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The IRS is asking the public for input into a rule that will determine when an employer-sponsored health plan is offering “substantial coverage” of inpatient hospital and physician services. This will be part of new rules defining minimum value in employer-sponsored health coverage. Employer-sponsored coverage must meet two tests to comply with the employer mandate: […]
Insurers and plan sponsors soon will have to report to the government (and list on a web page) their policies on: out-of-network liability and balance billing; enrollee claim submission; claims and denials; recoupment of overpayments; medical necessity; prior authorization; drug exception timeframes; explanations of benefits; and coordination of benefits. Guidance HHS published on Aug. 12 […]
New IRS guidance spells out more issues the agency plans to address in imposing the excise tax on high-cost employer-sponsored health coverage (commonly known as the Cadillac tax). These include: (1) identifying taxpayers who may be liable for the excise tax; (2) aggregating several employers under one plan sponsor’s payment; (3) allocating the tax among […]
The U.S. Supreme Court in a 6-3 vote affirmed that subsidies may go to individuals in states with exchanges established by the federal government, and the statute did not restrict subsidies to only states that themselves ran exchanges. Such a reading of the statute was not in line with the intent of the Affordable Care […]
Non-grandfathered employer-sponsored group health plans must abide by out-of-pocket maximums for every individual covered, whether they are enrolled in “self-only” or in “other than self-only” (family) coverage. And the government stayed enforcement of the Affordable Care Act’s provider nondiscrimination rules, according to a new set of frequently asked questions from the departments that administer health care reform. […]
Large employers learned more details in new IRS guidance about how to both report about their coverage and fill out and file IRS forms designed to determine whether they are meeting the Affordable Care Act’s coverage requirements for employers. Under the new guidance, if a large employer’s workforce is comprised entirely of part-time employees who were […]
Plans and insurers must cover all 18 contraception methods approved by the U.S. Food and Drug Administration, according to a new set of questions and answers on the Affordable Care Act’s preventive care coverage requirements. “Reasonable medical management” still may be used to steer members to specific products within those methods of contraception. A plan […]
The Centers for Medicare and Medicaid Services announced an April 30 deadline for claiming certain overpayments of the transitional reinsurance fee. The announcement covers overpayments due to miscalculating enrollment counts on which the fee is based. Such miscalculations occur for two reasons, CMS said: misapplication of a permitted method for determining the annual enrollment count; […]
Five years ago, in March 2010, the Affordable Care Act was signed into law by President Obama to resolve problems in the U.S. health system, including: the high number of uninsured Americans; Americans unable to get coverage due to pre-existing conditions; the high cost of care; and suboptimal care as a result of poor incentives […]
Tremendous cost-cutting and patient care improvements await insurers and plans that can leverage the recent gains of computing to improve patient self-management of care. The challenge is how to tap the big pools of data, and get “actionable” personalized results out to plan members so they can choose better, cheaper care and manage this care […]