per-enrollee contribution to fund this transitional reinsurance program. The contribution is $63 per covered life for 2014.

Specifically, the FAQs state that:

• a health insurance issuer may treat the contributions under the Reinsurance Program as ordinary and necessary business expenses; and 
• a sponsor of a self-insured group health plan may treat contributions (including contributions made directly or through a Third Party Administrator or an Administrative Services Only contractor) under the Reinsurance Program as ordinary and necessary business expenses. 

The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) recently released the form for submitting the TRP annual enrollment count. The deadline for the 2014 benefit year’s annual enrollment count submission is November 15, 2014.

IRS closes ACA minimum value health plan loophole

The Internal Revenue Service, in a surprise move Tuesday, said it will not qualify employer-sponsored health plans that fail to cover inpatient hospitalization as meeting the minimum value health plan standard under the Affordable Care Act.

In a notice issued under the public radar on Election Day, the IRS says it, the Treasury Department and the Department of Health and Human Services believe that plans that fail to provide substantial coverage for inpatient hospitalization services or for physician services (or for both) do not provide minimum value intended by the ACA’s minimum value requirement. The departments will shortly propose regulations to this effect, with the intention of finalizing them in 2015, the notice adds.

Read more via Employee Benefit Adviser.

USA TODAY: Feds to require big companies to cover hospitalization

Jayne O'Donnell, reporter for USA Today, wrote an article about efforts to close a loophole in the Affordable Care Act that allows large companies to refuse to cover in-patient hospital stays in any of their health insurance plans.

Comments from NBCH CEO Brian Klepper are included...

Plans that don't cover hospitalization are "preying on vulnerable people who don't have resources," says Brian Klepper, CEO of the National Business Coalition on Health. "The purpose of insurance is to cover the services that most of us cannot afford when we desperately need it."

The full article can be accessed here.

EEOC Continues to Pursue Legal Action Against Employer Wellness Programs

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. Equal Employment Opportunity Commission (EEOC) filed a new lawsuit against an employee wellness program on October 27, alleging violations of the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA).

The lawsuit, filed in the U.S. District Court for the District of Minnesota, seeks a temporary restraining order and a preliminary injunction to prevent Honeywell International Inc. from imposing penalties on employees who decline participation in the company’s biometric screening program. The program assesses a $500 surcharge if employees forego biometric screening and an additional $1,000 tobacco surcharge for the employee as well as a $1,000 tobacco surcharge for the employee’s spouse/domestic partner if either foregoes the biometric screening and does not satisfy a reasonable alternative, such as participating in a tobacco cessation program. Additionally, only employees who participate in the biometric screening will receive a contribution to their Health Savings Account.

The EEOC’s lawsuit contends that “The proposed medical testing is not voluntary, and therefore violates the [ADA]. The testing imposes penalties on employees whose spouses do not provide their medical information, and therefore violates [GINA].”

Is The Affordable Care Act Working?

Brian Klepper

The New York Times has published a major, multi-article piece, on different aspects of the Affordable Care Act's (ACA) performance. Here's the overview:

"After a year fully in place, the Affordable Care Act has largely succeeded in delivering on President Obama’s main promises, an analysis by a team of reporters and data researchers shows. But it has also fallen short in some ways and given rise to a powerful conservative backlash."

New FAQ Provides Updated Guidance on Reference-Based Pricing Under PPACA

NBCH thanks the American Benefits Council for the information provided in this post.


A new “frequently asked question” (FAQ) document was released jointly by the U.S. Departments of Labor (DOL), Health and Human Services (HHS) and Treasury on October 10, updating prior guidance on the application of Patient Protection and Affordable Care Act (PPACA) cost-sharing limitations for plans using “reference-based pricing.”

The new FAQ sets out specific factors that the departments will consider when evaluating whether a plan that uses reference-based pricing (or a similar network design) is using a “reasonable method” to ensure that it provides adequate access to quality providers at the reference base price.

Generally, reference-based pricing is a system under which the plan pays a fixed amount for a particular drug, procedure or other service (for example, a knee replacement), which certain providers will accept as payment in full. If an individual uses a provider that does not accept the reference price, the individual pays the difference between the reference price and the actual price of the service.

Most Employers Reject Private Exchanges According to NBCH and Benz Communications Survey

NBCH teamed with Benz Communications this summer to conduct the 2014 Inside Benefits Communication survey to learn how companies are strategizing and implementing benefits communications through the lens of the Affordable Care Act, compliance mandates and industry trends.

The ACA excerpts of the survey are being released today in the infographic below, and in the accompanying news release and executive summary report.

More than 300 employers across the country participated, spanning a wide cross-section of industries, employer sizes and geographic locations.

The full survey report, including detailed analysis of benefits communication investments, will be released at NBCH's annual conference on November 11.

CMS to Continue Webinar Series on Reinsurance Contributions

NBCH thanks the American Benefits Council for the information provided in this post.

The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) will host the latest in a series of webinars on required Transitional Reinsurance Program (TRP) contributions under the Patient Protection and Affordable Care Act (PPACA).

Under PPACA, during the first three years that health insurance exchanges are operational (i.e., 2014 through 2016), health insurance issuers and plan administrators (on behalf of self-insured group health plans) will be assessed a per-enrollee fee to finance the three-year transitional reinsurance program. The fee is $63 per covered life for 2014.

HHS and CMS released guidance on the process for making TRP contributions in May, previewing "a streamlined process for the collection of reinsurance contributions" through Pay.gov. This issuance was followed by an initial series of webinars to provide an overview of policy and operations for reinsurance contributions, followed by a second series to provide an overview of how a contributing entity can submit its annual enrollment count and make reinsurance contributions through Pay.gov.

CMS has announced this latest webinar series to provide an overview of the "job aid" available to assist entities in the development of supporting documentation and detail how an entity can update reinsurance contribution filings through Pay.gov if an issue arises after submission. The new webinars will be held on the following days and times:

• Wednesday, September 17, 2-3:30 p.m. ET
• Friday, September 19, 2-3:30 p.m. ET
• Wednesday, September 24, 2-3:30 p.m. ET

Registration will be on a first-come, first-serve basis, limited to three participants per organization. Registration will be limited to selecting only one of the event dates. You will need to log in to the official Registration for Technical Assistance Portal for more information.

 

10 ACA Questions Small Employers Are Asking

According to Health Partners America the majority of Americans, including many small business owners, are still confused about health reform legislation.

Employee Benefit News recently covered the ten Affordable Care Act questions small employers are asking. The slide show can be found here.