by Amy M. Gordon, Todd A. Solomon and Brian J. Tiemann
The U.S. Department of Health and Human Services (HHS) issued a bulletin on December 16, 2011, outlining and requesting comments on its proposed regulatory approach to allow states to define what is an “essential health benefit.”
To read the full article, please click here.
by Susan M. Nash and Elizabeth A. Savard
Group health plans that offer prescription drug coverage are required to issue a notice of creditable or non-creditable coverage to Medicare-eligible participants and beneficiaries each year prior to the annual Medicare Part D open enrollment period. In the past, the Medicare Part D open enrollment period ran from November 15 through December 31, so the notice had to be provided by November 15. The Patient Protection and Affordable Care Act moved the Medicare Part D open enrollment period earlier, beginning in 2011, to October 15 through December 7. Therefore, this year’s notice of creditable or non-creditable coverage must be provided by October 15, 2011.
A plan’s notice of creditable or non-creditable coverage describes whether prescription drug coverage under the plan is "creditable" — i.e., expected to pay out at least as much as standard Medicare prescription drug coverage, on average for all participants. This information is designed to help Medicare-eligible individuals avoid late enrollment penalties, which can apply when an individual who does not have creditable coverage fails to enroll in Medicare Part D when first eligible.
Plan sponsors will need to update their notices of creditable or non-creditable coverage to reflect the new dates for the Medicare Part D open enrollment period. The Centers for Medicare and Medicaid Services have updated their model notices of creditable and non-creditable coverage to reflect the new dates. No other substantive changes were made to the model notices. The updated notices are available here.
Live Knowledge Congress Webcast
Strategies to Deal with the Patient Protection & Affordable Care Act
September 13, 2011, Noon to 2 pm (EST)
Panel includes Susan Nash, Co-Chair of McDermott Will & Emery’s Health and Welfare Benefits Group.
The Patient Protection & Affordable Care Act (PPACA or “Health Reform Bill”) has been the subject of significant legal and policy debate since it was enacted in April 2010. The legislation has been both hailed as an important victory in the battle to improve the quality and accessibility of healthcare in the United States, and challenged as unconstitutional and ineffective in reducing medical costs and otherwise incenting choice and value in medical care and services.
Amidst this debate, legal and business strategies for dealing with the aspects of Health Reform that have been, or soon will be, implemented are often left in the background. These strategies are critical for ensuring compliance and optimizing business performance as PPACA rolls out. No matter how the broader policy or legal debate resolves, entities affected by PPACA must consider the Act’s impact on reimbursement, cost protection, and other day-to-day operational issues.
Strategies to Deal with the Patient Protection & Afford Care Act LIVE Webcast is a must-attend for healthcare professionals, health policy directors, health executives, pharmaceutical and medical device manufacturers and others who are interested in developing practical strategies to deal with healthcare reform. The Knowledge Group has assembled a panel of key thought leaders and regulators to discuss the fundamentals and updates regarding this topic.
Click here to register for the event.
To receive a discount courtesy of McDermott Will & Emery, please enter this code: will8992.
by Susan M. Nash and Maureen O’Brien
On June 17, 2011, the U.S. Department of Health and Human Services (HHS) issued additional guidance with respect to the annual waiver limit program. The annual waiver limit program allows issuers or other group health plan sponsors to apply for a waiver from the annual limit requirements if they present evidence that meeting the annual limits would result in diminished access to benefits or a significant increase in premiums. Typically, issuers or group health plan sponsors that offer extremely basic coverage would be interested in applying for the annual limit waiver program.
Importantly, recipients of these waivers must take action between June 24, 2011 and September 22, 2011 in order to preserve those waivers through the end of 2013. In addition, new applicants must submit applications under the annual limit waiver program between June 24, 2011 and September 22, 2011 in order to receive a new waiver. Extensions or new applications not received on or before September 22, 2011 will not be eligible for an annual limit waiver and will need to comply with the requirements of the Patient Protection and Affordable Care Act (PPACA).
Additional Modifications to the Annual Limit Waiver Program
The following additional modifications were made to the annual limit program:
Click here for the new HHS Guidance.
by Amy Gordon, Susan Nash and Maureen O’Brien
The 2011 budget agreement just passed by U.S. Congress on April 14, 2011, contains provisions that repeal and de-fund certain provisions of the Patient Protection and Affordable Care Act (as amended by the Health Care and Education Reconciliation Act of 2010) (PPACA).
Specifically, the “free choice voucher” program mandated under Section 10108 of PPACA has been repealed. The free choice voucher provision of PPACA required employers to provide vouchers for workers whose employer-provided health insurance premiums cost between 8 percent and 9.8 percent of the worker’s family income. The vouchers could then have been used by the worker to purchase insurance in the private market or in the exchanges.
In addition, the 2011 budget agreement rescinds $2.2 billion of the $6 billion in start-up funding provided for the Consumer Operated and Oriented Plan program created under Section 1322 of PPACA and also rescinds $3.5 billion in performance bonus payments authorized in the 2009 State Children’s Health Insurance Program reauthorization.
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