Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Brian M. Pinheiro

Subscribe to all posts by Brian M. Pinheiro

Temporary Enforcement Policy Addresses CAA’s Health Plan Service Provider Disclosure Requirements

Posted in Consolidated Appropriations Act (CAA), Employer Responsibilities, Enforcement, Grandfathered Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Insured Plans, Plan Design Requirements, Reporting, Wellness Programs
Summary The U.S. Department of Labor (DOL) has issued a temporary enforcement policy to address frequently asked questions about the requirement for certain service providers to disclose direct and indirect compensation data to group health plan fiduciaries under the Consolidated Appropriations Act (2021) (CAA). The Upshot The CAA’s disclosure requirement applies to entities providing brokerage or consulting services [&hellip… Continue Reading »

Upcoming Compliance Deadlines for Health and Welfare Plans

Posted in Consolidated Appropriations Act (CAA), COVID-19, Employer Responsibilities, Flexible Spending Accounts (FSAs), Health Benefits, Health Plans, Healthcare Providers / Suppliers, Mental Health, Plan Design Requirements, Reporting
Summary Throughout 2020 and 2021, employers sponsoring health and welfare plans have needed to respond to a myriad of legislative and regulatory changes arising from the COVID-19 pandemic and new health legislation. To comply with these changes, employers may need to work with their vendors, amend their plans, and take other action. In this alert, [&hellip… Continue Reading »

Keeping Up With No Surprises

Posted in Consolidated Appropriations Act (CAA), Cost-sharing Limits, Enforcement, Grandfathered Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Insured Plans, Plan Design Requirements, Short Term Limited Duration Insurance (STLDI)
Summary Two sets of rules were issued last month by federal agencies as part of the No Surprises Act. The Upshot The proposed rules come into play when an individual receives out-of-network care in at least one of the following situations: in an emergency, when an out-of-network provider furnishes services in connection with care provided [&hellip… Continue Reading »

Reminder: COBRA Notice Deadline is May 31

Posted in American Rescue Plan Act (ARP), COBRA, COVID-19
This is a reminder that a COBRA notice deadline is approaching. It applies to employers that are subject to the federal COBRA rules. The American Rescue Plan Act (ARPA) requires employers that are subject to the federal COBRA rules to provide notice to those who do not currently have COBRA continuation coverage, but who are [&hellip… Continue Reading »

COBRA Premium Assistance

Posted in COBRA, COVID-19
The United States Department of Labor has issued much anticipated guidance and model forms under the COBRA subsidy rules introduced by the American Rescue Plan (ARP). The FAQ guidance and forms clarify some issues that employers have raised about the COBRA subsidy provisions of the ARP, but leave a number of the most significant questions unanswered. Clarifications and confirmations [&hellip… Continue Reading »

ARP: Employee Benefits and Executive Compensation

Posted in American Rescue Plan Act (ARP), COBRA, Consolidated Appropriations Act (CAA), COVID-19
The American Rescue Plan (ARP) will have significant and immediate impacts on employee benefit plans, employers, and other plan sponsors and plan administrators. President Biden signed the ARP stimulus bill today. We highlight the most significant employee benefits and executive compensation changes under the ARP below. COBRA Provisions Section 9501 of the ARP requires employers [&hellip… Continue Reading »

New Stimulus Deal: Overview of Major Provisions Impacting Businesses and Individuals

Posted in COVID-19, Healthcare, Legislation
President Trump signed additional COVID-19 relief legislation (H.R. 133) into law on December 27, 2020. The deal includes a $900 billion economic stimulus package that will provide relief benefits to businesses and individuals impacted by the COVID-19 pandemic. The following is a summary of some of the provisions that will have a major impact: Financial [&hellip… Continue Reading »

