Patient Protection and Affordable Care Act Archives

“Because of Bostock” – Court Delays HHS Rule Re-interpreting Section 1557 Discrimination “Because of Sex”

by Jacob Mattinson, Todd Solomon, Gregory Fosheim and Winnie Uluocha | Aug 25, 2020 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

One day before an updated rule of the US Department of Health and Human Services regarding Section 1557 of the Patient Protection and Affordable Care Act took effect, the US District Court for the Eastern District of New York ordered a stay and issued a preliminary injunction precluding the most recent final rules from becoming operative. Entities subject to Section 1557 should — at least until decisions are issued in cases pending in US district courts — be cautious in their approach to their non-discrimination compliance obligations.

Access the article.

HHS Finalizes Anti-Discrimination Revisions to ACA Section 1557

by Jacob Mattinson, Gregory Fosheim, Winnie Uluocha and Todd Solomon | Jul 14, 2020 | Benefit Controversies, Health and Welfare Plans

On June 12, 2020, the Office for Civil Rights (OCR) of the US Department of Health and Human Services (HHS) finalized a rule under Section 1557 of the Patient Protection and Affordable Care Act (the 2020 Final Rule) that rescinds certain protections afforded to LGBTQ individuals and persons with limited English proficiency. At the same time, the 2020 Final Rule removes burdensome disclosure requirements that may be a welcome relief for entities covered by Section 1557. On June 15, 2020, the Supreme Court of the United States ruled that workplace discrimination based on gender identity and sexual orientation is forbidden under Title VII of the Civil Rights Act of 1964. Although Title VII is not included in the precedential civil rights laws that gave rise to Section 1557, we nevertheless anticipate that the Supreme Court’s holding will lead to legal challenges in a number of areas, including healthcare and health insurance, religious exemptions and the 2020 Final Rule from HHS OCR.

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Proposed Changes to the Template for the Summary of Benefit Coverage and Uniform Glossary Required under ACA

by McDermott Will & Emery | Mar 1, 2016 | Employee Benefits, Health and Welfare Plans

The U.S. Department of Labor recently published proposed revisions to the template and related materials for the summary of benefits and coverage (SBC) and the Uniform Glossary. These documents are required to be provided to plan participants under the Affordable Care Act (ACA).

See our articles Additional Guidance Issued on Summary of Benefits and Coverage Disclosure Requirements and Summary of Benefits and Coverage Disclosure Requirements for more details on the SBC.

U.S. Department of Labor Issues Proposed Regulations Amending the COBRA Notice Requirements

by McDermott Will & Emery | May 8, 2014 | Health and Welfare Plans

On May 2, 2014, the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) issued proposed regulations which seek to amend the notice requirements under the Consolidated Omnibus Budget Reconciliation Act (COBRA). The changes are intended “to better align the provision of guidance under the COBRA notice requirements with the Patient Protection and Affordable Care Act (ACA) provisions already in effect, as well as any provisions of federal law that will become applicable in the future.”

Under COBRA, a group health plan must provide participants with a general COBRA notice and COBRA qualified beneficiaries with an election notice. These notices describe a qualified beneficiary’s right to continue coverage under a group health plan. On May 8, 2013, DOL issued Technical Release 2013-02, which included a series of model COBRA notices (see “Notice of Coverage Options Available Through the Exchanges” for more information). These model notices include references to the ACA, noting that some qualified beneficiaries (1) may want to consider and compare health coverage alternatives to COBRA continuation coverage that are available through the ACA exchanges and (2) may also be eligible for a premium tax credit to help pay for the cost of coverage.

The proposed regulations eliminate the current versions of the model notices. However, until the regulations are finalized and effective, the DOL will consider appropriately completed use of the model notices that are currently available on its website to constitute good faith compliance with the notice content requirements of COBRA. Once the current notices are available, they will be posted at the following links:

Note: Use of the model notices is not required.

