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HealthCare Reform Blog
Reform/PPACA/Compliance



UPDATED MARKETPLACE NOTICE

The Department of Labor recently issued a new version of the model exchange notice, replacing the previous version READ THE FULL ARTICLE


EATING DISORDERS AND REQUESTS FOR INFORMATION UNDER PARITY RULES

Recent federal guidance clarifies the treatment of eating disorders under group health plans. READ THE FULL ARTICLE


ACA NON-DISCRIMINATION REGULATIONS CONTINUE TO SPAWN LAWSUITS FOR GENDER DYSPHORIA TREATMENT

Group health insurance claims for gender dysphoria treatment (formerly referred to as gender identity disorder) are increasingly READ THE FULL ARTICLE


ACA "REPEAL" IS DEAD, LONG LIVE ACA REPEAL

Late Monday, Senators Mike Lee (R-UT) and Ron Johnson (R-WI) announced they would not vote to allow debate READ THE FULL ARTICLE

SENATE REPUBLICANS RELEASE THE BETTER CARE RECONCILIATION ACT OF 2017

The Better Care Reconciliation Act retains many of the AHCA's key components and proposes additional changes to the ACA READ THE FULL ARTICLE


PAID FAMILY LEAVE JUST AROUND THE CORNER FOR NEW YORK EMPLOYERS

The New York Paid Leave Law (NYPLL) requires that, on or after January 1, 2018, eligible employees with triggering leave requests may collect up to eight weeks  READ THE FULL ARTICLE

NEW YORK PAID FAMILY LEAVE LAW GOING INTO EFFECT SOON

In 2016, New York State enacted a law that requires employers to provide employees with paid family leave benefits. READ THE FULL ARTICLE


WHAT DOES THE REPUBLICAN ACA-REPLACE PROPOSAL MEAN FOR EMPLOYERS?

For now, other than ACA health coverage mandate penalties changing to $0 (as opposed to ACA’s original “dual-trigger” $2,000 and $3,000 levels), it appears... READ THE FULL ARTICLE


REPUBLICAN ACA REPEAL EFFORTS GAIN STEAM

Republican efforts to repeal the Affordable Care Act advanced in the House yesterday (March 6, 2017) as GOP leadership officially unveiled its newest proposal. READ THE FULL ARTICLE


ACA REPORTING DEADLING FAST APPROACHING

Although Congress and the new Administration have expressed strong interest in repealing or reforming the Affordable Care Act (ACA) -- ACA-related requirements governing employers remain in effect (at least for now). READ THE FULL ARTICLE


CONGRESS WEIGHS ELIMINATING TAX EXCLUSION FOR EMPLOYMENT-BASED HEALTH BENEFITS

Through discussions now underway in Congress, lawmakers are eyeing the possibility of changing tax rules. READ THE FULL ARTICLE


IRS: PARTICIPATION IN BOTH AN HRA AND HSA IS PERMISSIBLE IN CERTAIN CIRCUMSTANCES

IRS guidance clarifies that participation in both a health reimbursement arrangement (HRA) and a health savings account (HSA) is permissible in certain circumstances. READ THE FULL ARTICLE


PRESIDENT TRUMP EXECUTIVE ORDER REGARDING THE ACA MOSTLY SYMBOLIC

President Trump issued his first Executive Order on Friday, January 20, 2017, just hours after his inauguration: READ THE FULL ARTICLE


COMPLIANCE NEWS & UPATES FOR JANUARY 2017

Six current and important topics: READ THE FULL ARTICLE
DECODING THE CODES FOR 2017

Understanding the IRS Form 1095-C ACA Reporting Codes: READ THE FULL ARTICLE


NEW FAQ ADDRESSES VARIED TOPICS INCLUDING HRA AND SPECIAL ENROLLMENT

FAQ guidance addressing a variety of health and welfare issues including further details about HRAs under the Cures Act: READ THE FULL ARTICLE


ACA RELIEF FOR 2016 IRS FILINGS

The IRS has announced an extension to the 2016 Form 1094 and Form 1095 deadlines, as follows: READ THE FULL ARTICLE


