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
Category Archives: Healthcare Reform
Subscribe to Healthcare Reform RSS FeedHHS 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
HHS Issues Final Rule Addressing Issues Related to Affordable Care Act’s Medical Loss Ratio Requirements
By Ilyse Schuman The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has issued a final rule (pdf) regarding certain issues associated with the Affordable Care Act’s medical loss ratio (MLR) requirements. The new health care law mandates that health insurers, depending on the size of the insurance market, spend… Continue Reading
Reports Provide Insight into Employer-Provided Healthcare Costs, Efforts to Stem Expenses
By Ilyse Schuman Two recently-released healthcare studies indicate that the rise in employer-provided healthcare coverage costs is part of a long-term trend, and that employers are taking affirmative steps to counter this escalation. The first survey, conducted by the Mercer consulting firm, suggests that while healthcare costs have increased over the years, the pace of… Continue Reading
Agencies Delay SBC Application Date, Issue New Guidance on MHPAEA
By Ilyse Schuman The Departments of Labor, Treasury, and Health and Human Services (HHS) have issued a new set of frequently asked questions (FAQs) announcing the delay of the Affordable Care Act’s summary of benefits and coverage (SBC) requirements for insurers and health plans, and providing guidance on the Paul Wellstone and Pete Domenici Mental… Continue Reading
Supreme Court Agrees to Decide Health Care Cases
By Ilyse Schuman As expected, the U.S. Supreme Court has agreed to review (pdf) cases challenging the constitutionality of the Affordable Care Act. The Court accepted the appeals filed in three cases that question the validity of the healthcare reform law, and will hear more than five hours of arguments during the Court’s spring session…. Continue Reading
DC Circuit Court Upholds Constitutionality of Affordable Care Act’s Individual Mandate
By Ilyse Schuman Adding to the existing split among the judicial circuits, in Susan Seven-Sky v. Eric Holder, Jr., (pdf) the U.S. Court of Appeals for the D.C. Circuit affirmed a lower court’s finding that the Affordable Care Act’s individual insurance mandate is constitutional. This mandate, set forth in the law’s minimum essential coverage provision,… Continue Reading
House Approves Bill Narrowing Eligibility to Receive Certain Health Care Subsidies
By Ilyse Schuman On Thursday the House of Representatives voted 262-157 in favor of a bill that would modify how adjusted gross income is calculated for the purposes of qualifying for certain healthcare programs under the Affordable Care Act. Specifically, H.R. 2576 would factor in the full amount of Social Security benefits received for determining… Continue Reading
Employees Are Warming Up to Health Care Reform, Survey Finds
By Ilyse Schuman According to the executive summary of a 2011 Mercer Workplace Survey, (pdf) employees continue to place a high value on employer-provided benefits, and are willing to pay more in premiums to keep their health insurance. The survey, which collected responses from 1,507 401(k) participants between June 16 and July 1, 2011, found… Continue Reading
Administration Drops CLASS Act
By Ilyse Schuman The Affordable Care Act’s beleaguered long-term care program has been officially abandoned due to its lack of financial sustainability. The Community Living Assistance Services and Supports (CLASS) Act (pdf) would have created a national, voluntary program for individuals to purchase long-term care benefits in the event they become functionally disabled. Adults would… Continue Reading
Institute of Medicine Releases Recommendations For Determining Essential Health Benefits
By Ilyse Schuman In a report by the Institute of Medicine (IOM) to the U.S. Department of Health and Human Services (HHS), the IOM recommends that in developing the essential health benefits (EHB) that certain insurance plans must offer under the Affordable Care Act, HHS should ensure that such benefits are affordable to consumers, employers,… Continue Reading
Surveys Find Health Care Premiums Have Substantially Increased in 2011, But that the Rate of Increase will Decelerate in 2012
By Ilyse Schuman The findings of two recent surveys on employer-provided health care indicate that while premiums have risen by 8-9% in 2011, the rate of cost increases will likely decrease the following year. The Employer Health Benefits 2011 Annual Survey (pdf) conducted by Kaiser Family Foundation (Kaiser) and the Health Research & Educational Trust… Continue Reading
Bill Would Repeal Affordable Care Act, Institute Health Insurance Market Reforms
By Ilyse Schuman The deluge of bills seeking to repeal the Affordable Care Act has ebbed but not subsided entirely. On September 21, Rep. Tom Price (R-GA) introduced the Empowering Patients First Act (H.R. 3000), the latest bill that would rescind the new health care law and enact additional measures designed to promote health insurance… Continue Reading
Agencies Seek Comment on Health Plan Affordability Safe Harbor
By Ilyse Schuman The Treasury Department and the Internal Revenue Service (IRS) are soliciting input on a proposed affordability “safe harbor” for employers under the shared responsibility provisions of the Affordable Care Act that would make it easier for employers to determine whether their health care plan is affordable. Under these shared responsibility provisions –… Continue Reading
Fourth Circuit Rejects Challenges to Health Care Law
By Ilyse Schuman In two opinions issued September 8, 2011 the U.S. Court of Appeals for the 4th Circuit rejected lawsuits challenging the Affordable Care Act’s constitutionally on technical grounds. In one case, the appellate court found that the plaintiffs’ lawsuit was premature. In the second, the court held that the plaintiff, the Commonwealth of… Continue Reading
Agencies Issue Proposed Rule Outlining Requirements for Summary of Benefits and Coverage
By Ilyse Schuman The DOL’s Employee Benefits Security Administration (EBSA) along with the Departments of the Treasury and Health and Human Services have issued a proposed rule (pdf) setting forth the requirements of the Summary of Benefits and Coverage (SBC) disclosure that health insurers and group health plans must provide to consumers to enable them… Continue Reading
11th Circuit Finds Individual Mandate Unconstitutional
By Ilyse Schuman Two months after the U.S. Court of Appeals for the Sixth Circuit upheld the constitutionality of the Affordable Care Act, the 11th Circuit has come to the opposite conclusion, holding that Congress exceeded its powers in requiring individuals to obtain health insurance or pay a penalty. The lawsuit – Florida v. U.S…. Continue Reading