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Annual Qualified Health Plan Certification Conference
March 2, 2016 in MD
(Centers for Medicare & Medicaid Services [CMS])

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Today's Discussions on the BenefitsLink Message Boards

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[Guidance Overview]

IRS Final Rules Address Affordability and Minimum Value of Employer-Sponsored Plans, Eligibility for Premium Tax Credits
"The regulations finalize the rule that incentives under a nondiscriminatory wellness program that reduce either cost-sharing or premiums generally are not taken into account as amounts paid by the plan for purposes of determining the plan's MV Percentage or affordability -- unless the program is designed to prevent or reduce tobacco use.... The final regulations retain rules that treat amounts newly made available for the current plan year under an integrated HRA ... For purposes of affordability, the final regulations adopt the rule that an employee's required contribution is reduced by employer contributions under a cafeteria plan that [1] may not be taken as a taxable benefit, [2] may be used to pay for minimum essential coverage, and [3] may be used only to pay for medical care within the meaning of Code Section 213." (Thomson Reuters / EBIA)  

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[Guidance Overview]

IRS Guidance on Health Care Reform Addresses Employer Shared Responsibility, Reporting, and More
"Q&As-7, -8, and -9 [of Notice 2015-87] explain how employer contributions affect the amount employees are required to pay to purchase employer-sponsored coverage.... Q&A-12 indicates that indexing applies to all provisions under Code Sections 4980H and 6056 that reference the 9.5% standard, including the three Section 4980H affordability safe harbors.... Q&A-13 confirms the indexed penalty amounts under Code Section 4980H.... Q&A-14 explains how the 'hour of service' rules under DOL regulations apply when determining full-time status under Code Section 4980H.... Two questions specifically address governmental employers." (Thomson Reuters / EBIA)  

[Guidance Overview]

Long-Awaited Final Regs Issued for Mandatory Oregon 'Sick' Leave
"Employers should now finalize policies to comply with Oregon's 2016 mandatory sick leave law, following publication of the law's final administrative rules. Although titled 'sick' leave, the law protects a broader range of absences, including preventative care, bereavement leave, and domestic violence absences. Businesses with at least one employee in Oregon are subject to the law." (Davis Wright Tremaine LLP)  

Aligning Payer-Provider Incentives to Improve Coding and ACA Risk Transfer Payments
"Experience for 2014 showed the impact of risk adjustment can be substantial, and health plans operating under the ACA need a thoughtful, innovative plan for managing risk scores.... Health plans should engage providers in their networks to code diagnoses accurately and completely. The most effective initiatives occur when the incentives of health plans and providers are aligned, and they work together to coordinate coding efforts. A successful risk adjustment strategy includes continuous monitoring and strong execution by both the health plan and the providers." (Milliman)  

The Telehealth Outlook for 2016
"2016 will be the year large employers will be heard loud and clear in the telehealth regulatory debates that are sure to take place.... 74 percent of large employers are expected to offer telehealth in 2016 compared to 48 percent in 2015. Given the important role employers play in health care, and how telehealth is increasingly being used by employers, it is only logical that employers would ultimately play a significant role in our ongoing telehealth regulatory debate." (Epstein Becker Green)  

The CBO's Crystal Ball: How Well Did It Forecast the Effects of the ACA?
"CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO's projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience." (The Commonwealth Fund)  

Insurers' Marketshare 2010-2014 Dataset
"Dataset tracks insurance carriers' marketshare, pre- and post-ACA, from 2010-2014 in each state.... [T]he dataset includes ... information on the three largest insurance plans for the Individual Market, The Small Group Market, and the Large Group Market." (Robert Wood Johnson Foundation)  

Small Business Insurance Health Options Program (SHOP) Participation Rules Dataset
"[This dataset] includes information such as whether a particular state's SHOP exchange considers the self-employed as a small business, whether the individual and SHOP exchanges are merged, and whether a particular state's SHOP exchange is a passive or active purchaser.... Much like the exchanges for individual consumers, there is a great deal of variation in small business exchanges across states." (Robert Wood Johnson Foundation)  

New York's Regulatory Failure and an Insurance CO-OP Collapse
"Health Republic's growing financial troubles should have been no surprise to insurance regulators at the Department of Financial Services (DFS). The company's filings to DFS showed steep operating losses, mounting debt, unanticipated costs and heavy reliance on a federal risk-management subsidy that failed to materialize. Yet the department did not intervene to order an increase in Health Republic's premiums, as other states did in similar situations. To the contrary, DFS repeatedly cut the company's premiums below what the insurer had requested, aggravating the co-op's losses." (Empire Center for Public Policy)  

IRS Provides Additional Guidance on Treatment of Same-Sex Marriages Under Benefit Plans
"[A] sponsor may want to amend its qualified retirement plans to provide additional benefits and protections for participants with same-sex spouses, such as offering a new joint and survivor annuity election in cases where the participant was previously required to begin receiving a single life annuity. Because these would be discretionary and not mandatory amendments, [Notice 2015-86] cautions that the amendments would be subject to the same funding restrictions (for defined benefit pension plans) and nondiscrimination tests that apply to all discretionary amendments.... For [health] plans that do offer spousal coverage ... the Obergefell decision may require the plan to recognize additional same-sex marriages and to extend coverage to additional spouses." (Pillsbury Winthrop Shaw Pittman LLP)