DRAFT INSTRUCTION FOR THE 2016 FORMS 1094-95 INFORMATION RETURNS RELEASED

Last month, draft Form(s) 1094/1095 information returns were released for the 2016 tax year (for filings submitted in 2017). READ THE FULL ARTICLE


CMS MEDICARE PART D CREDITABLE - NON-CREDITABLE

In preparation for the Medicare fall open enrollment period, employers sponsoring group health plans that include prescription drug coverage are required to notify all Medicare-eligible individuals whether such coverage is creditable. READ THE FULL ARTICLE

ASSESSING YOUR ACA REPORTING READINESS FOR 2017 Assessing your ACA Reporting Readiness for 2017

As employers prepare to comply with the 2016 ACA reporting requirements under IRC Section 6055 (Provider of Minimum Essential Coverage, “MEC”) and Section 6056 (Applicable Large Employer, “ALE”), employers should assess their ACA reporting readiness.  READ THE FULL ARTICLE

BRONZE LEVEL COVERAGE PREMIUM RELEASED FOR 2016 INDIVIDUAL SHARED RESPONSIBILITYLast month, draft Form(s) 1094 The Internal Revenue Service (IRS) recently released the monthly national average premium for the 2016 Exchange qualified health plans with bronze level coverage.  READ THE FULL ARTICLEADDITIONAL GUIDANCE TO HELP COMPANIES DETERMINE IF THEY ARE A HIPAA COVERED ENTITY

n>The Centers for Medicare and Medicaid Services (CMS) released an Interactive Tool to assist individuals and organizations in determining if they are a covered entity subject to the HIPAA Administrative Simplification Rules.  READ THE FULL ARTICLENOTICE OF BENEFITS AND PARAMETERS FOR 2018 RELEASED, PROVIDING INCREASE TO ANNUAL COST-SHARING LIMITS

The Departments of Health and Human Services (HHS) recently released a Proposed Notice of Benefit and Payment Parameters for 2018.  READ THE FULL ARTICLE

FEDERAL SUBSIDY NOTICES FAQ AND APPEAL FORM

FINAL INSTRUCTIONS FOR 2016 FORMS 1094/1095c

The information that Plan Sponsors will enter onto the ACA Reporting Forms in early 2017 remains mostly the same as the 2016 Forms 1094/1095-C; however, there are a few changes that Plan Sponsors should note.  READ THE FULL ARTICLE

FEDERAL SUBSIDY NOTICES FAQ AND APPEAL FORMInformative FAQ all about What Employers Need to Know about the Department of Health and Human Services Subsidy Notice. READ THE FULL ARTICLE


IRS CRACKS DOWN ON WELLNESS BANKS

The Internal Revenue Service (IRS) has issued a memorandum addressing wellness programs’ tax treatment of certain wellness incentives, including cash rewards and reimbursements of wellness program premiums that were paid on a pre-tax basis. READ FULL ARTICLE


FIRST CHANGES TO FLSA IN 11 YEARS FROM THE DOL

>On May 17th the Department of Labor (DOL) issued the final regulations modifying the Fair Labor Standards Act (FLSA). This is the first time that the DOL has made changes to the FLSA regulations in almost 11 years. READ THE FULL ARTICLE

The IRS recently released two information letters addressing the federal tax treatment of employer-provided health coverage for employees’ children and domestic partners. READ THE FULL ARTICLE


EMPLOYERS PAYING FOR INDIVIDUAL POLICIES STILL A NO-NO

The Internal Revenue Service (IRS) recently released four information letters on individual insurance policy and opt-out arrangements. Highlights can be found below. READ FULL ARTICLE


REGULATORS INTENSIFY HIPAA AUDIT ACTIVITY IMPACTING SELF FUNDED PLANS

The agency has announced a new HIPAA audit initiative that particularly affects sponsors of self-funded group health plans in their capacity as “covered entities” under the privacy law. READ FULL ARTICLE


THE IRS EXPLAINS CAFETERIA PLANS FURTHER

The Internal Revenue Service (IRS) recently released three information letters reiterating cafeteria plan design and administration rules. Highlights can be found below. READ FULL ARTICLE


ADDRESSING WAITING PERIODS - QUESTION OF THE MONTH

Are we permitted to impose the plan’s insurance waiting period on rehired employees? READ FULL ARTICLE


