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Health plans - policy

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GAO Testimony before House Oversight Committee: Federal Regulations -- Opportunities to Improve the Effectiveness of and Transparency of Regulatory and Guidance Practices (PDF)
21 pages. "[T]his testimony discusses : [1] the extent to which the Departments of ... Health and Human Services (HHS), and Labor (DOL) adhered to Office of Management and Budget (OMB) requirements and internal controls when developing regulatory guidance and [2] agencies' compliance with the Congressional Review Act (CRA) for regulations promulgated during presidential transitions. We consistently found opportunities to improve the transparency and effectiveness of regulatory and guidance practices." [GAO-18-436T, March 14, 2018] (U.S. Government Accountability Office [GAO])
[Opinion] Single-Payer Health Care: Opportunities and Vulnerabilities
"A bigger government role in the health system could bring down prices, but those prices represent income to hospitals, physicians, and drug companies, which they will fiercely resist reducing. People may not have to pay premiums or anything at the point of service, but they will pay higher taxes. The absence of deductibles or copays would remove financial barriers to accessing needed care but could also result in more unnecessary care." (JAMA Forum)
[Opinion] ERIC and Broad Coalition Push Health Savings Account Reforms for Omnibus
"ERIC and other coalition members have released a budget estimate showing that these HSA fixes would have only a nominal impact on the federal budget -- thus eliminating one of the primary objections that could have prevented these needed reforms and modernization provisions from being included in the coming omnibus spending package.... The package of reforms are individual bills that have been aggregated, in part, into H.R. 5138 ... Also part of the package is H.R. 365[.]" (The ERISA Industry Committee [ERIC])
Bill to Improve HSAs Would Permit Pre-Deductible Coverage of Preventive Care
"The Bipartisan HSA Improvement Act [would] ... [1] Clarify that certain services and prescription drugs that prevent chronic disease progression are preventive care that will not be subject to a deductible; [2] Allow employers to provide primary care, chronic disease prevention, and other high-value services at on-site and near-site medical clinics without imposing a deductible; [3] Permit the use of HSA funds to pay for medical expenses for adult children up to age 26; and [4] Permit HSA contributions if a spouse has a health FSA." (Wolters Kluwer Law & Business)
Uber Wants DOL's Association Health Plan Rule to Consider Gig Workers
"Uber Inc. and its health-care partner, Stride Health, ... asked the DOL in separate letters to allow workers with multiple jobs and varied hours to be eligible to participate in association health plans. Uber, which has long fought for portable benefits legislation for its independent contractor drivers, also said it wants clarification on worker classification under the plan." (Bloomberg BNA)
CMS Thwarts Idaho's Attempts to Skirt ACA, But Provides a Path Forward
"[CMS] outlined a path for Idaho to still allow its state-based plans within the bounds of the law. It explained that ... HHS [has] proposed a rule that would expand the availability of short-term, limited duration health insurance, by allowing consumers to buy these plans for any period less than 12 months, rather than the current maximum period of less than three months.... In stopping Idaho's current plan, CMS may very well have given other states the green light to adopt more creative ways to skirt the requirements of the ACA." (Pepper Hamilton LLP)
Tennessee Executive Pleads Guilty to Fraudulent Sales of Association Coverage and Limited Benefit Products
"On March 7, 2018, the Department of Justice (DOJ) announced that the former owner and chief executive officer of a Nashville-based telemarketing company had pled guilty to defrauding consumers to sell limited benefit health plans and association memberships as traditional, major medical health insurance. The announcement came just one day after comments were due on a proposed rule from the [DOL] to expand access to association health plans and appears to confirm some concerns about fraud, abuse, and insolvency raised by a variety of stakeholders in public comments." (Health Affairs)
Comments Indicate Concern that DOL's Small Employer Health Plan Proposal Ripe for Fraud