Supreme Court Finds ERISA Does Not Preempt State Prescription Drug Pricing Law

Posted in Health Plans, Healthcare Providers / Suppliers, Legislation
Summary The U.S. Supreme Court unanimously upheld an Arkansas statute that regulates the price that pharmacy benefit managers (PBMs) pay retail pharmacies for prescription drugs. The Upshot Act 900 in Arkansas regulates the price paid by PBMs for the cost of drugs purchased at retail pharmacies through mechanisms designed to ensure that the pharmacy would [&hellip… Continue Reading »

Court Issues Injunction Against Revised ACA Nondiscrimination Rules

Posted in Healthcare, Legislation, Non-discrimination Rules
The U.S. District Court for the Eastern District of New York issued an order on Monday (August 17, 2020) that prevented federal rules removing nondiscrimination protections from taking effect. The rules would have removed protections against discrimination based on gender identity and sex stereotyping from the nondiscrimination provision within the Patient Protection and Affordable Care Act (ACA). [&hellip… Continue Reading »

CMS Scales Back ACA Nondiscrimination Rules

Posted in Health Plans, Healthcare Providers / Suppliers, Nondiscrimination
The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has finalized rules that narrow and eliminate various nondiscrimination requirements under Section 1557 of the Affordable Care Act (Act). Section 1557 prohibits certain health care providers, health benefit plans, and health insurers from discriminating against individuals on account [&hellip… Continue Reading »

IRS Guidance Provides COVID-19 Relief for Participants Taking Retirement Plan Distributions and Loans

Posted in CARES Act, COVID-19, Employee Benefits/Executive Compensation
The IRS has released Notice 2020-50, which provides guidance to employers that have amended their retirement plans to take advantage of provisions under the CARES Act that provide access to special plan distributions, known as Coronavirus-Related Distributions (CRDs), and expanded plan loans. Coronavirus-Related Distributions The CARES Act permits employers to amend their eligible retirement plans to [&hellip… Continue Reading »

IRS Issues Guidance Allowing Employer-Sponsored Leave Donation Programs for COVID-19 Relief

Posted in COVID-19
The Internal Revenue Service (IRS) issued Notice 2020-46 providing guidance to employers whose employees forgo sick, vacation, or personal leave to aid victims of COVID-19. Generally, when an employee donates sick, vacation, or personal leave to which he or she otherwise is entitled, the donation is treated as an assignment of income – the employee is treated [&hellip… Continue Reading »

IRS Issues Guidance Allowing Employer-Sponsored Leave Donation Programs for COVID-19 Relief

Posted in COVID-19, Employee Benefits/Executive Compensation
The Internal Revenue Service (IRS) issued Notice 2020-46 providing guidance to employers whose employees forgo sick, vacation, or personal leave to aid victims of COVID-19. Generally, when an employee donates sick, vacation, or personal leave to which he or she otherwise is entitled, the donation is treated as an assignment of income – the employee is treated [&hellip… Continue Reading »

IRS Allows Remote Spousal Consent for Retirement Plans

Posted in COVID-19, Employee Benefits/Executive Compensation, Health Plans
The IRS released Notice 2020-42, which provides temporary relief during calendar year 2020 from the physical presence requirements for participant elections in retirement plans. Under the new guidance, there is relief during calendar year 2020 from the physical presence requirement for any participant election witnessed by a notary public through an electronic system that uses remote [&hellip… Continue Reading »

IRS Increases Carryover Limits for Health FSAs/Addresses Timing of Health Insurance

Posted in Health Plans, Individual Coverage Mandate, Plan Design Requirements, Stand-Alone HRAs
The Internal Revenue Service (“IRS”) has issued new guidance, Notice 2020-33, that increases the maximum carryover limit for health flexible spending arrangements (“health FSAs”), and clarifies the ability of health plans to reimburse premium expenses incurred prior to the beginning of the plan year. Increased Carryover Limit Health FSAs generally operate on a use-it-or-lose-it basis. [&hellip… Continue Reading »

IRS Provides Flexibility for Employer-Sponsored Cafeteria Plans and FSAs in Response to COVID-19 Pandemic

