Internal Revenue Service
Posted on May 14, 2013
According to a proposed rule released by the Internal Revenue Service (IRS), “activities that improve health quality” can not be used to determine Blue Cross and Blue Shield’s Medical Loss Ratio (MLR) in regards to obtaining their tax-exempt status. According to the Affordable Care Act (ACA), insurance companies lose their tax privilege under tax code Section 833 and the MLR if they do not spend 85% of their premium revenue on enrollee medical services. Until this proposed rule was released, interim guidance permitted insurance companies to count health care quality activities toward their 85%.
Posted on April 30, 2013
The Internal Revenue Service (IRS) issued a proposed rule discussing the minimum value of employer-sponsored health coverage and the ability of employees to receive premium assistance tax credits. According to the proposed rule, IRS states that the minimum value would be determined by dividing the cost of certain benefits to the standard population by the cost of all benefits, including employee cost-sharing and plan payments, and converting that value to a percentage. Several values, such as the amount contributed by employer’s to health savings accounts, will be considered in determining the employer’s share of costs. However, IRS has also proposed that employer contributions to wellness incentive programs does not count toward health plan minimum value. Additionally, the proposed rule also states that employee-sponsored large group plans are not beholden to every essential health benefit category (EHB), nor must they design their plans to mimic the EHB standards that apply to qualified health plans offered in the Exchange. Adherence to the minimum value requirements will prevent employers from paying the employee shared responsibility payment penalties and will render their employees ineligible for premium assistance tax credits in the Exchange.
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 3, 2013
The Affordable Care Act (ACA) mandates that charitable hospitals perform community health needs assessments (CHNA). The proposed rule released by the Internal Revenue Service (IRS) provides guidance on specific components of the CHNA, including related excise tax and reporting obligations, as well as clarification on consequences of failing to meet CHNA and other requirements.
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 7, 2013
The US House of Representatives approved a continuing resolution (CR) yesterday that would deny necessary funding for several agencies to implement their respective portions of the Affordable Care Act (ACA). The bill, H.R. 933, was introduced on Monday by Appropriations Committee Chairman Hal Rogers (R-KY). Several specific funding denials include:
- $949 million to the US Department of Health and Human Services (HHS) to aid in paying for the federal insurance exchanges.
- $29 million to the Centers for Medicare and Medicaid Services (CMS) for Health Care Fraud and Abuse Control.
- Funds requested by the Internal Revenue Service (IRS) for ACA tax provisions.
267 Members voted in favor of the bill.
Posted on March 1, 2013
The US Department of Health and Human Services (HHS) has released a flurry of regulations implementing various aspects the Affordable Care Act (ACA) today, including insurance market rules and rules related to the small business exchanges (SHOP). Additionally, both the Internal Revenue Service (IRS) and the Office of Personnel Management (OPM) have released ACA regulations. A list of the rules is…
Posted on January 31, 2013
The Internal Revenue Service (IRS) and the Centers for Medicare and Medicaid Services (CMS) have released 2 new proposed rules related to the individual requirement to purchase health insurance (mandate). The IRS rule clarifies the requirement that nonexempt individuals maintain minimum essential coverage or make a shared responsibility payment (penalty). The CMS rule lays out specific exemptions to minimum coverage requirement, most notably that any person otherwise eligible for Medicaid under the new ACA eligibility expansion, but who resides in a state that has chosen not to expand, will not be subject to the shared responsibility payment.
Stay tuned to HealthReformGPS for a detailed analysis of these rules in the future.
Posted on January 24, 2013
The Employee Benefit Securities Administration (EBSA) of the U.S. Department of Labor (DOL) and the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have jointly released a Frequently Asked Questions (FAQ) document addressing multiple issues related to Affordable Care Act (ACA) implementation. Most notably, the FAQs extend the deadline by which employers must notify their employees about coverage options in the Exchanges from March 1, 2013, to sometime in “the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.” DOL made the determination in part because they feel the notifications should coincide with HHS outreach and educational efforts and IRS guidance on Exchange Qualified Health Plan (QHP) minimum value. Furthermore…
Posted on December 29, 2012
On Friday, the Internal Revenue Service (IRS) of the Department of Treasury issued a notice of proposed rulemaking (NPRM) addressing the Affordable Care Act’s (ACA’s) employer mandate. The IRS also released a series of questions and answers, highlighting the key provisions in the NPRM. The 144-page document explains how to determine which companies constitute large employers and which employees qualify as full-time. In the guidance, IRS also said that large employers must offer coverage not only to employees, but to their families as well.
Comments on the proposed rule are not due until March 18, 2013, and a public hearing will be held on the proposal on April 23, 2013. This comment period contrasts the 30-day comment periods imposed on the proposed market reform and essential health benefits rules recently released by the Department of Health and Human Services (HHS).