June 17, 2021 - Health Care Reform Update

Supreme Court Determined there was No Legal Right to Sue

On June 17, 2021, the U.S. Supreme Court rejected a lawsuit challenging the constitutionality of the Affordable Care Act’s (ACA) individual mandate in a 7-2 ruling.

This lawsuit was filed in 2018 by 18 states as a result of the 2017 tax reform law that eliminates the individual mandate penalty. In 2012, the U.S. Supreme Court upheld the ACA on the basis that the individual mandate is a valid tax. With the penalty’s elimination, the appeals court in this case determined that the individual mandate is no longer valid under the U.S. Constitution.

The Supreme Court determined that the plaintiffs in this case did not have a legal right to sue. As a result, the ACA as it exists today will remain in place. The Court did not make any determinations on any other issue in the case, including the validity of the individual mandate or whether the rest of the ACA can be severed from the individual mandate provision. However, this case is now concluded.

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June 04, 2021 - Health Care Reform Update

2021 ACA Reporting is Due in Early 2022

The IRS has released draft 2021 versions of Forms 1094-C, 1095-C, 1094-B and 1095-B that employers will use in early 2022 to report under Internal Revenue Code Sections 6055 and 6056 for the 2021 calendar year. Draft instructions related to these forms for the 2021 calendar year have not yet been released.

No substantive changes were made to the draft forms for 2021 reporting. These forms are substantively identical to the final 2020 versions. However, certain changes may be made once these forms are finalized, or when draft or final instructions are released.

Employers should become familiar with these forms for reporting for the 2021 calendar year. However, these forms are draft versions only, and should not be filed with the IRS or relied upon for filing. In addition, employers should monitor future developments for the release of 2021 draft instructions for these forms.

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May 06, 2021 - Health Care Reform Update

The Notice Includes Additional Benefit and Payment Standards for 2022

On May 5, 2021, the Department of Health and Human Services (HHS) published a second Notice of Benefit and Payment Parameters (NBPP) for 2022 that finalized the remainder of the standards included in the proposed notice issued at the end of 2020. The first final 2022 NBPP was published Jan. 19, 2021.

This second NBPP describes additional benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2022 benefit year, including the following:

• The annual out-of-pocket maximum limitation will increase to $8,700 (self-only coverage) and $17,400 (family coverage) for 2022. This amount is $400 lower than was initially proposed.
• The required contribution percentage for catastrophic coverage eligibility will decrease from 8.27% for 2021 to 8.09% for 2022.
• An additional special enrollment period (SEP) for Exchange coverage to allow Exchange enrollees who lose premium tax credit eligibility to change to a new plan, and allow individuals who were unaware that an SEP triggering event occurred to select a new qualified health plan within 60 days.

The first 2022 NBPP finalized provisions including updated user fees for issuers offering plans through the Exchange, establishment of a new Exchange direct enrollment option, Exchange payment standards related to individual coverage HRAs (ICHRAs) or qualified small employer HRAs (QSEHRAs), and amended Section 1332 waiver procedures.

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March 26, 2021 - Health Care Reform Update

The Special Enrollment Period will Now be Available through Aug. 15, 2021, via HealthCare.gov

On March 23, 2021, the Centers for Medicare & Medicaid Services (CMS) announced that it is extending access to a special enrollment period (SEP) through Exchanges on the federal www.HealthCare.gov platform due to the coronavirus (COVID-19) pandemic. Originally available through May 15, 2021, the extended SEP provides three additional months for enrollment, allowing eligible individuals to enroll in Exchange coverage through Aug. 15, 2021.

Now through Aug. 15, 2021, this SEP is available through Exchanges using the www.HealthCare.gov platform to all Exchange-eligible consumers who are submitting a new application or updating an existing application. States using their own Exchange platforms are strongly encouraged to make a similar SEP available in their states. Consumers seeking to take advantage of this SEP can find out if they are eligible by visiting www.HealthCare.gov. Consumers will have 30 days after they submit their application to choose a plan.

As a result of the American Rescue Plan Act (ARPA), additional premium cost savings is available through www.HealthCare.gov starting April 1, 2021, that may lower premium costs or allow individuals to enroll in a higher-level plan at the same cost. Also, beginning in early July, consumers who are eligible for unemployment compensation for any week during 2021 may be eligible for additional cost savings through the Exchange.

© 2021 HR 360, Inc.