"The [DOL's] proposed expansion of health plans for employer groups would invite scammers back into the insurance market ... Employment lawyers, former DOL officials, insurers, and advocacy groups are among those to voice concerns about past fraud and insolvency problems with similar multiple employer health plans." (Bloomberg BNA)
No-Go for Idaho: Back to the Drawing Board on State-Based Health Plans
"No, you can't. That's what federal officials told Idaho regulators ... regarding the state's plan to allow insurers to sell health plans that fall short of the [ACA's] requirements. But the letter from [CMS] did offer an alternative: Tweak your plan a bit to make them qualify as 'short-term' policies ... which are exempted from ACA rules, including those barring insurers from rejecting people with preexisting medical conditions[.]" (Kaiser Health News)
Administration's Plan to Put You in Charge of Your Health Information
"Interoperability is essentially the ability of different computer systems to communicate with each other quickly and effectively. For healthcare specifically, that means being able to share patient data in an instant regardless of what hospital, pharmacy, laboratory, or clinic houses the information -- and being able to do so with complete reliability and privacy protection." (The White House)
Tri-Agencies Proposed Rule Alters Short-Term, Limited Duration Insurance Offering
"The consensus among policy makers is that extending the duration of the coverage period that STLDI can be offered is likely to increase the number of consumers who elect to enroll in these plans over health insurance that constitutes Minimum Essential Coverage. The number of people enrolling in STLDI plans is likely to increase further in 2019 when consumers will no longer face a tax penalty for failing to maintain minimum essential coverage." (Health Law Advisor, Epstein Becker Green)
Successful Challenge to ACA Risk Adjustment Formula in New Mexico
"In holding that the formula was arbitrary and capricious, the district court rejected HHS's argument that the formula was justified because the ACA requires risk adjustment to be budget neutral. The court agreed ... that the statute includes no such requirement. and vacated all HHS risk adjustment regulations dating back to 2014." [New Mexico Health Connections v. HHS, No. 16-878 (D.N.M. Feb. 28, 2018)] (Pepper Hamilton LLP)
HHS May Step in to Enforce the ACA in Idaho
"Idaho has 30 days to respond to CMS which will then make a preliminary determination of substantial enforcement (or not).... The letter explicitly identifies a conflict between the bulletin and the ACA's ban on preexisting condition exclusions, community rating standards, guaranteed renewability requirements, ban on lifetime and annual dollar limits on essential health benefits, ban on discrimination based on health status, coverage of preventive services without cost-sharing, and coverage of the entire essential health benefits package (including prescription drugs and the annual out-of-pocket maximum)." (Katie Keith, in Health Affairs)
CMS Administrator Statement on Enforcement Letter to Idaho
"CMS appreciates the Governor's concern for his citizens and his efforts to address their increasing premiums, an increase of 91.4% over the last four years alone. CMS looks forward to continuing to work with Idaho on their 1332 and 1115 waiver applications." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Text of Letter from CMS Administrator to Idaho Governor About Potential Sale of Non-Compliant Health Plans (PDF)
"Based on our review of Idaho Bulletin No. 18-01 ... we have reason to believe that Idaho may not be substantially enforcing provisions of the PPACA. If a state fails to substantially enforce the law, [CMS] has a responsibility to enforce these provisions on behalf of the State.... [We] believe that Idaho has options within the law to meaningfully implement many of the policy proposals contained in the Bulletin, to address the crisis facing the state's individual health insurance market. I outline a few of those options below." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
New Employer Coalition Aims to Ease Reporting Requirements
"Dubbed the Partnership for Employer-Sponsored Coverage, the group is planning a formal launch in the spring. P4ESC seeks to promote legislative and regulatory amendments to the [ACA], such as reducing the reporting requirements within the employer shared-responsibility provision." (Employee Benefit News)
Blue Cross of Idaho Makes Its Case to HHS
