In a surprise move, the Centers for Medicare & Medicaid Services (CMS) announced an indefinite delay in enforcement of regulations pertaining to “health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions” that would have otherwise required self-funded employer group health plans (among other “covered entities”) to take action as early as November 5, 2014. The CMS statement reads as follows:Statement of Enforcement Discretion regarding 45 CFR 162 Subpart E – Standard Unique Health Identifier for Health PlansEffective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, … [Read more...] about The Affordable Care Act—Countdown to Compliance for Employers, Week 8: Breaking Health Plan Identifier (HPID) News
Bcbs state health plan sc
On October 13th, President Trump signed an Executive Order directing various federal agencies to consider how to achieve three administration health reform objectives: (1) expand access to Association Health Plans (AHPs); (2) increase the current limits on short-term health insurance; and (3) allow wider use of employer health reimbursement arrangements so employees can buy coverage on their own in the individual market. This post considers what regulatory actions are necessary to accomplish the first objective—expanded access to AHPs. BackgroundIn a recent post (entitled, Association Health Plans—Can The Trump Administration Expand Access Without Congress?) we considered the legal status of AHPs under current law. We noted that fully insured AHPs are generally subject to state solvency and other requirements, and that the underlying insurance products are generally subject to state small group rules. We also pointed out that, under the ACA, small … [Read more...] about Expanding Association Health Plans—Which Agencies Need to do What
In recent weeks, the Trump Administration has been considering allowing health insurance to be purchased across state lines and expanding access to “Association Health Plans” (AHPs) that could take economic advantage of cross-border purchasing. President Trump is expected to issue an executive order this week to make that happen without legislation.This post addresses the key issue of whether the administration has the authority under existing law to act on its own initiative, and in doing so, it will address the seminal legal issues affecting AHPs under federal and state law. As explained below, we conclude that the administration has some—and perhaps even ample—authority to act without Congress, and that any legal constraints will depend on how the AHPs are structured. Background After the Senate’s most recent attempt to “repeal and replace” the Affordable Care Act (ACA) fell short, CNN reported on President’s Trump … [Read more...] about Association Health Plans—Can The Trump Administration Expand Access Without Congress?
A recent U.S. Court of Federal Claims decision spells good news and bad news for a Qualified Health Plan (QHP).First, the good news: the Court has jurisdiction of a claim for the Department of Health and Human Services’ failure under the Affordable Care Act’s (ACA’s) Risk Corridors Program to pay the amount required by the statute and regulations. The bad news is that the QHP must wait until completion of HHS’s audit and other procedures before it can sue. Whether the Court’s interpretation is right or wrong, it is difficult to understand how this Risk Corridor Program will provide temporary relief to a QHP if it must wait three years before receiving payment.The April 18, 2017 decision held that the Court has jurisdiction over a suit by a QHP seeking a monetary judgment against the HHS for alleged failure to properly pay the QHP amounts due under the ACA’s Risk Corridors Program under ACA Section 1342, 42 U.S.C. § 18062. Blue Cross and … [Read more...] about Federal Claims Decision: Good News, Bad News for Qualified Health Plans
On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the Affordable Care Act (ACA) and mental health parity disclosure, adding to the existing list of 28 previous editions of FAQs on the implementation of ACA.Section 2713 of the ACA requires non-grandfathered group health plans and health insurance offered in individual or group markets to cover preventive care without cost sharing, including 1) evidence-based services with a rating of “A” or “B” in the current recommendations of the U.S. Preventive Services Task Force (USPSTF); 2) immunizations for routine use in children, adolescents and adults that are recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC); 3) evidence-informed preventive care and screenings for infants, children … [Read more...] about Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications
Data security breaches affecting large segments of the U.S. population continue to dominate the news. Over the past few years, there has been considerable confusion among employers with group health plans regarding the extent of their responsibility to notify state agencies of security breaches when a vendor or other third party with access to participant information suffers a breach. A critical concern to employers facing these challenges is: “Assuming we comply with our obligations under HIPAA, do we have to notify U.S. state regulators under state data breach notification laws? Can we rely on the notifications provided by the breached insurer or vendor?”The following set of frequently asked questions and answers is designed to help employers with group health plans (data owners) navigate the challenging regulatory maze. Q: If our group health plan is a HIPAA covered entity, do we still have to notify our state regulators about a security … [Read more...] about Employers with Group Health Plans: Have You Notified State Regulators of the Breach?
