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Treasury, IRS and Labor Announce Plan to Implement Coronavirus-Related Paid Leave for Workers and Tax Credits for Small and Midsize Businesses to Swiftly Recover the Cost of Providing Coronavirus-Related Leave (PDF)

"[T]he U.S. Treasury Department, [IRS], and the [DOL] announced that small and midsize employers can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.... Eligible employers will be able to claim these credits based on qualifying leave they provide between the effective date and Dec. 31, 2020. Equivalent credits are available to self-employed individuals based on similar circumstances.... "For an employee who is unable to work because of Coronavirus quarantine or self-quarantine or has Coronavirus symptoms and is seeking a medical diagnosis, eligible employers may receive a refundable sick leave credit for sick leave at the employee's regular rate of pay, up to $511 per day and $5,110 in the aggregate, for a total of 10 days. For an employee who is caring for someone with Coronavirus, or is caring for a child because the child's school or child care facility is closed, or the child care provider is unavailable due to the Coronavirus, eligible employers may claim a credit for two-thirds of the employee's regular rate of pay, up to $200 per day and $2,000 in the aggregate, for up to 10 days. "Eligible employers are entitled to an additional tax credit determined based on costs to maintain health insurance coverage for the eligible employee during the leave period.... "[F]or an employee who is unable to work because of a need to care for a child whose school or child care facility is closed or whose child care provider is unavailable due to the Coronavirus, eligible employers may receive a refundable child care leave credit. This credit is equal to two-thirds of the employee's regular pay, capped at $200 per day or $10,000 in the aggregate.... "Under guidance that will be released next week, eligible employers who pay qualifying sick or child care leave will be able to retain an amount of the payroll taxes equal to the amount of qualifying sick and child care leave that they paid, rather than deposit them with the IRS. The payroll taxes that are available for retention include withheld federal income taxes, the employee share of Social Security and Medicare taxes, and the employer share of Social Security and Medicare taxes with respect to all employees.... "Under guidance that will be released next week, eligible employers who pay qualifying sick or child care leave will be able to retain an amount of the payroll taxes equal to the amount of qualifying sick and child care leave that they paid, rather than deposit them with the IRS. The payroll taxes that are available for retention include withheld federal income taxes, the employee share of Social Security and Medicare taxes, and the employer share of Social Security and Medicare taxes with respect to all employees. "If there are not sufficient payroll taxes to cover the cost of qualified sick and child care leave paid, employers will be able [to] file a request for an accelerated payment from the IRS. The IRS expects to process these requests in two weeks or less. The details of this new, expedited procedure will be announced next week.... "Labor will be issuing a temporary non-enforcement policy that provides a period of time for employers to come into compliance with the Act. Under this policy, Labor will not bring an enforcement action against any employer for violations of the Act so long as the employer has acted reasonably and in good faith to comply with the Act. Labor will instead focus on compliance assistance during the 30-day period."

Text of Agency Request for Information: Grandfathered Group Health Plans and Grandfathered Group Health Insurance Coverage

15 pages. "Given the limited information available regarding such coverage, the Department of the Treasury, the [DOL], and [HHS] are issuing this request for information to gather input from the public in order to better understand the challenges that group health plans and group health insurance issuers face in avoiding a loss of grandfathered status, and to determine whether there are opportunities for the Departments to assist such plans and issuers, consistent with the law, in preserving the grandfathered status of group health plans and group health insurance coverage in ways that would benefit employers, employee organizations, plan participants and beneficiaries, and other stakeholders."

Text of Agency Interim Final Rule and Comment Request: Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA

100 pages. "These interim final rules expand exemptions to protect moral convictions for certain entities and individuals whose health plans are subject to a mandate of contraceptive overage through guidance issued pursuant to the [ACA]. These rules do not alter the discretion of the Health Resources and Services Administration, a component of [HHS], to maintain the guidelines requiring contraceptive coverage where no regulatorily recognized objection exists. These rules also provide certain morally objecting entities access to the voluntary 'accommodation' process regarding such coverage....These interim final rules are effective on October 6, 2017.... Written comments on these interim final rules are invited and must be received by December 5, 2017."

Text of Agency Interim Final Rule and Comment Request: Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the ACA

163 pages. "These interim final rules expand exemptions to protect religious beliefs for certain entities and individuals whose health plans are subject to a mandate of contraceptive coverage through guidance issued pursuant to the [ACA].... These rules also leave the 'accommodation' process in place as an optional process for certain exempt entities that wish to use it voluntarily.... These interim final rules and temporary regulations are effective on October 6, 2017.... Written comments on these interim final rules are invited and must be received by December 5, 2017."