"Blue Cross of Idaho's outside counsel lays out four arguments that he believes bolster the DOI in approving the state-based plans and obviate the need for HHS to step in and enforce the ACA.... [T]he attorney essentially argues that Idaho is doing enough to otherwise 'substantially' enforce the ACA (even if not requiring compliance by the state-based plans) and that Idaho's approach is to help, not hurt, the marketplace so it should be allowed." (Katie Keith, in Health Affairs)
[Opinion] American Benefits Council Comment Letter to DOL on Proposed Regs for Association Health Plans
"Any final rule should permit employers of all sizes to participate in AHPs ... Clarify 'working owner' eligibility ... Final regulations should provide sufficient safeguards to protect the stability of the individual health insurance market." (American Benefits Council)
HHS Secretary Outlines 4-Point Plan to Accelerate Shift Toward a Value-Based System
"[1] Moving ownership and control of electronic health records from providers to patients.... [2] Providing payers and providers with incentives to be more transparent about healthcare costs.... [3] Using Medicare and Medicaid to drive industry change.... [4] Reducing regulatory burdens." (FierceHealthcare)
House Judiciary Subcommittee Holds Hearing on Proposed CVS/Aetna Merger
"[Unlike the Congressional] hearings on the proposed Aetna/Humana and Anthem/Cigna mergers in 2016, at which representatives for the AMA and other groups strongly opposed the transactions, the other witnesses testifying concerning the proposed CVS/Aetna deal struck a more measured tone." (Akerman)
Administration Announces MyHealthEData Initiative
"[T]he MyHealthEData initiative ... aims to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure.... This effort will approach the issue of healthcare data from the patient's perspective.... Medicare's Blue Button 2.0 ... will significantly improve the Medicare beneficiary experience by providing them with their claims data in a universal and secure digital format.... CMS believes that the private plans that contract through Medicare Advantage and the exchanges should provide the same benefit that is being provided through Medicare's Blue Button 2.0." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] American Academy of Actuaries Comment Letter to DOL on Proposed Regs for Association Health Plans (PDF)
"This comment letter provides information on the potential implications of broadening AHP eligibility on the ACA small group and individual markets.... By allowing AHPs to offer coverage under large group rules, the proposed rule would exempt AHPs from the ACA's essential health benefits requirements (EHBs) and related restrictions.... AHPs could design plans more attractive to lower-cost small groups, leading to adverse selection and higher premiums among ACA small group plans.... Cross-state marketing of AHPs raises concerns of an unlevel playing field." (American Academy of Actuaries)
[Opinion] ARA Comment Letter to DOL on Proposed Regs for Association Health Plans (PDF)
"[ARA recommends] the final regulation be modified to permit ... member-based associations ... the opportunity to sponsor an AHP. The Proposal contemplates that the association sponsoring the AHP would do so for the benefit of its members who are employers. Unfortunately, this would deprive thousands of associations whose membership is made up [of] individual members the opportunity to sponsor an AHP." (American Retirement Association [ARA])
DOL Urged to Release Data on Fraudulent Health Plans
"A group of stakeholders [in a comment letter dated March 1, 2018, asked the DOL] to hold off on finalizing the association health plan rule until the agency releases data on fraudulent health plans.... The group also filed a [FOIA] request demanding that the DOL release any statistics or information it has about the agency's enforcement efforts against [MEWAs].... The coalition says the public needs a fuller picture of the problems association health plans could face and to have that, the public needs data on fraudulent MEWAs." (Bloomberg BNA)
[Opinion] House Committee Comment Letter to DOL on Proposed Regs for Association Health Plans (PDF)
28 pages. "[We] ask that you consider the provisions included in the Small Business Health Fairness Act of 2017 as a strong, workable, and bipartisan model to successfully promote affordability, flexibility and predictability for American businesses. Excerpts from the Committee's report on the legislation are attached as additional comments for your consideration on the proposed rule." (Committee on Education and the Workforce, U.S. House of Representatives)
Reports Find Risk of Non-ACA-Compliant Plans to Be Higher Than Federal Estimates
