Benefits Forward » Articles, White Papers and Other Information

Amicus Brief Filed by States in Favor Of Individual Mandate

administrator — Tue, 17 Jan 2012 15:10:15 +0000

Several states have filed an amicus brief with the Supreme Court supporting the individual mandate of the Affordable Care Act.

Document Excerpt

Does Congress have the power, under Article I of the Constitution, to enact the minimum-coverage provision of the Patient Protection and Affordable Care Act, 26 U.S.C. § 5000A, which requires nonexempt individuals to maintain a minimum level of health insurance or pay a tax penalty?

Link http://ag.ca.gov/cms_attachments/press/pdfs/n2611_amicus_health.pdf

HHS Final Rule on Reporting Retiree-Plan Drug Costs

administrator — Fri, 13 Jan 2012 15:57:09 +0000

HHS has published a final rule implementing provisions regarding the reporting of gross covered retiree plan related prescription drug costs and retained rebates by Retiree Drug Subsidy sponsors.

Document Excerpt

This final rule implements and finalizes provisions regarding the reporting of gross covered retiree planrelated prescription drug costs (gross retiree costs) and retained rebates by Retiree Drug Subsidy (RDS) sponsors;and the scope of our waiver authority under the Social Security Act (the Act).

Link http://www.gpo.gov/fdsys/pkg/FR-2012-01-12/pdf/2012-473.pdf

Summary of Benefits and Coverage Template

administrator — Thu, 25 Aug 2011 02:00:42 +0000

The Departments release a completed Summary of Benefits and Coverage template.

Document Excerpt

Link http://www.dol.gov/ebsa/pdf/SBCtemplate.pdf

Exchange Functions and Eligibility Determinations

administrator — Tue, 23 Aug 2011 20:07:29 +0000

HHS releases proposd guidance on certain Exchange functions and determinations of eligibility.

Document Excerpt

This proposed rule would implement certain functions of the new Affordable Insurance Exchanges (‘‘Exchanges’’), consistent with title I of the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors.

Link http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/pdf/2011-20776.pdf

Additional Guidance on ERRP as General Revenue Prohibition

administrator — Thu, 04 Aug 2011 13:58:55 +0000

The Centers for Medicare & Medicaid Services has posted additional guidance on what plan sponsors who use Early Retiree Reinsurance Program (ERRP) reimbursements to reduce health benefit premiums must do to comply with prohibition on using ERRP reimbursement as general revenue.

Document Excerpt

This guidance is intended to give plan sponsors some flexibility in applying the maintenance of contribution requirement, while also helping to ensure that sponsors do not violate the prohibition against using ERRP reimbursement as general revenue. To the extent that a plan sponsor is unable to use the maintenance of contribution approaches set forth in this guidance, the sponsor may demonstrate compliance with this requirement in other ways. In such situations, the sponsor may be required, upon audit, to demonstrate how its approach is consistent with the statutory and regulatory requirements.

http://www.errp.gov/download/Ban_on_Using_ERRP_Funds_as_General_Revenue.pdf

Amendment to Rules governing Preventive Services

administrator — Mon, 01 Aug 2011 22:19:56 +0000

The agencies have issued an amendment to the rules governing coverage of preventive services.

Document Excerpt

This document contains amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services.

Link http://www.ofr.gov/OFRUpload/OFRData/2011-19684_PI.pdf

Correcting Amendment to Claims Regulations

administrator — Wed, 27 Jul 2011 14:14:38 +0000

The agencies have released the text of the correcting amendment to the internal review and appeal and external review claims regulations.

Document Excerpt

Link http://www.gpo.gov/fdsys/pkg/FR-2011-07-26/pdf/2011-18820.pdf

Regulations Governing Exchanges

administrator — Fri, 15 Jul 2011 14:36:00 +0000

HHS has issued regulations governing the establishment of Exchanges required under the Affordable Care Act.

Document Excerpt

This proposed rule would implement the new Affordable Insurance Exchanges

(“Exchanges”), consistent with title I of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152), referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

Link http://www.ofr.gov/OFRUpload/OFRData/2011-17610_PI.pdf

GAO Study on Waiver Applications

administrator — Wed, 15 Jun 2011 13:59:53 +0000

The GAO’s internal study found that applications with a projected premium increase of 10 percent or more tended to be approved while applications with a projected premium increase of 6 percent or less tended to be denied. Applications with a premium increase between 7 and 9 percent warranted additional staff reviews

Document Excerpt

CCIIO granted waivers on the basis of an application’s projected significant increase in premiums or significant reduction in access to health care benefits. According to CCIIO officials, applications with a projected premium increase of 10 percent or more tended to be approved while applications with a projected premium increase of 6 percent or less tended to be denied. Applications with a premium increase between 7 and 9 percent warranted additional staff reviews to determine if the application met the agency’s criteria. In corroboration, among our 5 percent sample of approved applications, we found that CCIIO granted waivers mostly for applications that projected the annual limit restriction would result in a significant premium increase of more than 10 percent, in addition to a significant decrease in access to benefits. Conversely, most of the denied applications projected a premium increase of 6 percent or less. In reviewing a draft of this report, HHS provided technical comments, which we incorporated as appropriate.

Link http://www.gao.gov/products/GAO-11-725R

Congressional Hearing on Rising Health Care Cost

administrator — Thu, 02 Jun 2011 14:05:06 +0000

The Subcommittee on Health, Employment, Labor and Pensions of the House of Representatives Commitee on Education andthe Workforce held a hearing on the pressures of rising costs on employer provided health care.

Document Excerpt

Link http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=112_house_hearings&docid=f:64941.pdf