Text of Agency FAQs on ACA Implementation: Set 11: Notice of Coverage Options, HRAs, Fixed Indemnity Insurance, and Payment of PCORI Fees

[Editor's Note: This set of eight Frequently Asked Questions addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees.] Excerpt: "The Department of Labor has concluded that the notice requirement under FLSA section 18B will not take effect on March 1, 2013 for several reasons. First, this notice should be coordinated with HHS's educational efforts and Internal Revenue Service (IRS) guidance on minimum value. Second, we are committed to a smooth implementation process including providing employers with sufficient time to comply and selecting an applicability date that ensures that employees receive the information at a meaningful time. The Department of Labor expects that the timing for distribution of notices will be the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges."

Text of IRS Rev. Proc. 2022-11: Methodology for Calculating Qualifying Payment Amount Under the 'No Surprises Act' in 2022 (PDF)

6 pages. "[T]his revenue procedure provides the combined percentage increase for calculating the qualifying payment amount for items and services furnished during 2022 for purposes of sections 9816 and 9817 of the Internal Revenue Code, sections 716 and 717 of [ERISA], and sections 2799A-1 and 2799A-2 of the Public Health Service Act ... [F]or an item or service furnished during 2022, the group health plan or group or individual health insurance issuer must calculate the qualifying payment amount by increasing the median contracted rate ... for the same or similar item or service under such plan or coverage, on January 31, 2019, by the combined percentage increase as published by the [Treasury Department and the IRS] ... For items and services provided on or after January 1, 2022, and before January 1, 2023, the combined percentage increase to adjust the median contracted rate is 1.0648523983. Pursuant to this revenue procedure, group health plans and group and individual health insurance issuers may round any resulting qualifying payment amount to the nearest dollar."

Text of Agency Request for Information: Coverage for Contraceptive Services

19 pages. "This document is a request for information on whether there are alternative ways (other than those offered in current regulations) for eligible organizations that object to providing coverage for contraceptive services on religious grounds to obtain an accommodation, while still ensuring that women enrolled in the organizations' health plans have access to seamless coverage of the full range of Food and Drug Administration-approved contraceptives without cost sharing. This information is being solicited in light of the Supreme Court's opinion in Zubik v. Burwell ... [HHS, DOL] and the Treasury invite public comments via this request for information."

Text of Agency Final Rule: Transparency in Coverage by Health Insurance Issuers and Group Health Plans

470 pages. "The final rules set forth requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request to a participant, beneficiary, or enrollee (or his or her authorized representative), including an estimate of the individual's cost-sharing liability for covered items or services furnished by a particular provider. Under the final rules, plans and issuers are required to make this information available on an internet website and, if requested, in paper form, thereby allowing a participant, beneficiary, or enrollee (or his or her authorized representative) to obtain an estimate and understanding of the individual's out-of-pocket expenses and effectively shop for items and services. The final rules also require plans and issuers to disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information through three machine-readable files posted on an internet website, thereby allowing the public to have access to health coverage information that can be used to understand health care pricing and potentially dampen the rise in health care spending. The Department of Health and Human Services (HHS) also finalizes amendments to its medical loss ratio (MLR) program rules to allow issuers offering group or individual health insurance coverage to receive credit in their MLR calculations for savings they share with enrollees that result from the enrollees shopping for, and receiving care from, lower-cost, higher-value providers.... The final rules are effective [60 days after publication in the Federal Register, now scheduled for Nov. 12, 2020]." [Also available: press release and Fact Sheet]

HHS, DOL and Treasury Expand Access to Quality, Affordable Health Coverage Through Health Reimbursement Arrangements

"[It] is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.... Under the rule, starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. These conditions strike the right balance between employer flexibility and guardrails meant to protect the individual market against adverse selection, and include a notice requirement to ensure employees understand the benefit. Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance."

Text of Agency Interim Final Rule: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PDF)

241 pages. "This [Interim Final Rule with Comment Period (IFC)] implements requirements in the CARES Act that providers of COVID-19 diagnostic tests make public their cash prices for those tests and establishes an enforcement scheme to enforce those requirements.... This rule also amends regulations regarding coverage of preventive health services to implement section 3203 of the CARES Act, which shortens the timeframe within which non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage must begin to cover without cost sharing qualifying coronavirus preventive services, including recommended COVID-19 immunizations. This IFC also revises regulations to set forth flexibilities in the public notice requirements and post award public participation requirements for State Innovation Waivers under section 1332 of the [ACA] during the public health emergency for COVID-19.... "These regulations are effective on November 2, 2020, except for amendatory instruction 36, which is effective on January 1, 2021.... Except as otherwise specified ... these regulations are applicable from the effective date until the end of the public health emergency for COVID-19 as determined by the HHS Secretary."  [Also see: CMS press release and fact sheet; COVID-19 vaccine resources for providers, health plans and State Medicaid programs; and FAQs on billing for therapeutics.]