"[Three recent] studies suggest that the proposed rules -- combined with the repeal of the individual mandate penalty and other federal policy changes -- will lead to higher premiums in ACA markets, a higher number of uninsured people, a higher number of people without minimum essential coverage, and higher federal spending. These analyses run counter to much of the data and projections included in the proposed rules, suggesting that the rules, if finalized, would have a greater impact than the federal government estimates." (Katie Keith, in Health Affairs)
Congress Races the Clock in Quest to Bring Stability to Individual Insurance Market
"[A] bipartisan group of senators and House members has been working since last summer on measures to keep prices from rising out of control and undermining the individual market ... Insurers have until summer to decide if they want to continue to sell policies in the ACA marketplaces, but many start making preliminary decisions as early as April. In the absence of congressional action, insurers say premiums will go up in 2019 due to the uncertainty -- raising costs for consumers and the government." (Kaiser Health News)
Franchisers Say Health Plan Rule Needs Joint-Employer Protection
"A franchise group and three lawmakers want to make sure that franchises and small businesses wouldn't be put in jeopardy of joint-employer liability under a proposed [DOL] rule to expand association health plans.... The International Franchise Association and Reps. Bradley Byrne (R-Ala.), Henry Cuellar (D-Texas), and Tim Walberg (R-Mich.) are telling the department they support the proposed regulation but want a 'safe harbor' from any new joint-employer liability as a result of participating in a plan." (Bloomberg BNA)
Eliminating the Individual Mandate Penalty in California: Harmful But Non-Fatal Changes in Enrollment and Premiums
"18 percent of enrollees in California's individual market in 2017 say they would not have purchased insurance in the absence of a penalty, [but] the substantial majority of lower-risk enrollees would still have purchased. Based on this changing risk mix, [the authors] estimate that eliminating the mandate penalty would have caused premiums to rise 5 percent to 9 percent in California's individual insurance market plans." (Health Affairs)
Projecting the Impact of Proposed Rules for Association Health Plans (PDF)
16 pages. "If the proposed AHP rule is finalized, ... premiums would rise in the current individual (2.7% to 4 .0%) and small group (0.1% to 1.9%) markets relative to current law, largely due to healthier enrollees shifting into AHPs.... [An] increase in the number of uninsured Americans.... An additional 2.4M to 4.3M people enrolled in AHPs.... Lower premiums for enrollees that enroll in AHPs." (Avalere Health)
Lawsuit Filed by 20 States Claims That Individual Mandate Penalty Repeal Should Topple Entire ACA
"[T]he states argue that the repeal of the individual mandate penalty in 2019 is fatal to the ACA ... [T]hey argue that the Supreme Court upheld the individual mandate as a tax. Now that Congress eliminated the individual mandate penalty beginning in 2019, the mandate is no longer enforceable as a tax and thus is no longer valid. They further argue that the entirety of the ACA relies on the mandate and, without the penalty, the entirety of the ACA is also unconstitutional." (Katie Keith, in Health Affairs)
Reducing the Cost of Health Care: Current Innovations and Future Possibilities (PDF)
"10 of the country's leading experts on health care policy [developed] recommendations that ... could reduce the cost of health care ... [1] Allow the government to use cost and cost-effectiveness in decision-making; [2] Eliminate fee-for-service; [3] Standardize quality-of-care metrics; [4] Empower patients to be responsible for their own health and health care; [5] Improve care coordination through task shifting; [6] Reduce Emergency Department utilization and readmissions; [7] Develop more specific approaches to improving end-of-life care; [8] Meaningfully address the impacts of adverse childhood experiences." (Texas Medical Center Policy Institute)
CBO Cost Estimate: Repeal Insurance Plans of the Multi-State Program Act of 2017
"S. 2221 would repeal Section 1334 of the [ACA], eliminating multi-state plans (MSPs) offered through marketplaces established by the ACA.... OPM reports that in 2018 Arkansas Blue Cross and Blue Shield is the only insurer to offer MSPs and such plans are only available in Arkansas.... CBO estimates that enacting S. 2221 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028." (Congressional Budget Office [CBO])
Delaware Seeks a Solution as Health Costs Rise