Posted in COVID-19
The Internal Revenue Service (IRS) has issued new guidance, Notice 2020-29, in response to the COVID-19 pandemic, providing for temporary flexibility with respect to mid-year elections made during 2020 under Code section 125 cafeteria plans related to employer-sponsored health coverage, health Flexible Spending Arrangements (health FSAs), and dependent care Flexible Spending Arrangements (DC FSAs). The guidance [&hellip… Continue Reading »

IRS Issues New Guidance on CARES Act Provisions Affecting Retirement Plans

Posted in CARES Act, COVID-19
The Internal Revenue Service has issued frequently asked questions (FAQs) clarifying the special distribution options and loan relief provisions applicable to eligible retirement plans and IRAs found in section 2202 of the CARES Act. The following is a high-level overview of the clarifications detailed in the FAQs. A more in-depth analysis of the CARES Act can be [&hellip… Continue Reading »

PBGC Provides Pandemic Relief for Pension Plans

Posted in COVID-19, Employee Benefits/Executive Compensation
The Pension Benefit Guaranty Corporation (PBGC) – the federal agency created by the Employee Retirement Income Security Act of 1974 (ERISA) to insure certain defined benefit pension plans offered by private-sector employers – has announced that it will extend deadlines for upcoming premium payments and certain other required plan filings under Title IV of ERISA to July [&hellip… Continue Reading »

The CARES Act – How the Coronavirus Stimulus Bill Impacts Employee Benefit Plans

Posted in CARES Act, COVID-19, Health Benefits, Health Plans
The Coronavirus, Aid, Relief, and Economic Security Act, or CARES Act, which passed the Senate last night, is Congress’s third legislative answer to the coronavirus pandemic. The CARES Act represents a heavily negotiated bipartisan effort that now moves to the House, where Speaker Nancy Pelosi has said she will seek swift approval. The CARES Act [&hellip… Continue Reading »

Employee Benefits and Furloughs in the Era of COVID-19

Posted in COVID-19, Health Benefits, Health Plans
Across the United States, employers are carefully considering how the COVID-19 pandemic is affecting their business. As we await further guidance and pronouncements from federal, state, and local officials, some employers are being forced to consider furloughs for some or all of their workforce. We can assist employers in strategizing on furlough decisions and crafting [&hellip… Continue Reading »

IRS Provides Relief for High-Deductible Health Plans to Cover COVID-19 Testing and Treatment Without Deductibles

Posted in COVID-19, Health Plans
The Internal Revenue Service (IRS) issued a notice that allows individuals to participate in a health savings account (HSA) while participating in a high deductible health plan (HDHP) that provides coverage for both the testing and treatment of coronavirus (COVID-19), without first satisfying the required deductible. The March 12 notice, titled Notice 2020-15, means that participants in [&hellip… Continue Reading »

States Waive Cost-Sharing for Screening and Testing in Face of COVID-19 Pandemic

Posted in COVID-19
To encourage individuals to seek prompt medical attention for the coronavirus (COVID-19), a number of states have taken, or are considering, action to eliminate the costs associated with testing and treating the virus and to increase access to such testing and treatment. Colorado, California, and New York, for example, have directed commercial insurers to eliminate co-pays, deductibles, [&hellip… Continue Reading »

SECURE Act In; Cadillac Tax Out: The Spending Act Makes Serious Changes to Benefits Rules

Posted in Cadillac Tax, Health Insurance Providers, Health Plans, Healthcare Providers / Suppliers, Legislation, Medical Devices, PCORI, Taxes and Fees
President Trump signed into law a nearly $1.4 trillion spending package that avoided a government shutdown and will fund the government through September 30, 2020. The year-end spending package, signed December 20, 2019, contains a number of retirement and health and welfare provisions that will be of interest to employers and other plans sponsors and [&hellip… Continue Reading »
.