February 04, 2021 - Health Care Reform Update

These Codes were Previously Reserved on the 2020 Instructions for Forms 1094-C and 1095-C

On Feb. 2, 2021, the Internal Revenue Service (IRS) provided two additional codes from Code Series 1, that can be used on Form 1095-C, line 14, for reporting offers of individual coverage HRAs (ICHRAs) under Section 6056. These codes were previously reserved on the instructions for Forms 1094-C and 1095-C.

• 1T. ICHRA offered to employee and spouse (no dependents) with affordability determined using employee's primary residence location ZIP code.
• 1U. ICHRA offered to employee and spouse (no dependents) using employee's primary employment site ZIP code affordability safe harbor.

These additional codes may be used when an employer offers ICHRA coverage to an employee and his or her spouse, but not to any dependent children.

When the final forms and instructions for reporting under Section 6056 were released back in October 2020, they included eight additional codes in Code Series 1 (Codes 1L-1M) that may be used to report offers of ICHRA coverage.

© 2021 HR 360, Inc.

February 02, 2021 - Health Care Reform Update

The Order Directs Federal Agencies to Review Existing Policies to Determine whether they Undermine the ACA

On Jan. 28, 2021, President Joe Biden issued an executive order that is intended to strengthen the Affordable Care Act (ACA) and Medicaid. The executive order directs the Department of Health and Human Services (HHS) to consider establishing a special enrollment period through Federally Facilitated Exchanges due to the coronavirus (COVID-19) pandemic. 

The order also directs HHS, the Treasury and the Department of Labor (DOL) to review all existing regulations and guidance, and other agency actions to determine whether they are inconsistent with the policy of the executive order, and consider whether to suspend, revisit or rescind those actions. Finally, the executive order revokes two prior executive orders issued by the Trump administration.

An executive order is a broad policy directive that directs federal agencies to consider new regulations or guidance to implement the order’s policies. The order itself does not make any changes to existing regulations. As a result, the executive order’s specific impact will remain largely unclear until agencies can issue further guidance.

© 2021 HR 360, Inc.

February 02, 2021 - Health Care Reform Update

The Special Enrollment Period will be Available Feb. 15 – May 15, 2021, through HealthCare.gov

On Jan. 28, 2021, the Centers for Medicare & Medicaid Services (CMS) announced a new special enrollment period (SEP) due to the coronavirus (COVID-19) pandemic through Exchanges using the federal www.HealthCare.gov platform. States using their own Exchange platforms are strongly encouraged to make a similar SEP available in their states.

Starting on Feb. 15, 2021, and continuing through May 15, 2021, Exchanges using the www.HealthCare.gov platform will make a SEP available to all Exchange-eligible consumers who are submitting a new application or updating an existing application. Beginning on Feb. 15, 2021, consumers seeking to take advantage of this SEP can find out if they are eligible by visiting www.HealthCare.gov. Consumers will have 30 days after they submit their application to choose a plan.

Consumers do not need to provide any documentation of a qualifying event (such as loss of a job or birth of a child), which is typically required for SEP eligibility.

© 2021 HR 360, Inc.

January 22, 2021 - Health Care Reform Update

Policies Renewed Under Extended Non-Enforcement Policy Must Comply by Jan. 1, 2023

On Jan. 19, 2021, the Department of Health and Human Services (HHS) extended an existing transition policy for certain health plans that do not comply with the Affordable Care Act (ACA) for an additional year, to policy years beginning on or before Oct. 1, 2022. Any plans that are renewed under this extended transition policy must comply with the specified requirements by Jan. 1, 2023.

In states that allow it, coverage subject to the non-enforcement policy will not be considered to be out of compliance with key ACA market reform requirements, including:

• The requirement to cover a core package of items and services known as essential health benefits;
• The requirement that any variations in premiums be limited with regard to a particular plan or coverage to age, tobacco use, family size, and geography;
• The requirements regarding guaranteed availability and renewability of coverage; and
• The requirements relating to coverage for individuals participating in approved clinical trials.

Plans renewed under this transition policy are often called “grandmothered” plans. Originally announced in 2013, the transition policy has already been extended several times.

© 2021 HR 360, Inc.

January 22, 2021 - Health Care Reform Update

The Remaining Proposals are Expected to be Finalized in a Second Notice

On Jan. 19, 2021, the Department of Health and Human Services (HHS) published a Notice of Benefit and Payment Parameters for 2022 that finalized some of the standards included in the proposed notice issued at the end of 2020. This notice describes certain benefit and payment parameters under the Affordable Care Act (ACA) that apply for the 2022 benefit year.

