By Ilyse Schuman The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has issued a final rule (pdf) that imposes a new reporting requirement on health insurance issuers in the group and individual markets that meet or exceed the applicable medical loss ratio (MLR) standard for the 2011 reporting year…. Continue Reading
Category Archives: Healthcare Reform
Subscribe to Healthcare Reform RSS FeedAgencies Issue New Guidance on Summary of Benefits and Coverage Requirement
By Ilyse Schuman The Department of Labor’s Employee Benefits Security Administration (EBSA) along with the Departments of Health and Human Services (HHS) and the Treasury have released a ninth set of Frequently Asked Questions (FAQs) on the Affordable Care Act’s implementation. This most recently issued guidance addresses questions regarding the health care reform law’s summary… Continue Reading
Information Sought on Stop Loss Insurance Coverage
By Ilyse Schuman The Departments of Treasury, Health and Human Services, and Labor are soliciting input from group health plans and their sponsors regarding the use of stop loss insurance. Stop loss insurance protects against catastrophic or unpredictable health insurance claims and provides coverage to self-insured group health plans once a certain level of risk… Continue Reading
CMS Issues Guidance on Medical Loss Ratio Requirement
By Ilyse Schuman The Centers for Medicare & Medicaid Services (CMS) has issued new guidance (pdf) on the medical loss ratio (MLR) requirement under the Affordable Care Act. The new health care law mandates that health insurers, depending on the size of the insurance market, spend between 80 and 85% of premium revenue on reimbursement for… Continue Reading
IRS and HHS Release Guidance for Determining What Constitutes “Minimum Value” for Employer-Sponsored Health Plans and Health Coverage Reporting and Verification Requirements
By Ilyse Schuman The Internal Revenue Service has issued three new guidance documents related to certain requirements the Affordable Care Act imposes on employer-provided health plans. The Department of Health and Human Services (HHS) also issued a bulletin regarding verification of access to employer-sponsored coverage. IRS Notice 2012-31 The first guidance document, Notice 2012-31, (pdf) suggests various possible… Continue Reading
IRS Issues Proposed Rule on Comparative Effectiveness Research Fees
By Ilyse Schuman 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… Continue Reading
Supreme Court Hears Final Day of Oral Argument on Severability, Medicaid Expansion
By Ilyse Schuman If the Affordable Care Act’s (ACA) individual mandate provision is deemed unconstitutional, which parts – if any – of the law can survive without it? That was the first question the Supreme Court considered during the third and final day of oral argument on the constitutionality of the health care law. Members… Continue Reading
Supreme Court Hears Arguments on Constitutionality of Individual Mandate
By Ilyse Schuman On Tuesday the U.S. Supreme Court presided over two hours of oral argument on the most publicized aspect of the Affordable Care Act (ACA) under review: whether the individual mandate is constitutional. The minimum coverage provision of the Affordable Care Act provides that, beginning in 2014, non-exempted federal income taxpayers who fail… Continue Reading
Supreme Court Hears First Day of Argument in Affordable Care Act Challenge
By Ilyse Schuman Whether the controversial individual mandate contained in the new health care law can even be challenged at this time was the subject of debate during the first of three days of oral argument before the U.S. Supreme court on the Affordable Care Act’s (ACA) constitutionality. Under the individual responsibility provisions of the… Continue Reading
Agencies Issue Eighth Set of FAQs on Affordable Care Act Implementation
By Ilyse Schuman The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury have released additional guidance in the form of Frequently Asked Questions (FAQs) regarding the Affordable Care Act’s requirement that group health plans and health insurance issuers provide consumers with a summary of benefits and coverage (SBC) that “accurately describes… Continue Reading
Agencies Seek Input for Future Religious Exemption Rule
By Ilyse Schuman The Departments of Labor, Health and Human Services, and the Treasury have issued an advance notice of proposed rulemaking (ANPRM) (pdf) in order to solicit comments for proposed amendments to a recently-issued rule on preventive health services that non-grandfathered health plans must cover without any cost-sharing. The current rule exempts group health… Continue Reading
Estimate of Reduction in Employer-Provided Health Coverage as a Result of Affordable Care Act Varies Depending on Scenario
By Ilyse Schuman A new report (pdf) released on Thursday by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) supports their initial finding that the Affordable Care Act (ACA) will likely lead to a modest reduction in employment-based health insurance over the next decade. Specifically, the report estimates that as a… Continue Reading
