The Centers for Medicare and Medicaid Services (CMS) and the IRS have each published guidance on matters arising under the Affordable Care Act (ACA). It is too early to tell whether these measures—some of the first guidance published under the ACA by the new administration—are singular acts or signals of guidance to come, as Congress [&hellip… Continue Reading »
Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze health care reform developments. This Health Care Reform Dashboard was a product of that initiative. We intend to continue following [&hellip… Continue Reading »
The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) has posted an alert (and a follow-up alert) warning health plans, health care providers, and their vendors of a mock communication involving the OCR audit program under the Health Insurance Portability and Accountability Act (HIPAA). The email falsifies HHS departmental letterhead [&hellip… Continue Reading »
The IRS has extended the deadline for furnishing 2016 Forms 1095-C and 1095-B to individuals by 30 days to March 2, 2017. The reprieve offers welcome relief to employers, health insurers, and other plan sponsors who would otherwise have been required to distribute these forms under the Affordable Care Act (ACA) by January 31, 2017. [&hellip… Continue Reading »
As we start looking forward to 2017, and as many employers head into annual enrollment periods this fall, it is necessary to account for changes in the law that have a significant impact on health benefit plans. This short list of significant developments may help you prepare for what is coming: Affordable Care Act (ACA) Reporting. The [&hellip… Continue Reading »
The IRS has issued proposed regulations on the individual mandate reporting requirements under section 6055 of the Internal Revenue Code. To a significant degree, the new regulations reflect guidance previously published by the IRS. Although the rules are only proposed, health plan sponsors may generally rely on them now. The new guidance addresses several discrete [&hellip… Continue Reading »
The U.S. Department of Health and Human Services (HHS) has issued final regulations under Section 1557 of the Affordable Care Act (ACA) which prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. To be subject to these nondiscrimination rules, the health program or activity [&hellip… Continue Reading »
The U.S. Department of Labor (DOL) has issued an updated template Summary of Benefits and Coverage (SBC), Glossary of Coverage and Medical Terms, and related materials. The revised materials remain in proposed form, but have been sent to the U.S. Office of Management and Budget with a request that the templates and glossary be approved [&hellip… Continue Reading »
Recognizing that many employers and others may need additional time to prepare reports under new Affordable Care Act requirements, the IRS has announced an automatic extension automatic extension of the deadline for delivering these reports. As a result: Forms 1095-B and 1095-C for 2015 do not need to be furnished to individuals until March 31, 2016. The deadline [&hellip… Continue Reading »
Following up on the issuance of final regulations on various market reform provisions under the Affordable Care Act (ACA), the IRS has issued a notice with Questions and Answers that take a more detailed look at specific ACA issues. In particular, this notice addresses: Health reimbursement arrangements (HRAs). The guidance confirms that retiree-only HRAs may [&hellip… Continue Reading »
In the first significant congressional modification of the Affordable Care Act (ACA) since its passage, the notorious “Cadillac tax” on high-cost employer health plans has been delayed two years, from 2018 to 2020. The delay is included in the omnibus spending and tax extenders bills President Obama signed on December 22. Delay of the Cadillac [&hellip… Continue Reading »
The Bipartisan Budget Act of 2015 (H.R. 1314), signed into law on November 2, 2015, repeals the automatic enrollment rule added by Section 1511 of the Affordable Care Act (ACA). The auto-enrollment rule amended the Fair Labor Standards Act (FLSA) to require employers, if they employed more than 200 full-time employees and offered a health [&hellip… Continue Reading »
The IRS has finalized the 2015 forms and instructions for reporting under the individual and employer mandates and issued additional guidance on these new reporting requirements. Forms and Instructions. The following forms are now available: Form 1094-B Form 1095-B Form 1094-C Form 1095-C Instructions for Forms 1094-B and 1095-B Instructions for Forms 1094-C and 1095-C [&hellip… Continue Reading »
The IRS has completed drafts of the 2015 forms and instructions for employers, insurers, and other health plan sponsors to use to meet their reporting obligations for the employer and individual mandates under the Affordable Care Act. These new forms and instructions include: Form 1094-B Form 1095-B Form 1094-C Form 1095-C Instructions to Forms 1094-B [&hellip… Continue Reading »
The U.S. Departments of Labor, Health and Human Services, and the Treasury have jointly issued a new set of FAQs that clarifies the application of the rules establishing cost-sharing limits. For 2016, non-grandfathered group health plans must cap the amount that plan participants pay in deductibles, copayments, coinsurance and the like at $6,850 for self-only [&hellip… Continue Reading »
The Internal Revenue Service has issued two lengthy sets of questions and answers on the requirement under the Affordable Care Act that employers report on their compliance with the employer mandate and employees’ qualification for exchange subsidies. The new guidance is divided into general information about the reporting rules and information about completing the actual [&hellip… Continue Reading »
In a new frequently asked question (FAQ) released by the U.S. Departments of Labor (DOL), Treasury, and Health and Human Services on March 30, 2015, the agencies advised the public that they intend to finalize the summary of benefits and coverage (SBC) regulations (proposed on December 30, 2014 and described below) in time to apply [&hellip… Continue Reading »
The Internal Revenue Service has finalized the forms and instructions for reporting information necessary for enforcement of the individual and employer mandates under sections 6055 and 6056 of the Internal Revenue Code. The forms and instructions are very similar to the drafts previously issued by the IRS but clarify several specific points, such as: The [&hellip… Continue Reading »
In the Consolidated and Further Continuing Appropriations Act (the recently enacted federal budget bill often known as the “CRomnibus” legislation), Congress has exempted health plans designed to cover expatriates from most of the requirements of the Affordable Care Act. The exemption will generally apply where a group health plan provides significant health coverage and substantially [&hellip… Continue Reading »
Late on October 31, the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services announced that it was suspending the program that required all health plans to register for a health plan ID number to be used in certain electronic transactions. This program required larger health plans to obtain a health [&hellip… Continue Reading »
Employers and other health plan sponsors may be focused on preparing for the commencement of the employer mandate under the Affordable Care Act on January 1, 2015, but a number of other deadlines and developments are emerging this autumn for plan sponsors to consider. Health Plan IDs. As we reported earlier, many health plans are [&hellip… Continue Reading »
Following up on regulations and forms published earlier this year, the IRS has issued instructions and other guidance on the shared responsibility reporting requirements under the Affordable Care Act. The new rules require: Health benefit providers, including group health plan sponsors and insurers, to provide information on an individual’s compliance with the individual mandate requirements [&hellip… Continue Reading »
In response to the recent U.S. Supreme Court decision in Burwell v. Hobby Lobby, Inc., the U.S. Departments of Health and Human Services (HHS) and Labor (DOL) published proposed rules on August 22, 2014, expanding the availability of the religious accommodation to the contraceptive mandate provided in their July 2013 final regulations to closely held [&hellip… Continue Reading »
The Internal Revenue Service recently released draft versions of the forms that will be used to meet the shared responsibility reporting requirements under the Affordable Care Act (ACA). These draft forms have been released for comment and may not be used for filing until they are finalized. Instructions for the forms have not yet been [&hellip… Continue Reading »