"Delaware Gov. John Carney (D) on Feb. 22 ordered the state to form an advisory group to set a benchmark that would help slow the state's rising health care costs.... [An] analysis in June from [CMS] showed that Delaware's per capita health-care costs were more than 27 percent above the U.S. average, behind only Alaska and Massachusetts.... Yet Delaware ranks 31st among states in terms of overall health." (Bloomberg BNA)
Twenty States Sue Federal Government, Seeking End to Obamacare
"Led by Texas Attorney General Ken Paxton and Wisconsin Attorney General Brad Schimel, the lawsuit said that without the individual mandate, which was eliminated as part of the Republican tax law signed by President Donald Trump in December, Obamacare was unlawful." (Reuters)
ERISA Advisory Council to Meet March 27
"[T]he 190th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held on March 27, 2018 ... from 9:00 a .m. to approximately 3:00 p.m. The purpose of the open meeting is to set and discuss the topics to be addressed by the Council in 2018." (Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL])
Risk Corridor Litigation and the Trump Budget
"In its [2019 budget] proposal, the White House included a request to fully fund the risk corridor program through a mandatory appropriation of about $11.5 billion and an additional $812 million to cover the cost of exempting the program from sequester. Seizing on this information, Land of Lincoln and Moda Health Plan wrote to the Federal Circuit to provide the budget as 'supplemental authority' they argue is relevant to the court's decision." (Katie Keith, in Health Affairs)
The Potential Impact of Short-Term Limited-Duration Policies on Insurance Coverage, Premiums, and Federal Spending
"The introduction of expanded short-term, limited-duration policies, consistent with proposed regulations, would increase the number of people without minimum essential coverage by 2.5 million in 2019.... The combined effect of eliminating the individual-mandate penalties and expanding short-term limited-duration policies would increase 2019 ACA-compliant nongroup insurance premiums 18.2 percent on average in the 43 states that do not prohibit or limit short-term plans." (Urban Institute)
HHS Scrubs $11.5B in Risk Corridor Funding from Budget; DOJ Attorney Chalks It Up to an Accounting Error
"In court filings last week, attorneys with Land of Lincoln Mutual Health Insurance Company and Moda Health Plan highlighted portions of the HHS budget proposal that included $11.5 billion for risk-corridor payments in fiscal year 2018 ... But HHS has since scrubbed the budget of the $11.5 billion appropriation, substituting $25 million for risk corridor collections instead. It also removed language indicating it would fully fund the program." (FierceHealthcare)
D.C. Marketplace Formally Recommends District-Level Individual Mandate
"D.C. would be the first to adopt its own mandate in the wake of repeal of the [ACA's] individual mandate, but it joins at least eight states considering or studying their own individual mandate. If approved, D.C.'s mandate would go into effect in 2019 and would largely mirror the federal individual mandate. D.C. would also prohibit new association health plans (AHPs) from qualifying as coverage for purposes of the mandate; this means that individuals who enroll in AHPs under future federal regulations may have to pay a penalty under D.C. law." (Katie Keith, in Health Affairs)
How CBO and Jct Analyze Major Proposals That Would Affect Health Insurance Coverage
"The undertaking is a joint effort: CBO takes the lead in estimating the changes in coverage, premiums, and federal spending, and JCT takes the lead in estimating the tax-related budgetary effects, including those related to changes in the exclusion for employment-based insurance and premium tax credits provided for coverage obtained in the health insurance marketplaces established under the ACA." (Congressional Budget Office [CBO])
Association Health Plans and the Sale of Group Health Insurance 'Across State Lines'
"While the [DOL]'s proposed AHP regulation seeks to expand the reach of AHPs by encouraging small groups to band together to form larger, homogeneous risk pools, there is no shortage of state laws that seek to require small groups to remain a part of a single, state-wide, heterogeneous risk pool. There is no middle ground. If the Department of Labor's regulation is adopted as a final rule--and there is no reason to think that it will not be--this issue will likely have to be resolved by the courts." (Employment Matters, Mintz Levin)
Is This the End of 'Guidance Documents'?