Standards that were finalized in the notice include:

• Updated user fees for the 2022 benefit year for issuers offering plans through a Federally Facilitated Exchange (FFE) or State-based Exchange on the Federal Platform (SBE-FP);
• Establishment of a new Exchange direct enrollment option through a state Exchange, SBE-FP or FFE;
• Implementing standards requiring individual market QHP issuers to accept payments made from an individual coverage health reimbursement arrangement (ICHRA) or qualified small employer health reimbursement arrangement (QSEHRA); and
• Amending Section 1332 waiver application procedures, monitoring and compliance, and periodic evaluation requirements.

The remaining provisions from the proposed notice, such as the updated cost-sharing limit and affordability exemption percentage, are expected to be finalized in a second notice that will be issued later in the year.

© 2021 HR 360, Inc.

December 22, 2020 - Health Care Reform Update

The Ban on Surprise Medical Bills Will Take Effect in 2022

On Dec. 27, 2020, President Donald Trump signed the Consolidated Appropriations Act of 2021 into law, a $900 billion stimulus bill that includes emergency economic relief, government funding and tax cuts. The bill also includes the No Surprises Act, a ban on surprise medical bills, which will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. For example, a patient may go to an in-network hospital for treatment, such as surgery or emergency care, but an out-of-network doctor may be involved in the patient’s care. 

Patients often cannot determine the network status of these providers, such as emergency room doctors or anesthesiologists, in order to avoid the additional charges. In many cases, the patient is not involved in the choice of provider at all.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Rather, providers will have to work with the group health plan or health insurance issuer to determine the appropriate amount to be paid by the plan or issuer, under the methodology provided in the Act. 

The Dept. of Health and Human Services will work with the Depts. of Labor and the Treasury to issue regulations regarding this methodology and other requirements of the Act. 

We will continue to keep you updated as information becomes available on the details of the law. 

© 2021 HR 360, Inc.

December 02, 2020 - Health Care Reform Update

The Fee is $2.66 per Covered Life for Plan Years Ending in 2021

The IRS issued Notice 2020-84, which increases the Patient-Centered Outcomes Research Institute (PCORI) fee amount for plan years ending on or after Oct. 1, 2020, and before Oct. 1, 2021. Specifically, the PCORI fee amount for plan years ending on or after Oct. 1, 2020, and before Oct. 1, 2021, is increased to $2.66 multiplied by the average number of lives covered under the plan.

The IRS provided transition relief related to the 2020 PCORI fee calculation, due to the anticipated termination of the PCORI fee prior to its extension. This transition relief allowed issuers and plan sponsors to use any reasonable method for calculating the average number of covered lives for this period, in addition to existing methods, so long as it was applied consistently for the duration of the plan year. However, this transition relief was not extended for the 2021 plan year. As a result, plans and issuers must use one of the existing methods for calculating the PCORI fee for 2021.

As a reminder, employers of certain self-insured health plans are responsible for paying PCORI fees annually. Fees for plan years that ended in 2020 are due Aug. 2, 2021, since July 31, 2021, is a Saturday.

© 2021 HR 360, Inc.

October 29, 2020 - Health Care Reform Update

Rule Requires Disclosure of Personalized Cost-sharing Information

On Oct. 29, 2020, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued a final rule regarding transparency in coverage that imposes new transparency requirements on group health plans and health insurers in the individual and group markets. The final rule requires plans and issuers to disclose:

• Cost-sharing estimates to participants, beneficiaries and enrollees through an internet-based self-service tool, beginning with the 2023 plan year; and
• In-network provider-negotiated rates and historical out-of-network allowed amounts on their public website, for plan years beginning on or after Jan. 1, 2022.

These provisions only apply to non-grandfathered coverage, including both insured and self-insured group health plan sponsors.

© 2021 HR 360, Inc.

October 27, 2020 - Health Care Reform Update

Contribution Limit to Remain the Same in 2021

The IRS has announced that the contribution limit for health flexible spending arrangements (health FSAs) will remain at $2,750 in 2021. For 2020, the contribution limit was also set at $2,750.

© 2021 HR 360, Inc.

October 20, 2020 - Health Care Reform Update

2020 ACA Reporting is Due in Early 2021

The IRS has released final 2020 forms and instructions for use in early 2021 to report under IRS Code Sections 6055 and 6056 for the 2020 calendar year. 

• 2020 Form 1094-B and Form 1095-B (and related instructions) will be used by providers of minimum essential coverage (MEC), including self-insured plan sponsors that are not ALEs, to report under Section 6055.
• 2020 Form 1094-C and Form 1095-C (and related instructions) will be used by applicable large employers (ALEs) to report under Section 6056, as well as for combined Section 6055 and 6056 reporting by ALEs who sponsor self-insured plans. 

