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[Guidance Overview]
IRS Updates Guidance on ACA Information Reporting by Health Coverage Providers
"Employers that sponsor insured health plans do not report as providers of health coverage under Section 6055. Rather, the insurer is responsible for reporting the coverage.... Plan sponsors in a controlled group may report under Section 6055 as separate entities or may have one entity report for the entire controlled group.... IRS has extended the due date for furnishing 2016 statements (i.e., Forms 1095-B) to individuals from January 31, 2017, until March 2, 2017. It has not extended the due date for filing the 2016 Form 1094-B with the IRS."
The Wagner Law Group
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[Guidance Overview]
CRS Report: Resources for Frequently Asked Questions about the Affordable Care Act (PDF)
33 pages. "This report provides resources to help congressional staff respond to constituents' frequently asked questions (FAQs) about the law. The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize the ACA's provisions." [Report R43215, updated Jan. 17, 2017]
Congressional Research Service [CRS]
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[Guidance Overview]
CRS Report: Use of the Annual Appropriations Process to Block Implementation of the ACA (FY 2011-2017) (PDF)
24 pages. "In addition to considering ACA repeal or amendment in authorizing legislation, some lawmakers have used the annual appropriations process in an effort to eliminate funding for the ACA's implementation and address other aspects of the law. ACA -- related provisions have been included in enacted appropriations acts each year since the ACA became law." [Report R44100, updated Jan. 13, 2017]
Congressional Research Service [CRS]
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[Guidance Overview]
Calendar Year Health Plans Must Complete Online CMS Disclosure by March 1
"The plan sponsor must complete the disclosure within 60 days after the beginning of the plan year if it has any employees or dependents eligible for and receiving Part D prescription drug benefits.... Employer plans that do not offer drug coverage to any Medicare-enrolled employee, retiree or dependent at the beginning of the plan year are exempt from filing."
Kushner & Company
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Avoiding COBRA's Bite: Measures to Counter COBRA Class Actions
"Wal-Mart is just one of several companies that have faced putative class action complaints as a result of allegedly inadequate COBRA notices.... Among the allegations listed was that the required information was 'piecemealed' throughout Wal-Mart's notice, and the notice did not provide contact information for the plan administrator; the notice did not explain that a covered employee's spouse may elect continuation coverage on behalf of all other qualified beneficiaries; and the notice did not explain how electing continuation coverage would affect the qualified beneficiaries' future group health coverage rights."
Perkins Coie LLP
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Court Finds Congress Intended for HHS to Make ACA Risk Corridor Payments Each Year to Insurers
"The risk corridor program, as one of three premium stabilization programs under the [ACA], was intended to reimburse insurers that covered high-risk individuals on an annual basis during the three-year period beginning January 1, 2014, the U.S. Court of Federal Claims ruled. Congress created the temporary risk corridors program to provide relief to insurers who, in the first three years of insurance market reforms, underestimated their allowable costs and accordingly set their premiums too low." [Health Republic Ins. Co. v. U.S., No. 16-259C (Ct. Claims Jan. 10, 2017)]
Wolters Kluwer
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ACA Repeal Could Cost 18 Million Their Insurance
"Eighteen million people could lose their insurance within a year and individual insurance premiums would shoot upward if Congress repealed major provisions of the [ACA] while leaving other parts in place, the nonpartisan [CBO] said ... If nothing followed the [repeal], the budget office said, 32 million people could lose their health insurance by 2026, and premiums in the individual insurance market could double."
The New York Times; subscription may be required
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Universal Access and Delegation to States: Examining Two Currents in ACA Replacement Plans
"Proposals for universal access presumably will reduce the cost of health insurance to make it more affordable. Some claim that they can also reduce high deductibles and eliminate narrow networks, the primary strategies insurers have used under the ACA to reduce premiums.... There are in fact only a limited number of ways to reduce the cost of health insurance.... Although the ACA imposed a number of federal requirements on insurers, states have retained authority for most aspects of insurance regulation, including rate and form review and financial and market conduct oversight.... [A]ny Republican ACA replacement will almost certainly give more authority to the states."
Health Affairs
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A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon
147 pages. "The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the [ACA] Marketplace.... The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable.... Adding a Public Option to the Marketplace will not expand coverage substantially over current levels."
RAND Corporation
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[Opinion]
Can President Trump Reduce Drug Prices? Should He?
"When deciding whether and how much to pay for drugs, most industrialized nations rely to a certain extent on cost-effectiveness analysis. And if a drug is not cost-effective, then the health system refuses to pay for it.... A good first step would be to eliminate rules under Medicare Part D that force insurers to cover many drugs, seemingly regardless of the price.... Without profits from the United States, then the pipeline of R&D will begin to dry up."
David Dranove and Craig Garthwaite, at Code Red
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Benefits in General
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[Guidance Overview]
DOL Publishes Final Regs on Disability Claims and Appeals Procedures (PDF)
"The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the [ACA]."
United Actuarial Services, Inc.
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[Guidance Overview]
DOL Issues Final Rule on Disability Benefit Claims and Appeals
"Employers should update all relevant disability benefit plan documents, SPDs, claims forms, denial letters and related systems to comply with the changes to the final requirements for claims and appeals by the effective date. Employers also might want to discuss with legal counsel the possibility of adding details about any contractual limitation periods on claims to all ERISA-covered plans, SPDs and denial letters, as the DOL seems to be taking the position that the requirement is not limited to disability claims."
Willis Towers Watson
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Executive Compensation and Nonqualified Plans
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Press Releases
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David Rhett Baker, J.D., Editor and Publisher
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.
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