Administration released final rule on employee-sponsored wellness programs
Posted by Nikki Hurt on May 29, 2013
A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.
IRS updates guidance with MLR proposed rule
Posted by Nikki Hurt 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%.
IRS releases NPRM on employer coverage and tax credits
Posted by Nikki Hurt 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 for the population, 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.
IRS and EBSA issue next set of ACA FAQs
Posted by Nikki Hurt on
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.
Update: Treasury/IRS Proposed Rule on Community Benefit Obligations of Nonprofit Hospitals
Posted by Mark Dorley on April 17, 2013
Prior to 1969, nonprofit hospitals, as a condition of their tax-exempt status, were expected to furnish uncompensated care to persons unable to pay. In 1969, the Nixon Administration broadened this obligation to encompass “community benefits,” which could take the form of not only free or reduced-cost care, but also other activities that hospitals determined would benefit their communities, such as health promotion activities, research, and education and training. This more amorphous concept of community benefit went unenforced for decades. However, following years of government reports and news stories focusing on the limited level of uncompensated care furnished by many nonprofit hospitals, as well as the imposition of excessive charges and use of harsh billing practices on the uninsured, Congress moved to address the issue…
CRS report details employer penalties under ACA
Posted by Nikki Hurt on April 8, 2013
A Congressional Research Service (CRS) report released last week clarified confusion associated with how companies treat their part-time and seasonal workers, and how this treatment may make them eligible for employer penalties under the Affordable Care Act (ACA). The CRS report includes updated information on employer penalties, which was provided by IRS guidance released late last year. According to the ACA, employers with a minimum of 50 full-time equivalent employees must offer affordable and adequate health insurance to their employees, or run the risk of receiving significant penalties under the law. The confusion on the issue stems from the difference in calculating which businesses are subject to penalties, and the IRS guidance helps to clarify this issue by explaining the ACA’s classification of a full-time employee and provisions related to seasonal workers.
IRS issues NPRM for charitable hospital organizations
Posted by Nikki Hurt 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.
House approves continuing resolution to withold ACA funding
Posted by Nikki Hurt 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.
Feds release ACA regulation roundup
Posted by Mark Dorley 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…
Final Rule: Taxable Medical Devices
Posted by Mark Dorley on February 13, 2013
The Internal Revenue Service (IRS) and Department of Treasury released the final Medical Device Tax rule on December 11, 2012. The rule imposes a tax on the sale of any “taxable medical device” by the manufacturer, producer or importer of a device. The amount of the tax is 2.3 percent of the price of the device, with an effective date of January 1, 2013.