AFFORDABLE CARE ACT: PREPARING FOR 2015
It’s time to start planning for 2015! Consult our updated Compliance Checklist to be sure that you are preparing for the basic compliance elements of the Affordable Care Act.
- Health Care Reform Legislative Brief: 2015 Compliance Checklist Document #105375
- Federal Register, Vol. 79, No. 101, May 27, 2014, pp. 30239 – 30353. Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond. http://www.gpo.gov/fdsys/pkg/FR-2014-05-27/pdf/2014-11657.pdf
COBRA GUIDANCE ISSUED AND MODEL NOTICES UPDATED
The Employee Benefits Security Administration of the Dept. of Health and Human Services recently issued a Frequently Asked Questions (FAQ XIX) announcement. Among the issues discussed in the FAQ, there is significant guidance on COBRA, including updates to both the model general notice and the model election notice.
The following articles provide helpful guidance, including simplified templates for the election notice (health plan and a health FSA). Touchstone also has reports regarding compliance with state vs federal continuation coverage rules. The Rhode Island report is included below, as an example. Please contact us if you’d like to receive a report on your state.
- Health Care Reform Bulletin: Agencies Release New COBRA Guidance for Individuals and Employers Document #103865
- Benefits Buzz: New COBRA and CHIPRA Model Notices, and COBRA and Exchange Rules Clarified Document #94325
- COBRA Election Notice Template Document #45260
- COBRA Election Notice Template – Health FSA Document #45259
- COBRA Rhode Island – Comparison of Federal and Rhode Island Continuation Laws Document #11542
- “FAQs about Affordable Care Act Implementation (Part XIX)”, U.S. Dept. of Labor, Employee Benefits Security Administration: See “Updated Department of Labor Model Notices” and Q1. http://www.dol.gov/ebsa/faqs/faq-aca19.html
- U. S. Dept. of Labor, Employee Benefits Security Administration website, “COBRA Continuation Coverage” http://www.dol.gov/ebsa/cobra.html
- Updated COBRA Model Notices:
- Updated COBRA Model General Notice, available at http://www.dol.gov/ebsa/modelgeneralnotice.doc
- Updated COBRA Model Election Notice, available at http://www.dol.gov/ebsa/modelelectionnotice.doc
- Updated CHIP Notice, available at http://www.dol.gov/ebsa/chipmodelnotice.doc
- Notice of Proposed Rulemaking, available at http://www.dol.gov/ebsa/pdf/cobranprm.pdf
- HHS Bulletin Allowing COBRA Qualified Beneficiaries to Enroll in the Health Insurance Marketplace, available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf
ACA PREVENTIVE CARE – BEWARE OF CHANGES!
Along with the updated COBRA guidance and notices described above, and clarifications on Out-of-Pocket Limits (described in the following article), FAQ XIX also addressed ACA-mandated preventive services.
FAQ XIX notably addressed coverage for drugs that reduce the risk of breast-cancer. These must be included in preventive care for plan years beginning 9/24/2014, so plans should check now to be sure that their coverage is in compliance.
Good news in the FAQs included specifics on a safe harbor for tobacco counseling programs. In the section entitled “Coverage of Preventive Services”, check the response to Q5 for details.
The services which are required to be provided at no cost to the plan participant may change or be more clearly defined over time, so it is important for benefit professionals to refer to the details provided on the HealthCare.gov website (see links below).
The following articles offer some summary guidance:
- Health Care Reform Legislative Brief – Preventive Care Coverage Guidelines Document #43291
- Health Care Reform Legislative Brief – Recommended Preventive Care Services Document #57767
- Health Care Reform Legislative Brief – Preventive Care Guidelines for Women Document #54187
- Health Care Reform Legislative Brief – Tobacco Use Surcharge in 2014. Document #103854
- “FAQs about Affordable Care Act Implementation (Part XIX)”, May 2, 2014. U.S. Dept. of Labor, Employee Benefits Security Administration: See “Coverage of Preventive Services”. http://www.dol.gov/ebsa/faqs/faq-aca19.html
- “FAQs about Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation”, January 9, 2014. U.S. Dept. of Labor, Employee Benefits Security Administration: See “Coverage of Preventive Services”, Q1. http://www.dol.gov/ebsa/faqs/faq-aca18.html
- “Preventive Health Services for Women” HealthCare.gov, Preventive Care Benefits https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2
- “Preventive Health Services for Adults” HealthCare.gov, Preventive Care Benefits https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=1
- “Preventive Health Services for Children” HealthCare.gov, Preventive Care Benefits https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3
ACA OUT-OF-POCKET LIMITS – SOME FLEXIBILITY IN PLAN DESIGN
The FAQ XIX released on May 2 clarified how cost-sharing restrictions may be satisfied by health plans. Responses to Questions 2, 3, and 4 dealt with the following issues regarding out-of-pocket maximums: balance billing, patient insistence on using brand drugs over generics, and reference-based pricing.
FAQ XVIII issued in January also clarified certain issues regarding the application of out-of-pocket maximums: as applied to essential health benefits, division of the annual maximum across different categories of benefits, out-of-network payments, and non-covered items.
Briefly, these clarifications are summarized in the following article:
- Health Care Reform Legislative Brief – Cost-Sharing Limits for Health Plans Document #78888
- “FAQs about Affordable Care Act Implementation (Part XIX)”, U.S. Dept. of Labor, Employee Benefits Security Administration: See “Limitations on Cost Sharing under the Affordable Care Act” and Q2, Q3, and Q4. http://www.dol.gov/ebsa/faqs/faq-aca19.html
- “FAQs about Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation”, January 9, 2014. U.S. Dept. of Labor, Employee Benefits Security Administration: See “Limitations on Cost Sharing”, Q2, 3, 4, and 5. http://www.dol.gov/ebsa/faqs/faq-aca18.html
MASSACHUSETTS – CHANGES TO EMPLOYER RESPONSIBILITIES AS STATE ‘HEALTH CARE REFORM’ IS COORDINATED WITH FEDERAL LAW
The Massachusetts Health Care Reform Act’s requirements regarding employers’ provision of health care coverage have been superseded by the requirements of the federal Affordable Care Act (ACA). Although the Commonwealth no longer imposes the “fair share contribution” on employers, a new “Employer Medical Assistance Contribution” (EMAC) must be paid by most employers, regardless of whether the employer provides any health coverage.
As of January 1, 2014, the Unemployment Health Insurance (UHI) contribution was replaced by EMAC. Employers are still required to file quarterly wage and employment reports through UI Online, and the applicable EMAC contribution will be calculated based on those filings.
Review the following information. If you have further questions, contact the Commonwealth’s Department of Unemployment Assistance at 617-626-5075.
- Massachusetts Finalizes Repeal of Employer Coverage Rules Document #105804
- Mass.gov website, Labor and Workforce Development, Unemployment Insurance. Employer Responsibilities under EMAC http://www.mass.gov/lwd/unemployment-insur/employer-contributions/employer-medical-assistance-contribution-emac/employer-responsibilities.html
- Mass.gov website, Labor and Workforce Development, Unemployment Insurance. Employer Contributions to EMAC: http://www.mass.gov/lwd/unemployment-insur/employer-contributions/employer-medical-assistance-contribution-emac/uhi-contributions.html
- Health Connector Administrative Bulletin 03-13 https://www.mahealthconnector.info/portal/binary/com.epicentric.contentmanagement.servlet.ContentDeliveryServlet/Health%2520Care%2520Reform/Regulations/documents/AdminBulletin03-13.pdf