Feds issue regs on SBC requirement
cmonfils | April 25, 2012
In February, the Departments of Labor, Treasury, and Health and Human Services issued final regulations implementing the new summary of benefits and coverage requirement under the Patient Protection and Affordable Care Act. The agencies also released a separate document providing additional guidance on the SBC requirement, which includes a template for the summary, instructions, sample language, a guide for coverage example calculations and the uniform glossary.
Florida failing to take action on the Affordable Care Act
cmonfils | April 25, 2012
Recently, I hadan opportunity to attend a luncheon where Florida Governor Rick Scott gave the keynote addres s. He was surprisingly bright and certainly on top of things here in our sunny state, which has suffered a few economic kicks in the head over the past few years. He spoke on myriad issues and provided a number of positive statistics that indicated his short time in office has been a success. Unemployment is going down, while tourism is going up. Each topic was one of importance, but I was particularly interested in hearing what this first-time politician had to say about Florida’s current position on health care reform.
Health Benefits Litigation In A Post-Health Reform World
cmonfils | April 25, 2012
Employer’s Guide to Self-Insuring Health Benefits April 2012 | Vol.19, No.7
By Adam V. Russo, Esq., Contributions by Ron E. Peck, Esq.
Led by health reform, 2012 is ushering in a set of new health benefits disputes over whether workforce realignments (from full-time to part-time) constitute discrimination against affected employees, Attorney James Napoli tells the Guide. He also says disputes will center around whether Independent Review Organizations (IROs) are recognized as fiduciaries. Under reform, IROs will have the authority to review claim disputes de novo and their binding rulings will overturn plan determinations. In another column, Contributing Editor Adam Russo and Attorney Ron Peck describe current issues (including reform) that impact plans’ ability to administer benefits. They discuss fiduciary duty in a case in which a court upheld a drug benefit administrator’s decision not to share discount information with a plan sponsor. And they discuss the conflicted position of plans in states that have collateral source and anti-subrogation rules. (more…)
Issues Proposed Rule on Comparative Effectiveness Research Fees
cmonfils | April 24, 2012
The Internal Revenue Service (IRS) has issued a proposed rule addressing the fees imposed by the Affordable Care Act on issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to fund comparative effectiveness research. These fees are designed to support the Patient-Centered Outcomes Research Trust Fund (“Trust Fund”). The Affordable Care Act includes provisions establishing the Patient-Centered Outcomes Research Institute (the “Institute”), a private, nonprofit corporation whose purpose is to “assist, through research, patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings.” The Institute is to be paid for by the Trust Fund, which, in turn, will be partly financed by fees paid by issuers of specified health insurance policies and sponsors of applicable self-insured health plans.
Labor and Employment Alert: Health Plans Must Pay Patient-Centered Outcomes Research Fee and Other Employee Benefits News
cmonfils | April 24, 2012
Why the new fee?
The Patient Protection and Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute to study the effectiveness of various treatments. The Institute’s work will be supported by the Patient-Centered Outcomes Research (PCOR) fee.
DOL Begins Enforcing the ACA through Plan Audits
cmonfils | April 24, 2012
Recent written audit requests to health and welfare plans from the U.S. Department of Labor (DOL) have included inquiries related to various mandates under the Affordable Care Act (the ACA or the Act). This is a significant development in the ongoing implementation of the ACA’s various coverage and related mandates, in that it marks the first appearance of ACA-related topics in DOL auditing practices. While the recent U.S. Supreme Court oral arguments caused speculation as to the future of the ACA, unless and until the ACA is ruled unconstitutional by the Supreme Court, the Act is enforceable and will be enforced by the DOL. Thus, employer-provided group health plans must continue to comply and otherwise implement the ACA’s various coverage and related mandates. Likewise, plan sponsors must comply with any ACA-related DOL audit requests, and be prepared to produce documents to prove that their plan complies with the ACA’s various mandates.