Proposed Regulations on Excepted Benefits Provide Guidelines, but Employers Should Watch for Final Rules

by McDermott Will & Emery | Mar 20, 2014 | Employment, Health and Welfare Plans

On December 24, 2013, the Departments of Labor, Health and Human Services, and the Treasury issued highly anticipated proposed regulations that would amend the definition of limited excepted benefits. Excepted benefits are generally exempt from the Patient Protection and Affordable Care Act’s (ACA) market reform requirements. The proposed rules would be effective for plan years beginning in 2015. While the proposed regulations provide guidelines on excepted benefits, employers should watch for the final rules to accurately design ACA-compliant excepted benefits plans. To get a better handle on how the proposed rules on excepted benefits impact employers, Wolters Kluwer of Employee Benefits Management Directions, spoke with Joanna C. Kerpen, partner in the employee benefits practice group at McDermott Will & Emery.

Read the full article.

Notice of Coverage Options Available Through the Exchanges

by McDermott Will & Emery | May 23, 2013 | Health and Welfare Plans

by Amy M. Gordon

On May 8, 2013, the U.S. Department of Labor (DOL) published Technical Release No. 2013-02, which provides temporary guidance addressing the Patient Protection and Affordable Care Act’s (ACA) required notice to employees regarding their coverage options under state and federally facilitated health insurance exchanges (Exchanges).

As part of the ACA, an applicable employer was required to provide each employee at the time of hiring (or with respect to current employees, not later than March 1, 2013), a written notice:

Informing the employee of the existence of the Exchanges, including a description of the services provided by the Exchanges and the manner in which the employee may contact the Exchanges to request assistance
If the employer’s plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs, that the employee may be eligible for a premium tax credit under section 36B of the Internal Revenue Code (the Code) if the employee purchases a qualified health plan through an Exchange
If the employee purchases a qualified health plan through an Exchange, that the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for federal income tax purposes

FAQs about ACA Implementation Part XI published in January of this year pushed back the timing for distribution of these notices until late summer or early fall. This new technical release provides guidance on the notice requirement, including setting a notice deadline of October 1, 2013 for current employees. More importantly, the new technical release provides model notices.

The following are links to the DOL model notices:

Model notice for employers who offer a health plan to some or all employees
Model notice for employers who do not offer a health plan
COBRA model election notice (Adobe PDF format)
COBRA model election notice redline version (Adobe PDF format)

ACA Guidance on 90-Day Waiting Periods and Certificates of Creditable Coverage

by McDermott Will & Emery | Apr 16, 2013 | Health and Welfare Plans

by Amy M. Gordon, Jamie A. Weyeneth and Megan Mardy

Recently issued Affordable Care Act guidance clarifies the prohibition on waiting periods in excess of 90 days and eliminates the requirement to issue HIPAA group health plan certificates of creditable coverage after December 31, 2014.

To read the full article, click here.

Proposed ACA Regulations on Transitional Reinsurance Program Premiums and Potential Effects for Employer-Sponsored Group Health Plans

by Jackie Sinn | Dec 31, 2012 | Health and Welfare Plans

by Amy M. Gordon, Jacob Mattinson and Susan M. Nash

As part of the Patient Protection and Affordable Care Act (ACA), the U.S. Department of Health and Human Services (HHS) recently released proposed regulations regarding the estimated amount of annual contributions that are required to be paid to HHS from employer-sponsored group health plans to finance state transitional reinsurance programs. The reinsurance programs are intended to help stabilize premiums for coverage in the individual market during the first three years the state health insurance exchanges are operational (2014 through 2016). HHS is estimating the annual contribution rate for 2014 will be $63 per covered life (employees and their dependents). This will undoubtedly impact the overall cost of providing coverage under an employer-sponsored group health plan and should be taken into account by employers for purposes of estimating cost trends.

Read the full article here.

New Proposed Wellness Guidance under PPACA

by McDermott Will & Emery | Dec 11, 2012 | Health and Welfare Plans

by Amy M. Gordon and Susan M. Nash

New proposed employer wellness program regulations have been released under the Patient Protection and Affordable Care Act.

To read the full article, click here.

What Employers Need to Know for 2012 and 2013 Under the Patient Protection and Affordable Care Act

by McDermott Will & Emery | Oct 30, 2012 | Health and Welfare Plans

by Amy M. Gordon and Susan M. Nash

With the end of 2012 quickly approaching, and for 2013 planning purposes, this newsletter provides a high-level list of the important changes to be aware of under the Patient Protection and Affordable Care Act and the effective date of those required changes.

To read the full article, click here.

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