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.
As part of the regulations under the Patient Protection and Affordable Act (PPACA), the U.S. Office of Personnel Management (OPM) proposed a requirement that OPM contract with private health insurance companies to ensure that at least two multi-state plans are offered in each state’s Affordable Insurance Exchange. Under the law, a multi-state plan issuer may phase in the states in which it offers coverage over four years, but must offer a multi-state plan in exchanges in all States and the District of Columbia by the fourth year. The proposed regulations generally address OPM’s approach to the offering of multi-state plans and the attributes of the multi-state plans to be offered. Comments are being solicited, and are due within 30 days after the rules are published in the Federal Register, which is expected to take place this week.
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.
An IRS compensation rule aimed at health insurers could actually apply to a wide range of companies.
It is well known that the Patient Protection and Affordable Care Act (PPACA, or the federal health care reform law) significantly limits the ability of health insurance companies to deduct payment of compensation beginning in 2013. What is not so well known is that the Internal Revenue Service might apply this limitation to health care services providers that are not typically considered to be insurance companies, to captive insurance companies, and even to companies outside the health insurance industry.
While the Supreme Court of the United States has in large part resolved questions regarding the constitutionality of the Patient Protection and Affordable Care Act, participants in the health care industry should prepare for ongoing uncertainty in the manner and degree to which states will participate in the expansion of Medicaid.
On June 28, 2012, the Supreme Court upheld the most significant provisions of the Patient Protection and Affordable Care Act (the Act), including the controversial individual mandate. The vote was 5-4 and the majority opinion was written by Chief Justice John Roberts. Ironically, the justices concluded that the mandate was not a valid exercise of Congress’ commerce clause power but was a proper use of Congress’ tax authority. One of the most complicated issues that everyone struggled with, the severability issue, is now moot because the individual mandate was upheld.
On March 26–28, the Supreme Court of the United States will undertake an extraordinary six hours of oral argument to decide the fate of the health reform legislation known as the Patient Protection and Affordable Care Act. McDermott Will & Emery will be there, and will share the insights gleaned from three days of court-watching with clients and friends of the Firm.
McDermott has assembled a team of constitutional and health law authorities and seasoned political analysts to discuss the arguments and questions from the justices, make predictions about the ultimate decision and offer implications of possible decision outcomes, including the implications for providers, payors, products and employers who offer health insurance. McDermott Speakers M. Miller Baker, Partner Jon Decker, Senior Professional Advisor Amy Gordon, Partner Joel Michaels, Partner Paul Radensky, M.D., Partner J. Peter Rich, Partner
This interactive webcast is the first of a two-part series. Our second webcast will occur within 24 hours of the Supreme Court’s ultimate decision, which is expected to be issued in the last week of June.
Recently issued final regulations and related guidance clarify the requirement under the Patient Protection and Affordable Care Act that group health plans and health insurance issuers provide a summary of benefits and coverage and a uniform glossary. The guidance includes final regulations and sample summaries and instructions.
The Internal Revenue Service (IRS) has issued revised guidance, Notice 2011-28, regarding the requirement under the Patient Protection and Affordable Care Act (PPACA) that employers report to employees the cost of their employer-sponsored group health plan coverage on Forms W-2. This requirement applies to calendar year 2012 W-2s, which employees will receive from their employer in 2013.
The guidance provided assistance on calculating aggregate reportable cost. Aggregate cost may be calculated in accordance with one of several methods including the “COBRA applicable premium” method, the “premium charged” method (for fully-insured coverage), or a “modified COBRA premium” method.
In addition to medical coverage, employers must include in the cost of employer-sponsored group health plan coverage, coverage under an Employee Assistance Program, wellness program coverage, on-site medical clinic coverage (but only aggregate reportable cost to the extent that the coverage is provided under a group health plan and the employer charges a premium for such coverage to beneficiaries of federal continuation coverage [e.g., COBRA]), Health Flexible Spending Account coverage (FSA), but only where the employer itself contributes to the FSA or otherwise provides flex credits through a Internal Revenue Code Section 125 cafeteria plan, and coverage under a dental plan or vision plan if such plans are not excepted from the Health Insurance Portability and Accountability Act (HIPAA). Employers do not need to include in the cost of employer-sponsored group coverage the cost of coverage under a dental plan or vision plan if such plans are excepted from HIPAA, amounts contributed to an Archer medical savings account (MSA) or a Health Savings Account, amounts of any salary reduction election to an FSA, the cost of coverage under a multiemployer plan, cost of coverage under a Health Reimbursement Arrangement not included in aggregate reportable income, and the cost of coverage provided under a self-insured group health plan that is not subject to federal continuation coverage requirements (i.e., a church plan).
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