Employers should note upcoming cafeteria plan design changes that require an amendment no later than December 31, 2014 and other upcoming 2015 action items.Required Amendment to a Cafeteria PlanSince the 2010 passage of the Affordable Care Act (ACA), employers have witnessed what often feels like a lifetime of plan design changes. Fortunately, regulators have consistently allowed employers to delay amending their plan documents to address these changes—unfortunately, in 2014, these delays come to an end. As noted in prior communications, cafeteria plans must be amended by December 31, 2014 to adopt the $2,500 limit ($2,550 for 2015) on an employee's annual pretax contributions made to a health flexible spending account (FSA).Optional Amendments to a Cafeteria PlanSpecial Enrollment. In Notice 2014-55, the Internal Revenue Service (IRS) allowed two new permissible midyear cafeteria plan election changes. The first change is intended to allow employees who were expected to … [Read more...] about Group Health Plans: Year-End Action Items and Upcoming Changes an Update
Health Plans and health care providers are getting into each other’s business. This payor/provider convergence has taken different forms. Health systems have ventured into the health insurance business by acquiring or starting their own health plans and by establishing joint ventures with payors, to jointly own and operate a health plan. Health plans have also moved into the health care provider business by acquiring hospitals, surgery centers, medical groups, and other providers. This blog post examines one aspect of this Payor/Provider Convergence – payor/provider joint ventures to operate health plans.A recent study by McKinsey & Company recites that as of 2015 “13% of all US health systems offer health plans in one or more markets – commercial, Medicare Advantage (MA), or managed Medicaid,” with provider-led plans representing a higher percentage (23%) of the Medicaid Market. Consistent with this trend, there have been a … [Read more...] about Payor/Provider Convergence: Joint Venture Health Plans
Early last week, House Republicans released long-awaited legislation designed to “repeal and replace” the Affordable Care Act (ACA), which had been a central campaign promise of President Donald Trump. The bill, titled the American Health Care Act (AHCA), does not repeal the ACA as a whole but instead dismantles many of its central provisions, including the mandates and many of the taxes. The bill was released in two parts by the House Committee on Ways and Means and the House Energy and Commerce Committee. The proposed legislation passed the mark-up process in both Committees last week and is now subject to consideration by the House Budget Committee.The AHCA includes several provisions that are central hallmarks of the Republicans’ proposed framework on health care. Key provisions that will impact employers and individual employees include the following:Penalties for both large employers who fail to provide coverage for full-time employees (the “employer … [Read more...] about American Health Care Act (Phase 1) Has Arrived: How Proposal Will Impact Employer Health Plans
If you were to ask most employers whether reporting is a core function of employee benefit plan administration, they would likely say yes, particularly as many are currently in the middle of completing IRS Forms 1094-C and 1095-C. On top of the numerous reporting requirements for group health plans imposed by IRS and other federal agencies, a number of states, including Vermont, have enacted laws that add a layer of state reporting obligations for plans, including self-funded group health plans. In what is clearly welcome news for employers and plan sponsors, this added state law burden has been lessened by yesterday’s Supreme Court decision in Gobeille v. Liberty Mutual Ins. Co., No. 14-181.The Court decided that state reporting mandates, like the one in Vermont, are preempted by the Employee Retirement Income Security Act of 1974 (ERISA). The essence of the Supreme Court’s rationale is that ERISA’s goal of having a uniform plan administration system — … [Read more...] about Vermont’s Health Plan Reporting Law Impermissibly Impacts National Plan Administration and Falls to ERISA Preemption, Supreme Court Holds