"What [a recent] DOJ memo means is that DOJ lawyers cannot, in essence, take informal guidance documents (which are roughly the equivalent of the ACA FAQs) and turn them into binding rules. Instead, the lawyers have to prove that a person violated a statute passed by Congress or a regulation that went through formal notice-and-comment rulemaking to show a legal violation.... [M]ere guidance posted on a department's website will not, by itself, be enough to demonstrate a legal violation. However, informal guidance documents can still be used to explain or interpret the law; they just cannot be used to impose new legal obligations." (HUB International)
Administration Moves to Liberalize Rules on Short-Term, Non-ACA-Compliant Coverage
"The new rule would extend the maximum duration of these plans from three months to 'less than 12 months' (which could be as long as 364 days), and would appear to allow individuals to reapply for short-term coverage (if not renew their policy) at the end of the 12-month period. [The rule] also includes updated notice requirements." (Katie Keith, in Health Affairs)
Supreme Court Again Tells Sixth Circuit to Rethink Retiree Health Benefits
"The justices once again rejected the U.S. Court of Appeals for the Sixth Circuit's way of handling these disputes, which the justices said was rooted in inferences and assumptions and not the text of the applicable collective bargaining agreements. The result is a victory for CNH Industrial, which was sued for its attempt to modify the health-care benefits it provides for union retirees." [CNH Industrial N.V. v. Reese, No. 17-515 (U.S. Feb. 20, 2018, per curiam)] (Bloomberg BNA)
Administration Proposes to Loosen Restrictions on Short-Term Health Plans
"The new rule is expected to entice younger and healthier people from the general insurance pool by allowing a range of lower-cost options that don't include all the benefits required by the federal law -- including plans that can reject people with preexisting medical conditions. In addition, according to the proposed rule, the plans would not be required to sell to everyone, so people with medical problems may not be able to get this coverage." (Kaiser Health News)
Some States Attempt to Close the Health Coverage Gap
"This review examines prominent state efforts to expand health coverage to the remaining uninsured ... in Massachusetts, Vermont, Colorado, California, and Nevada ... It explores the context and climate for reform within the state, stakeholder involvement, political coalitions, financing, and possible opposition. As such, it serves as a case study in how different states build, or fail to build, the popular and political will towards health care coverage for all residents." (The Leonard Davis Institute of Health Economics (LDI) at the University of Pennsylvania)
[Guidance Overview] Proposed Regs on Short-Term Health Insurance Provide Relief to Americans Facing High Premiums, Fewer Choices
"The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law." (U.S. Department of Health and Human Services [HHS])
Section 1557 Rule on the Horizon; Focus on Employer Mandate
"HHS continues to make progress, however slowly, in revisiting the Section 1557 rule.... Because Section 1557 includes a private right of action, covered entities -- such as hospitals, clinics, or state Medicaid programs -- that fail to comply with the regulations could be sued by someone that has faced discrimination and makes a claim under Section 1557.... [S]ome members of Congress are considering an additional push to repeal or delay the employer mandate ... In the meantime, the IRS continues to implement the employer mandate and recently submitted an information collection request to [OMB] regarding reporting requirements under the employer mandate." (Katie Keith, in Health Affairs)
[Opinion] A Transformative Year for Health Care
"The time has come to think beyond using a carrier-administered narrow network or having a health system and its TPA partner market directly to the employers using the system's Accountable Care Organizations (ACO) platform. Rather than replicate old models with broad-based PPOs (and their primary focus on discounts), or imposing higher, HDHP-style employee cost sharing (believing the covered members will magically become better health care consumers) a new approach is necessary for these AHPs (or any employer-sponsored health plan for that matter) to succeed and be self-sustaining." (Findley Davies | BPS&M)
Airlines Association Challenges State of Washington Paid Sick Leave Requirements
"Airlines for America is challenging the application of Washington Paid Sick Leave Act to the airlines on the grounds that it violates the United States Constitution ... because the law also applies to employees outside the state of Washington and has a negative impact on interstate commerce. The lawsuit also challenges the sick leave law on the basis that it is preempted by the Airline Deregulation Act because it negatively impacts carriers' 'prices, routes, and services.' " [Air Transport Ass'n of America v.Wash. Dept. of Labor & Industries, No. 18-5092 (W.D. Wash. complaint filed Feb. 6, 2018)] (Polsinelli at Work)
