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IRS releases new ACA rules

Posted on February 24, 2015 | No Public Comments

The Internal Revenue Service (IRS) issued final temporary regulations for how it will assess the health insurance tax in 2015, including how it defines a covered entity, which is subject to the fees. The IRS also released guidance on the excise tax on high cost employer-sponsored health coverage, or “Cadillac tax”, which is scheduled to go into effect in 2018. This notice is intended to initiate and inform the process of developing regulatory guidance on the tax.

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CMS issues final rule on benefit and payment parameters for 2016

Posted on February 23, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016. The final rule builds on previously issued standards to further strengthens transparency, accountability, and the availability of information for consumers about their health plans. The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. CMS also released its final annual letter to issuers, which provides additional guidance on these and related standards for plans participating in the Federally-facilitated Marketplace.

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IRS delays penalties on small employer HRAs

Posted on February 19, 2015 | No Public Comments

The Internal Revenue Service (IRS) announced in guidance that small businesses (less than 50 employees) now have until July to end arrangements in which they give their workers tax-free payments to buy coverage on the individual market, or else face significant tax penalties. In the past, some employers have chosen to contribute to HRAs instead of providing insurance. With a health reimbursement arrangement (HRA), employees pay out-of-pocket for health services and submit claims to be paid by the employer. Some workers used these contributions to subsidize their health insurance premiums.

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GAO issues Medicaid report

Posted on February 17, 2015 | No Public Comments

The Government Accountability Office (GAO) issued a report examining (1) the extent to which Medicaid enrollees have private insurance, and (2) state and CMS initiatives to improve third-party liability (TPL) efforts. GAO found that 7.6 million Medicaid enrollees (13.4 percent) had private health insurance in 2012. Additionally, the number of Medicaid enrollees with private health insurance is expected to increase with the expansion of Medicaid. To combat this issue, GAO recommends that the Centers for Medicare and Medicaid Services (CMS) routinely monitor and share across all states information regarding key TPL efforts and challenges, as well as provide guidance on state oversight of TPL efforts conducted by Medicaid managed care plans.

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IRS issues notice on tax penalties related to premium tax credits

Posted on January 27, 2015 | No Public Comments

The Internal Revenue Service (IRS) issued a notice that provides some relief from tax penalties for taxpayers who find out when they file their taxes that they received an overpayment of premium tax credits for buying health insurance under the Affordable Care Act (ACA). The notice offers limited relief for taxpayers who have a balance due on their 2014 income tax return as a result of reconciling advance payments of the premium tax credit against the premium tax credit allowed on the tax return. To qualify for the relief, however, taxpayers must meet certain requirements and the relief applies only for the 2014 taxable year.

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New CBO report estimates ACA costs

Posted on January 26, 2015 | No Public Comments

A new report released by the Congressional Budget Office (CBO) estimates that the coverage provisions of the Affordable Care Act (ACA) will result in $76 billion in net costs to the federal government in 2015 and $1,350 billion between 2016 and 2025. These costs come almost entirely from tax subsidies, accounting for $32 billion in 2015, and from the increase in spending from Medicaid expansions, $47 billion in 2015. CBO predicts that these costs will be offset slightly by an estimated $2 billion in penalties paid by the uninsured in 2015. This new CBO estimate of the ACA’s coverage provisions represents a 7 percent decline since their last estimate.

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CMS issues FAQ on Medicaid plan marketing rules

Posted on January 20, 2015 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) posted a document which clarifies whether Medicaid managed care plans can market their private qualified health plans (QHP) to potential enrollees. CMS says federal rules do not prohibit Medicaid plans from providing information about QHPs to potential enrollees who might enroll in such a plan as an alternative to the Medicaid plan. However, CMS recommends that plans consult contracts and their state Medicaid agencies for more information on what is allowed.

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White paper outlines potential King v. Burwell scenarios

Posted on January 14, 2015 | No Public Comments

Consulting firm Leavitt Partners released a white paper outlining several scenarios that Congress, the states, and the administration could take should the Supreme Court rule against the administration in the King v. Burwell case. Under the first scenario Congress could amend the Affordable Care Act (ACA) in a way that establishes the subsidies were meant for all Americans regardless of who establishes the exchange. In the second proposed scenario Congress would pair a fix to the ACA with “material concessions”, such as the employer mandate or premium tax credit thresholds. In the third scenario outlined in the white paper, Congress would take no action regarding the Court’s decision, leaving it up to states to create their own contingency plans. The Leavitt white paper also suggests several fall-back ideas that may be under consideration by the administration as well as potential state reactions.

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Studies examine impact of possible King v. Burwell decision

Posted on January 13, 2015 | No Public Comments

Two studies by the Robert Wood Johnson Foundation (RWJF) and the RAND Corporation came up with similar findings regarding the Supreme Court’s potential decision in the King v. Burwell case. RWJF speculates that a ruling in favor of King, eliminating subsidies in federal exchanges, would shrink the nongroup insurance market by 9.7 million nonelderly adults and increase the number of uninsured Americans by 8.2 million in 2016. The RAND study also predicts that a ruling in favor of King could cause a 47 percent increase in premiums in federally facilitated marketplaces (FFM). The implications of the court’s decision could ricochet beyond those directly losing subsidies, affecting higher income individuals and even people who obtain coverage outside of the marketplaces.

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HHS issues proposed rule on summary of benefits and coverage

Posted on January 5, 2015 | No Public Comments

The U.S. Department of Health and Human Services (HHS) issued a proposed rule, simultaneously released by the Internal Revenue Service (IRS) and the Department of Labor (DOL), regarding the summary of benefits and coverage (SBC) and the uniform glossary for health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). The proposed rule would change disclosure requirements to help plans and individuals better understand their health coverage and allow for informed comparisons of coverage options. The proposed regulation also makes amendments to the template for the SBC, instructions, sample language, guides for coverage example calculations, and the uniform glossary.

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