HHS Releases Final Rule on Insurance Exchanges
By Ilyse Schuman The U.S. Department of Health and Human Services (HHS) has released its long-awaited final rule (pdf) implementing the new health insurance exchanges (“Exchanges”) established by the Affordable Care Act. The Exchanges, set to become operational as of January 1, 2014, are designed to work as state-based virtual health insurance marketplaces where individuals… Continue Reading
Survey Analyzes Employer Tactics, Trends for Managing Rising Health Care Costs
By Ilyse Schuman According to the findings of a new employer health care survey conducted by Towers Watson/National Business Group, most large employers will continue to offer health care benefits once the health insurance exchanges are in place in 2014, but are less confident that they will do so a decade from now. The survey… Continue Reading
Senate Defeats Conscience Amendment
By Ilyse Schuman On Thursday March 1 the Senate narrowly defeated an amendment to a highway transportation bill that would have allowed insurers and employers to refrain from offering health coverage of any service or item if doing so would be against their moral or religious beliefs. The so-called “conscience” amendment (S. Amdt. 1520) offered… Continue Reading
HHS Issues New Set of FAQs on Determining Essential Health Benefits
By Ilyse Schuman The Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight (CCIIO) has issued additional guidance (pdf) on the approach the agency plans to take in defining the essential health benefits (EHB) that non-grandfathered insured health plans in the individual and small group markets must cover under the Affordable… Continue Reading
HHS Releases Model Notices Related to Medical Loss Ratio Requirement
By Ilyse Schuman The U.S. Department of Health and Human Services (HHS) has issued proposed notices that health insurance companies may use for compliance with the new Medical Loss Ratio (MLR) requirements under the Affordable Care Act. The new health care law mandates that health insurers, depending on the size of the insurance market, spend… Continue Reading
Agencies Issue Final Rule on Contraceptive Coverage
By Ilyse Schuman The Departments of Labor, Health and Human Services, and the Internal Revenue Service have issued a final rule that adopts without change interim final regulations that exempt group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the… Continue Reading
DOL Issues New Guidance Related to Affordable Care Act Provisions
By Ilyse Schuman The Department of Labor has issued a new technical release document that provides responses to frequently asked questions (FAQs) about the Affordable Care Act’s automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods provisions. In addition to providing guidance on these topics, the document discusses possible approaches under consideration… Continue Reading
Agencies Issue Final Rule Regarding Summary of Benefits and Coverage
By Ilyse Schuman The Departments of Health and Human Services, Labor, and the Treasury have issued final regulations (pdf) under the Affordable Care Act to implement the requirement that group health plans and health insurance issuers provide consumers with a summary of benefits and coverage (SBC) that “accurately describes the benefits and coverage under the… Continue Reading
House Votes to Repeal Affordable Care Act’s Long-Term Care Program
By Ilyse Schuman The House of Representatives on Wednesday voted to rescind another portion of the Affordable Care Act. The chamber approved by a 267-159 margin the Fiscal Responsibility and Retirement Security Act of 2011 (H.R. 1173), a measure that would repeal the Community Living Assistance Services and Supports (CLASS) Act, (pdf) the Affordable Care… Continue Reading
Agencies Outline Plans for Issuing Rules under Affordable Care Act
By Ilyse Schuman On January 20, 2012 various federal agencies released their regulatory agendas for the coming year. These documents describe which rules agencies such as the U.S. Department of Health and Human Services (HHS) and the Department of Labor’s Employee Benefits Security Administration (EBSA) intend to develop and/or issue in proposed and final form… Continue Reading
HHS Proposes Framework for Meeting Essential Health Benefits Requirement Under Affordable Care Act
By Ilyse Schuman On December 16, 2011, the Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight (CCIIO) released an essential health benefits bulletin (pdf) that describes a proposed regulatory approach that the HHS will use to define essential health benefits (EHB) under the Affordable Care Act. The health care reform law… Continue Reading
HHS Issues Final Rule Implementing CO-OP Program Under Affordable Care Act
By Ilyse Schuman The U.S. Department of Health and Human Services (HHS) has issued a final rule (pdf) implementing the Consumer Operated and Oriented Plan (CO-OP) program under the Affordable Care Act. The CO-OP program is designed to provide loans to encourage the creation of consumer-governed, private, nonprofit health insurance issuers that will ultimately offer… Continue Reading