Rulemaking, Rules, and Guidance

Senate passes payroll-tax cut extension; prevention fund takes hit

Posted on February 17, 2012

In a vote of 60 to 36, the Senate passed a $150 billion economic package to extend the payroll tax holiday, unemployment compensation, Medicare physician payment, provide for the consideration of the Keystone XL pipeline, and for other purposes. The package will extend a payroll tax holiday for 160 million workers and unemployment benefits for the rest of the year. The bill passed in the House earlier today. The legislation will now go to President Obama, awarding him a victory on a portion of the jobs bill he presented to Congress in the fall.

The package will take the first significant…

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Categories: Key Developments, Legislation, Rulemaking, Rules, and Guidance

IRS releases rules on tax exempt entities under the CO-OP Program

Posted on February 6, 2012

The Internal Revenue Service (IRS) released new rules for the Consumer Operated and Oriented Plan (CO-OP) Program regarding what will be recognized as tax exempt under Section 501(c)(29) of the tax code. Proposed and temporary IRS rules denote that qualified nonprofit CO-OP health insurers will need to apply for tax-exempt recognition with IRS. IRS and the Treasury Department will recognize them as exempt effective on either their date of formation or March 23, 2010, the date that the ACA became law. To qualify for a tax exemption, the entity must have received a loan from CMS for operation. IRS’s upcoming revenue procedure requires that a copy of the CMS notice of award and the fully executed loan agreement are included in the entity’s application for exemption.

The IRS temporary rules did include statutory guidance for tax exemption: in addition to notifying the Treasury Department that the group is applying for exemption recognition, no private inurement of earnings to shareholders or individuals can exist, (unless it lowers premiums, improves benefits, or improves the quality of health care delivered to the organization’s members). Additionally, no attempt to influence legislation or politics can be made.

HHS issued the CO-OP final rule in December, which discussed CO-OP Program eligibility standards. For for information on CO-OPs, click here.

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Categories: Department of the Treasury, Internal Revenue Service, Key Developments, Rulemaking, Rules, and Guidance, Tax Policy

Sebelius announces additional time for religious employers to comply with contraception coverage requirement

Posted on January 20, 2012

US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that religious non-profit employers who do not currently offer contraceptive coverage to their employees will have an additional year to comply with the preventive services requirement set forth in an earlier Interim Final Rule (IFR). The earlier rule requires, that as of August 1, 2012, all employers except for churches must include contraception among the free preventive services covered in the insurance plans they offer to employees. The new announcement allows those employers who have religious objections an additional year to comply with the requirement.

For more information on preventive services, click here.

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Categories: Department of Health and Human Services, Key Developments, Office of the Secretary, Public Health, Rulemaking, Rules, and Guidance

Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule

Posted on January 18, 2012

The Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing the Consumer Operated and Oriented Plan (CO-OP) Program on December 13, 2011. This rule finalizes the notice of proposed rulemaking (NPRM) issued by CMS on July 20, 2011, and takes into consideration the numerous comments received during the public notice and comment period ending September 16, 2011. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by ACA §1322(b)(2). Two previous Implementation Briefs provided an overview of the CO-OP program and set forth the key provisions of the proposed rule; this update describes significant changes to the proposed rule as codified in the final rule.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Implementation Briefs, Implementation Update, Rulemaking, Rules, and Guidance

IRS releases Draft Schedule H, instructions for tax-exempt hospitals

Posted on January 6, 2012

The Internal Revenue Service (IRS) has issued a draft Schedule H and accompanying instructions for tax-exempt hospitals. As required by the Affordable Care Act (ACA), non-profit hospitals must respond to questions on financial assistance policies, billing and collection practices, emergency medical care, and individuals eligible for financial assistance, beginning with the 2011 tax filing year. The draft instructions have been revised to more clearly follow the statutory provision of Section 501(r) of the Internal Revenue Code. Several of the changes relate to billing and collections.

For more information on tax-exempt hospital requirements, click here and here.

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Categories: Department of the Treasury, Internal Revenue Service, Key Developments, Rulemaking, Rules, and Guidance, Tax Policy

Update: Essential Health Benefits

Posted on December 20, 2011

On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Implementation Briefs, Implementation Update, Key Developments, Rulemaking, Rules, and Guidance

HHS releases bulletin on essential benefits, allows for state flexibility

Posted on December 16, 2011

The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States’ judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:

One of the three largest small group plans in the State by enrollment
One of the three largest State employee health plans by enrollment
One of the three largest federal employee health plan options by enrollment
The largest HMO plan offered in the State’s commercial market by enrollment

If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State.

For more information on Essential Benefits, click here.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Office of Consumer Information and Insurance Oversight, Office of the Secretary, Rulemaking, Rules, and Guidance

Final Rule on CO-OPs released by HHS

Posted on December 9, 2011

The U.S. Department of Health and Human Services (HHS) has issued a final rule on the Consumer Operated and Oriented Plan (CO-OP) program. Created by the Affordable Care Act (ACA), the CO-OP program seeks to establish nonprofit cooperative insurance plans in all States. The ACA authorizes HHS to make loans available to eligible prospective CO-OPs, with the goal of creating one CO-OP per State. The ultimate intent is for CO-OPs to be able to offer affordable, qualified health plans (QHPs) to consumers through each State’s health insurance Exchange.

For more information on the CO-OP program, click here.

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Categories: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Rulemaking, Rules, and Guidance

HHS issues MLR interim final rule

Posted on December 2, 2011

The U.S. Department of Health and Human Services (HHS) has issued an interim final rule (IFR), with public comment, on the medical loss ratio (MLR) requirement under the Affordable Care Act (ACA). Beginning in 2012, the ACA requires that health insurers spend at least 80% (in some cases 85%) of premiums on health care services, or be required to pay rebates to plan members. HHS issued both the rule itself as well as a separate IFR on the rebate requirements, each allowing for public comment.

For more information on medical loss ratios, click here. An update to the previous brief is pending.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Health Insurance, Key Developments, Rulemaking, Rules, and Guidance

CMS releases ACO final rule, others agencies weigh-in

Posted on October 20, 2011

The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.

Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.

To read more about ACOs, click here.

For the ACO final rule fact sheet, click here.

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Categories: Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Department of Justice, Health Care Quality and Delivery System Reform, Health Insurance, Key Developments, Medicare, Office of Inspector General, Rulemaking, Rules, and Guidance