The forms and instructions include a number of changes and clarifications related to 2020 reporting. 

• The deadline for furnishing statements to individuals under Sections 6055 and 6056 has been extended to March 2, 2021.
• Good faith relief from penalties for reporting incorrect or incomplete information has been extended to 2020 reporting.
• The IRS has extended relief from penalties for reporting entities that furnish individual statements under Section 6055 only upon request for 2020 calendar year reporting.
• The “Plan Start Month” box on Form 1095-C is now required for 2020 reporting.
• Certain additions were made to the 2020 Forms 1095-B and 1095-C related to individual coverage HRAs (ICHRAs). Form 1095-B includes a new code G to be used on line 8, Origin of the Health Coverage, to identify coverage under an ICHRA. In addition, Form 1095-C includes new codes in Code Series 1 for reporting offers of ICHRAs, as well as new lines for reporting required information. 

Employers should become familiar with these forms and instructions for reporting for the 2020 calendar year. Individual statements must be furnished by March 2, 2021, and IRS returns must be filed by Feb. 28, 2021 (March 31, 2021, if filed electronically).

© 2021 HR 360, Inc.

October 15, 2020 - Health Care Reform Update

2020 ACA Reporting is Due in Early 2021

The IRS has released draft 2020 instructions for Forms 1094-B and 1095-B, and draft 2020 instructions for Forms 1094-C and 1095-C that employers will use in early 2021 to report under IRS Code Sections 6055 and 6056 for the 2020 calendar year. Draft forms related to this reporting were previously released in July 2020.

The draft instructions include a number of changes and clarifications related to 2020 reporting.

 

• The deadline for furnishing statements to individuals under Sections 6055 and 6056 has been extended to March 2, 2021.
• Good faith relief from penalties for reporting incorrect or incomplete information has been extended to 2020 reporting.
• The IRS has extended relief from penalties for reporting entities that furnish individual statements under Section 6055 only upon request for 2020 calendar year reporting.
• The “Plan Start Month” box on Form 1095-C is now required for 2020 reporting.
• Certain additions were made to the 2020 draft Forms 1095-B and 1095-C related to individual coverage HRAs (ICHRAs). Draft Form 1095-B includes a new code G to be used on line 8, Origin of Health Coverage, to identify coverage under an ICHRA. In addition, draft Form 1095-C includes additional codes in Code Series 1 for reporting offers of ICHRAs, as well as new lines for reporting required information.

 

Employers should become familiar with these forms and instructions for reporting for the 2020 calendar year. However, these are draft versions only, and should not be filed with the IRS or relied upon for filing.

© 2021 HR 360, Inc.

October 05, 2020 - Health Care Reform Update

2020 Furnishing Deadline Delayed and Additional Transition Relief Granted

The IRS has delayed the deadlines by which employers must furnish 2020 Forms 1095-C and 1095-B in early 2021. For 2020, the furnishing deadline was Feb. 1, 2021, Since Jan. 31, 2021, is a Sunday. The IRS has provided an additional 30 days for furnishing the 2020 Form 1095-B and Form 1095-C, extending the due date from Feb. 1, 2021, to March 2, 2021. The deadline for filing with the IRS under Sections 6055 and 6056 remains March 1, 2021 (since Feb. 28, 2021, is a Sunday), or March 31, 2021, if filing electronically.

The IRS provided additional relief from penalties related to failures to furnish 2020 forms to individuals under Section 6055 only, under certain circumstances. Under this relief, employers will only have to provide Form 1095-B to covered individuals upon request.

The IRS also provided a final extension of good-faith relief from penalties related to incorrect or incomplete information returns filed for the 2020 calendar year under Sections 6055 and 6056. This is the last year that the IRS intends to provide good-faith relief from penalties, since it was intended to be transitional relief only.

© 2021 HR 360, Inc.

September 25, 2020 - Health Care Reform Update

The America First Health Care Plan aims to Protect People with Preexisting Conditions and Combat Surprise Medical Billing

On Sept. 24, 2020, President Donald Trump introduced his plan for affordable, high-quality health care, called the America First Health Care Plan. This plan, issued in an executive order, is primarily aimed at protecting people with preexisting conditions and combating surprise medical billing.

The executive order directs the Departments of Health and Human Services (HHS), Labor and the Treasury to maintain and build upon existing actions to:

• Expand options for affordable health care and access to affordable medicines;
• Ensure consumers have access to meaningful price and quality information before the delivery of care; and
• Reduce waste, fraud and abuse in the health care system.