ACA REMINDERS! EMPLOYER MANDATE AFFORDABILITY STATUTORY THRESHOLD ADJUSTS ANNUALLY

Originally 9.5% of household income (with the availability of the Federal Poverty Level, Rate of Pay and W-2 Wages safe harbors). Employers subject to the employer mandate should pay attention to these adjustments. READ FULL ARTICLE


NIRS RELEASES 2017 HDHP AND HSA CONTRIBUTION LIMITS

The Internal Revenue Service (IRS) recently released the inflationary adjustments for 2017 High-Deductible Health Plan (HDHP) and Health Savings Account (HSA) plans. Generally, the limits for 2016 and 2017 will remain the same, with the exception of the self-only HSA maximum contribution limit (i.e., the employer plus employee total contribution to the HSA plan). READ FULL ARTICLE


RETROACTIVE REIMBURSMENT OF TRANSIT EXPENSES FOLLOWING TRANSIT PARITY MUST BE TAXED

The Internal Revenue Service released a technical advice memorandum explaining that employers choosing to provide employees retroactive cash reimbursements for substantiated transit expenses must do so only if providing those reimbursements in taxable form. READ FULL ARTICLE


WHAT NONDISCRIMINATION TESTS ARE REQUIRED FOR CAFETERIA PLANS?

Employers offering cafeteria plans, including health and dependent care Flexible Savings Accounts and Health Savings Accounts run through the cafeteria plan, must comply with nondiscrimination requirements in order to qualify to allow employees to pay using pretax premiums. READ FULL ARTICLE


NEW GUIDANCE ON EXCHANGE MARKETPLACE APPEALS

On March 22, 2016, the Centers for Medicare and Medicaid Services (CMS) provided guidance on the use of paper-based processes to appeal certain Exchange-related determinations, including individuals’ eligibility to enroll in a qualified health plan through an Exchange.  READ FULL ARTICLE


NY MOVES TO ENACT PAID FAMILY LEAVE LAWS

Led by Governor Cuomo, the State of New York’s recently passed 2016-17 State Budget includes a landmark paid family leave policy – the longest and most comprehensive in the nation – to help workers maintain financial stability while taking time to care for a family member. READ THE FULL ARTICLE


MEDICARE PART D PARAMETERS

CMS has released the following 2017 parameters for the standard Medicare Part D prescription drug benefit. Any creditable coverage must be equal to or better than these parameters, otherwise a non-creditable notice is provided to participants and CMS rather than a creditable coverage notice. READ THE FULL ARTICLE


CSBC TEMPLATE UPDATED...AGAIN!

The DOL Releases New Templates and Related Materials After Pulling Templates Just Last Month. READ THE FULL ARTICLE


HOUSE APPROVES BILL THAT COULD POSTPONE CADILLAC TAX

The House on Thursday passed a sweeping $622 billion tax package, the first of two massive end-of-year measures Congress is rushing to conclude this week. READ THE FULL ARTICLE


 SPENDING BILL WILL POSTPONE CADILLAC TAX

The Speaker told colleagues that the spending bill will postpone the "Cadillac Tax" on expensive heathcare plans. READ THE FULL ARTICLE


CMS REMINDER:

Transitional Reinsurance Program Upcoming Deadlines for Contributions November 16, 2015 Deadline. READ FULL ARTICLE


EEOC PROPOSES RULES UNDER GINA

Late last week, the Equal Employment Opportunity Commission (EEOC) released a proposed regulation on family members and wellness programs that would make it easier for employers to engage their employees’ spouses. READ THE FULL ARTICLE


 CONGRESS REPEALS THE AUTOMATIC ENROLLMENT PROVISION OF THE AFFORDALBE CARE ACT

A key provision of the Affordable Care Act (ACA) that required employers with 200 or more employees to automatically enroll eligible employees in a core medical plan has been repealed by Congress as part of the Bipartisan Budget Act of 2015. READ THE FULL ARTICLE


FINALLY! CLARITY FROM THE IRS ON HRA'S

HRAs: Will reporting be required? The IRS has now finalized the reporting forms and instructions that are to be used starting in the first quarter of 2016. READ THE FULL ARTICLE


