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December 26, 2013          Get Retirement News  |  Advertise
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[Official Guidance]

Text of CMS Submission Certification Instructions for Marketplace Issuers (PDF)
"CMS will be using an interim process for estimated payments of advance premium tax credit (APTC) and cost sharing reduction (CSR) amounts in the initial months of 2014. The purpose of this email is to provide a revised Submission Certification Form and instructions that submitters must follow in completing and submitting this form. [Each] organization (issuer or State Based Marketplace (SBM)) is required to submit this form in order to receive payment in January." (Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)  

[Guidance Overview]

Agencies Propose Changes to HIPAA-Excepted Benefit Regs (PDF)
"Because employers will have to make a shared responsibility payment for individuals eligible for wraparound coverage, some may be reluctant to also incur the cost and administrative complexity of providing such coverage. The proposed regulations do not seem to require employers to pay the cost of that coverage, but it may be difficult to find a plan that meets the cost requirement if the entire amount is paid by the employee." (Buck Consultants)  

[Guidance Overview]

IRS Issues Cafeteria Plan Guidance Under Windsor (PDF)
"The Windsor-related mid-year changes may be considered to take effect not later than the date on which coverage would be added under normal plan procedures or within a 'reasonable time' after December 16, 2013. The effect of this rule is that plans that permitted mid-year changes after Windsor but before the issuance of [IRS Notice 2014-4] are considered to be in compliance with the law, as are plans that waited to permit coverage of a same-sex spouse until guidance was issued and do so now. Naturally, 'reasonable time' is not defined, so a reasonable interpretation would apply." (Ferenczy + Paul)  

Agencies Provide Follow-Up Guidance on Health Benefits Following Supreme Court Windsor Ruling (PDF)
"Issues Specifically Addressed by the Agencies: How are 'spouse' and 'husband and wife' defined for federal tax purposes? ... How may/must adjustments be made if the employer-provided health coverage to same-sex spouses treated the coverage as taxable? ... How can employees request refunds? ... Can an employee with a same-sex spouse change his or her cafeteria plan election? ... How does Windsor affect Health and Dependent Care FSAs? ... How does Windsor affect HSAs? ... Issues Not Specifically Addressed by the Agencies: Do I have to offer welfare benefits to same-sex spouses? ... Are medical expenses for a same-sex spouse eligible for reimbursement from an HRA ... How does Windsor impact COBRA?" (Alston & Bird, LLP)  

Navigating Subsidies for the Self-Employed Caught in the 'Coverage Gap'
"If you have signed up for insurance coverage through Healthcare.gov, the federal Obamacare marketplace, and qualified for subsidies in 2014, you might indeed find yourself in the odd situation of having to refund them sometime in 2015 -- not because you made too much but because you made too little. As with many detailed questions about health-care reform, rules governing this situation have not yet been written ... What we do know ... is that subsidy repayments will be capped, based on income." (Bloomberg BusinessWeek)  

Obamacare Had Lots of Sign-Ups on Deadline Day
"California estimates that 27,000 people picked insurance plans this past Monday and 29,000 the Friday prior. Just last week, the state was averaging 15,000 sign-ups per day. Washington State had 10,000 people enroll Monday, and a total of 20,000 from Dec. 20-23. That accounts for one in 10 Washingtonians picking private health insurance plans. And New York had about 20,000 sign-ups come in that same day.... The 36 states on HealthCare.gov do not release data on their own schedule but rather rely on the federal government's monthly data sets. We won't know December enrollment numbers until sometime in the middle of January." (Sarah Kliff in The Washington Post; subscription may be required)  

Why Retail Clinics Failed to Transform Health Care
"Retail clinics have demonstrated that they are a sustainable business model and clearly fit a patient need: Today, there are more than 1,600 clinics across the country, which have had a total of 20 million patient visits. Nonetheless, their performance has been disappointing: Their growth has been less than expected, they have not expanded care to underserved markets (namely, the poor), and their impact on health care spending -- helping to lower it -- remains unclear." (Harvard Business Review blog; free registration required)  


What to Do When Obamacare Unravels
"We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics.... The [ACA] bets instead that more regulation, price controls, effectiveness panels, and 'accountable care' organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked? ... Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation. Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable[.]" (The Wall Street Journal; subscription may be required)  

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