Idaho Blue Cross Jumps Into Controversial Market for Plans That Bypass ACA Rules
"Blue Cross of Idaho unveiled a menu of new health plans that break with federal health law rules in several ways, including setting premiums based on applicants' health.... The firm filed five plans to the state for approval and hopes to start selling them as soon as next month." (Kaiser Health News)
DOL Issues Proposed Regs to Expand Association Health Plans
"[T]he proposed rule would broaden the definition of 'employer' under ERISA and related regulations by: [1] Relaxing the requirement that associations sponsoring AHPs must exist for a reason other than offering health insurance; [2] Relaxing the requirement that association members share a common interest ... [3] Allowing associations whose members are in the same industry but in different areas to sponsor AHPs; [4] Clarifying that 'working owners' (the self-employed) and their dependents may participate in AHPs.... Comments on the proposed regulations are due by March 6, 2018." (Willis Towers Watson)
2017 in Review: ERISA Guidance and Enforcement (PDF)
11 pages. "In 2017, the principal focus in the administration of [ERISA] by the [DOL] appropriately remained one of the extraordinary developments under DOL's new fiduciary definition and related exemptions (Fiduciary Rule). DOL's regular program of issuing advance guidance and enforcing the statute continued in a more conventional manner as well ... The regulatory guidance plans under ERISA and the Internal Revenue Code, as they relate to employee benefits and executive compensation, were also recently updated." (Eversheds Sutherland)
Treasury Inspector General Releases Report on ACA Tax Filings for Plan Year 2016
"Of the 5.1 million total tax returns during the 2017 filing season (for plan year 2016), about 2.1 million tax filers were entitled to a higher premium tax credit than they received in APTC. About 2.8 million tax filers received more APTC than they were entitled to and must repay some or all of this amount." (Katie Keith, in Health Affairs)
California Regulators to Investigate Aetna's Medical Coverage Decisions
"The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Hartford, Ct.-based Aetna after CNN first reported Sunday that one of the company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records -- and that was how he was trained by the company, he said." (Kaiser Health News)
States Might Require Individuals to Buy Health Insurance
"Massachusetts has already had an individual mandate in effect since 2007.... Maryland lawmakers recently introduced a bill that would impose penalties on the uninsured in the state. And an individual mandate is also being informally advocated for or considered by state legislators or representatives of insurance exchanges in a number of other states, including California, Connecticut, Minnesota, Rhode Island and Vermont[.]" (Society for Human Resource Management [SHRM])
Budget, White Paper Provide Insight Into Administration's Strategy on Drug Pricing
"The bulk of the proposed reforms would act on the Medicare and Medicaid programs. For Medicare, the Trump administration's proposals are largely targeted at [1] assisting beneficiaries with high out-of-pocket costs and [2] realigning incentives to alter prescribing and reimbursement practices." (Health Affairs)
[Opinion] Association Health Plans: Self-Funded vs. Fully Insured
"[The DOL] invites comments on whether the standards that govern fully-insured AHPs should be extended to self-funded AHPs. Such an extension would be a step into unchartered regulatory territory ... If groups and associations have the option to self-fund, it is a safe bet that they will flock to self-funded arrangements. The savings are too big to pass up. There are consequences, however, which cut both ways: [1] Who is the primary regulator? ... [2] State mandated benefits ... [3] State insurance protections ... [4] Options for State policy-makers and regulators." (Mintz Levin)
New Bill Would Mean More Flexibility for High-Deductible Health Plans
"[T]he Chronic Disease Management Act of 2018 [H.R. 4978], would amend the IRS tax code so that high-deductible health plans paired with health savings accounts could cover chronic disease prevention and treatment on a pre-deductible basis.... The existing IRS regulations ... permit a 'safe harbor' that allows for the coverage of preventive services prior to satisfaction of the plan deductible. But that exception doesn't include clinical services meant to treat an existing illness or condition, which narrows plan options and can stifle consumers' ability to benefit from the financial advantages of a tax-free health savings account." (FierceHealthcare)

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