The executive order specifically directs HHS to work with Congress to reach a legislative solution to end surprise medical billing by Dec. 31, 2020. If a legislative solution is not reached by that date, the executive order directs HHS to take administrative action to prevent out-of-pocket expenses that cannot be reasonably foreseen.

An executive order is a broad policy directive used to establish how laws will be enforced by the administration. The order does not make any changes to existing laws or regulations, but directs federal agencies to issue new guidance to implement the order’s policies. As a result, the executive order’s specific impact will remain largely unclear until agencies issue further guidance or Congress takes action in response to the order.

© 2021 HR 360, Inc.

September 23, 2020 - Health Care Reform Update

Whether Justice Ginsburg’s Seat should be Filled Prior to the November Election is the Subject of Much Controversy

On Sept. 18, 2020, U.S. Supreme Court Justice Ruth Bader Ginsburg passed away at the age of 87. Under federal law, the President is responsible for nominating a new Supreme Court Justice, and the nominee must be confirmed by the U.S. Senate.

On Sept. 26, 2020, President Donald Trump nominated federal circuit court judge Amy Coney Barrett to fill the vacancy, and the Senate plans to hold a vote on this nomination. However, a number of Democrats in Congress believe that the nomination process should not take place until after the November election.

Currently, a lawsuit seeking to invalidate the ACA in its entirety is pending before the Supreme Court, with oral arguments scheduled for November. If a new Supreme Court Justice is confirmed before the election, it could greatly impact the outcome of that litigation. It is widely expected that President Trump’s nominee will have a more conservative viewpoint and would be more likely to invalidate the ACA. In contrast, a Supreme Court Justice nominated by Democratic Party candidate Joe Biden would be more likely to uphold the ACA.

Until a nominee is ultimately confirmed, the practical impact of this decision remains to be seen. As a result, employers may want to closely monitor developments related to the Supreme Court nomination.

© 2021 HR 360, Inc.

August 31, 2020 - Health Care Reform Update

The Adjusted Penalty Amounts for 2021 are $2,700 and $4,060

Under the Affordable Care Act’s employer shared responsibility (pay or play) rules, applicable large employers—generally those who have 50 or more full-time employees (including full-time equivalent employees)—may be subject to a penalty if they do not offer affordable coverage that provides minimum value to their full-time employees and their dependent children.

Two separate penalties can apply under the employer shared responsibility rules—the Section 4980H(a) penalty and the Section 4980H(b) penalty.

• The Section 4980H(a) penalty can apply when an ALE does not offer coverage to “substantially all” full-time employees (and dependents). The annual Section 4980H(a) penalty is calculated as the ALE’s number of full-time employees (minus 30) x $2,000 (as adjusted).
• The Section 4980H(b) penalty can apply when an ALE does not offer coverage to all full-time employees, or the ALE’s coverage is unaffordable or does not provide minimum value. The annual Section 4980H(b) penalty is calculated as $3,000 (as adjusted) x the number of the ALE’s full-time employees who receive an Exchange subsidy.

After 2014, the applicable per-employee dollar amounts of $2,000 and $3,000 are increased based on the premium adjustment percentage for the year. The IRS announced that, for the 2021 calendar year, the adjusted $2,000 amount is $2,700 and the adjusted $3,000 amount is $4,060.

© 2021 HR 360, Inc.

July 28, 2020 - Health Care Reform Update

Series of Four Executive Orders Issued

On July 24, 2020, President Donald Trump issued the following series of executive orders in an effort to lower drug prices: 

• Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen: directs federally qualified health centers to pass along massive discounts on insulin and epinephrine received from drug companies to certain low-income Americans.
• Executive Order on Increasing Drug Importation to Lower Prices for American Patients: intended to allow state plans for safe importation of certain drugs, authorize the re-importation of insulin products made in the United States, and create a pathway for widespread use of personal importation waivers at authorized pharmacies in the United States.
• Executive Order on Access to Affordable Life-saving Medications: intended to prohibit secret deals between drug manufacturers and pharmacy benefit manager middlemen, ensuring patients directly benefit from available discounts at the pharmacy counter. 

President Trump also announced a fourth executive order intended to ensure that the United States pays the lowest price available in economically comparable countries for Medicare Part B drugs. However, the order's implementation is delayed until Aug. 25, 2020, to give pharmaceutical executives a chance to propose an alternative.

© 2021 HR 360, Inc.