DOL Audits Health Reform Compliance of Employer Plans
cmonfils | April 24, 2012
It may seem paradoxical that the U.S. Department of Labor (DOL) should begin auditing health plans for compliance with the health reform law’s mandates, given that the U.S. Supreme Court could very well strike down the Affordable Care Act (ACA) for being unconstitutional in early summer. But it’s better that plans be ready to demonstrate compliance with the coverage mandates that are presently hanging in the balance.
IRS issues proposed regulations on excise tax imposed on sponsors of health plans
cmonfils | April 24, 2012
It has been just over two years since Congress passed the controversial Patient Protection and Affordable Care Act (PPACA), more commonly known as Health Care Reform. PPACA celebrated its second birthday while preparing to have the constitutionality of some of its key provisions—including the individual health coverage mandate—challenged before the U.S. Supreme Court. We won’t know the outcome of that challenge until June. Meanwhile, an undeterred Obama Administration continues to publish regulations and extra-regulatory guidance to implement PPACA’s provisions.
http://www.nixonpeabody.com/publications_detail3.asp?ID=4364
The Individual Mandate and the Math-less Health Reform Debate
cmonfils | April 20, 2012
Regardless of how the Supreme Court decides the constitutionality of the individual mandate, the health care debate is now reignited. If the mandate is sustained, the Accountable Care Act enacted under President Obama still has too many kinks to remain unaltered. If it’s thrown out, a return to the unsustainable system with growing numbers of uninsured is not a solution. Yet no fix is possible as long as elected officials dodge the basic arithmetic of health care.
IRS Issues Proposed Rule on Comparative Effectiveness Research Fees
cmonfils | April 20, 2012
The Internal Revenue Service (IRS) has issued a proposed rule addressing the fees imposed by the Affordable Care Act on issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to fund comparative effectiveness research. These fees are designed to support the Patient-Centered Outcomes Research Trust Fund (“Trust Fund”). The Affordable Care Act includes provisions establishing the Patient-Centered Outcomes Research Institute (the “Institute”), a private, nonprofit corporation whose purpose is to “assist, through research, patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings.” The Institute is to be paid for by the Trust Fund, which, in turn, will be partly financed by fees paid by issuers of specified health insurance policies and sponsors of applicable self-insured health plans.
How to Replace Obamacare
cmonfils | April 16, 2012
When the Patient Protection and Affordable Care Act (commonly known as “Obamacare”) was signed into law in the spring of 2010, congressional opponents vowed that the fight was not over.
What to Do on the Day After ObamaCare
cmonfils | April 16, 2012
Two weeks ago, the Supreme Court heard arguments on the constitutionality of the administration’s health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down.
http://thehealthcareblog.com/blog/2012/04/09/what-to-do-on-the-day-after-obamacare/
Federal Regulatory Guidance Issued on Self-Insured Health Plan Fees
cmonfils | April 16, 2012
April 13, 2012 – The U.S. Department of Treasury this week signaled how the Internal Revenue Service (IRS) will implement rules designed to collect fees from health insurers and self-insured health plans imposed by the Affordable Care Act in order to fund the Patient-Centered Outcome Research Trust Fund. According to the ACA, the funding requirements are as follows: (more…)
Health Plan Quality Improvement Strategy Reporting Under the Affordable Care Act: Implementation Considerations
cmonfils | April 13, 2012
The Affordable Care Act calls for the U.S. Secretary of Health and Human Services to issue quality improvement reporting requirements for employer group health plans, including self-insured plans, and individual plans, as well as for qualifying plans in health insurance exchanges. Health plans will need to report on their quality improvement activities regarding plan or coverage benefits and provider reimbursement structures that: improve health outcomes, prevent hospital readmissions, improve patient safety and reduce medical errors, and implement wellness and health promotion activities. Mindful of the opportunity to leverage existing plan reporting tools and achieve administrative efficiencies, this report summarizes key features of the eValue8 Health Plan Request for Information, National Committee for Quality Assurance accreditation, and Medicaid’s external quality review process. The authors offer the National Quality Strategy as a framework for quality improvement reporting requirements to align efforts among health plans, health care providers, and health care purchasers.
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