IT'S FALL! TIME TO PAY THE TRANSITIONAL REINSURANCE FEE

The TRF deadline approaches and the IRS clarifies its position on HRA reporting. Among the myriad of health care reform related changes affecting employers, the Affordable Care Act announced arrival of new plan-related fees. READ THE FULL ARTICLE


ADDITIONAL CADILLAC GUIDANCE FROM IRS

The Internal Revenue Service (IRS) recently published its second set of pubic observations about the looming 40% Cadillac Tax excise tax for plans that exceed federal thresholds for high cost employer-sponsored health coverage. READ THE FULL ARTICLE


ACA FORM UPDATE

We are pleased to be sharing this information regarding ACA Updates from our partner SyncStream Solutions. New developments that were included in Draft Instructions released by the IRS for the 2015 1094-C and 1095-C series forms.  On August 6th the IRS released draft instructions for the 2015 1094-C and 1095-C Forms that Applicable Large Employers are required to submit in early 2016. There were several small changes made to the Forms, but nothing substantive has changed. SyncStream will continue to keep our partners updated and informed so they will be able to relay pertinent information to their customers.  READ THE FULL ARTICLE


CONGRESS DOUBLES PENALTIES

Congress has just doubled the penalties for failure to comply with employer reporting requirements under the health reform law. These changes immediately heighten the business case for a technology investment by employers facing this looming reporting requirement.  READ THE FULL ARTICLE


SUPREME COURT DECISION UPHELD

CNN reports - In a major win for the Obama administration, the Supreme Court held in a 6-3 decision that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal exchanges. READ THE FULL ARTICLE


ACA RESOURCE "TOOLKIT"

Department of Labor-authored document offering a consolidated index of PPACA related guidance and links. Think of it as a resource “toolkit” for all things ACA. READ THE FULL ARTICLE


ACA: THE EXPANDING WORLD OF AUDIT AND PENALTY ENFORCEMENT

Back in 2012, the first wave of audit activity to feature health care reform compliance directives under the Patient Protection and Affordable Care Act (ACA) began to take hold. READ THE FULL ARTICLE


DON'T LOSE GRANDFATHERED STATUS

When the Affordable Care Act was first passed, many employers were under the impression that if they were happy with their current health plan offerings, they could keep them intact. But when they examined the fine print, “they soon understood that keeping their current health plan offerings and maintaining their grandfathered status would not be an easy task. READ THE FULL ARTICLE


SMALL GROUP EXPANSION FAQ

Small Group Expansion in 2016 - Currently, defined small group businesses have been defined as having 2 to 50 eligible employees. As a result of the Affordable Care Act (ACA), rules are scheduled to change in January 1, 2016 to define a small group as having 1 to 100 employees. READ THE FULL ARTICLE


SUMMARY OF IRS SECTIONS REPORTING

Details regarding information reporting of Minimum Essential Coverage (MEC) and for applicable large employers on health insurance coverage offered by employe-sponsored plans. READ THE FULL DETAILS


5 WILD CARDS AT HIGH COURT'S ACA ARGUMENTS

The Supreme Court will hear oral arguments today beginning at 10:00 AM in King v. Burwell, the most serious challenge to the Affordable Care Act and the second Supreme Court case in three years regarding Obamacare. The implications of this case are enormous.  The Supreme Court is expected to issue a ruling by the end of June.  Here’s what you need to know about the case and today’s hearing: READ THE FULL ARTICLE


CADILLAC TAX IS NO ROLLS ROYCE

The theory of the law is apparently that health insurance should be the great leveler. The Affordable Care Act included the Cadillac tax as a tool to cut health care costs. It puts direct and forceful pressure on employers to offer less-generous health insurance plans than in the past...READ THE FULL ARTICLE


TAX FILERS GET RELIEF FROM IRS

The recent news that there were 800,000 incorrect tax forms sent out under the Affordable Care Act was bad. Like a Form W-2, the incorrect Forms 1095-A are needed by tax filers. Reports said that approximately 50,000 of the affected people had already filed their income tax returns with the IRS...READ THE FULL ARTICLE