Department of Labor
Posted on November 8, 2013
The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
- Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
- Clarifying transparency expectations for insurers to remain compliant with the law; and
- Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today’s rule.
Posted on September 5, 2013
On September 4th, the Departments of Labor, Health and Human Services, and Treasury jointly issued the sixteenth installment of their FAQs about implementing the Affordable Care Act (ACA). This particular set addressed employer notice of coverage and the 90-day waiting period limitation before employer-sponsored benefits are required to kick-in. As specifically stated in the FAQ, an employer will be considered to have satisfied the notice of coverage obligation if another entity “provides a timely and complete notice.” The FAQ also stated that employers can refer to the proposed rule issued in March 2013 on compliance expectations for the 90-day waiting period limitation. A final rule will be released before January 2015.
Posted on June 28, 2013
In a joint rule released by the US Department of Health and Human Services (HHS), the US Department of the Treasury (DoT), and the US Department of Labor (DoL), the administration finalized the requirement for employers to offer contraception coverage through their workplace health insurance policies. The rule defines a “religious employer” to include predominantly churches and houses of worship. For religiously-affiliated institutions, such as universities, the rule provides a simplified process by which insurance companies can cover contraceptives for employees. Religiously-affiliated entities using self-insured plans can use the same streamlined approach for a third-party administrator to provide contraceptives. In addition to the rule, the administration extended the safe harbor for religiously-affiliated hospitals and universities, which prevented those institutions from fines associated with non-compliance to the contraception mandate, through January.
Interview of Phyllis Borzi, Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA), United States Department of Labor
Posted on June 11, 2013
Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act….
Posted on May 29, 2013
A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.
Posted on May 10, 2013
The Employee Benefits Security Administration (EBSA), a division of the Department of Labor, published guidance concerning employer notification of insurance options in the health insurance marketplaces established by the Affordable Care Act (ACA), including model language for employers to notify their employees on marketplaces and employer-sponsored coverage. Technical Release Number 2013-02 states that employers must begin to inform their employees about available insurance options beginning October 1st, and the guidance contains a model notice for employers to utilize. EBSA released this guidance in advance of the proposed rule so that employers are equipped with the appropriate knowledge so they may begin to notify employees as soon as they desire.
Posted on April 30, 2013
In the 15th set of Affordable Care Act (ACA) FAQs, the Internal Revenue Service (IRS) and the Employee Benefit Security Administration (EBSA) answer questions posed by the public and stakeholders to demystify the implementation of various components of the ACA. This particular set discusses annual limit waivers, stating that an alteration to a health plan or policy year will not impact the expiration of an annual limit waiver. The FAQs also indicate that IRS, EBSA and the US Department of Health and Human Services (HHS) will not issue guidance on provider nondiscrimination prior to January 1st, 2014, because the statutory language on the topic is “self-implementing.” In regards to transparency reporting, the FAQs clarify that plans are not beholden to the transparency provisions of the ACA until the plans have been certified as a qualified health plan (QHP) for one benefit year.
Posted on April 25, 2013
The US Department of Labor Employee Benefits Security Administration (EBSA) published their 14th set of frequently asked questions regarding the implementation of the Affordable Care Act (ACA). One key topic covered by the FAQs addresses disclosure requirements for individual or group plan summary of benefits coverage (SBC). In regards to disclosure of minimum essential coverage and the attainment of minimum value requirements, the guidance does not make notable changes for the SBC during 2014, the second disclosure year. The FAQs also state that plans unable to alter their SBC for 2014 are permitted to use the authorized year template without penalty if they also provide a cover letter stating whether or not the minimum value requirements are met.
Posted on March 19, 2013
A proposed rule issued yesterday by the US Department of Labor, US Department of Treasury, and the US Department of Health and Human Services (HHS) implements a provision in the Affordable Care Act (ACA) that requires employer-sponsored health plans to be activated for employees within 90 days. In addition, employers cannot require employees to accrue a minimum number of hours before the 90 day wait period starts. The rules specifically state the 90 day wait limit in and of itself is not an employer mandate.
Comments on the proposed rules will be due by May 20, 2013.
Posted on March 18, 2013
In a guidance issued Friday, the US Department of Health and Human Services (HHS), US Department of Labor, and US Department of the Treasury extended the interim standards for state external review processes. These standards are meant to make health care claim denials easier for patients to appeal, as set forth in the Affordable Care Act (ACA). Under the new guidance, health insurance issuers will be deemed compliant as long as their external review processes meet the National Association of Insurance Commissioner (NAIC) interim process standards established by Technical Release No. 2011-02. The transitional period expires January 1, 2016, and issuers will then have to meet the standards from the July 2010 regulations issued by the federal government.