Affordable Care Act Review

Affordable Care Act Review

Category Archives: Insurers and Brokers

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Developments February 6 – 10: Is the Price Right?

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
During the week reviewed, no new bill was introduced which, if passed, would repeal or replace the Affordable Care Act, and little else happened at the three main ACA enforcement agencies – DOL, HHS and IRS. Department of Labor The Department of Labor still has no Secretary and the nominee, Andrew Puzder, has not yet… Continue Reading

The End of the Beginning: Developments January 27 – February 5

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Nothing resembling a repeal/replace consensus bill emerged from any committee in either chamber during the survey period.  Instead, in a Fox News interview broadcast just before the Super Bowl, the President confessed that ACA repeal may require more than a year.  A concise summary by Peter Sullivan in The Hill is online here. Consistent with… Continue Reading

Hitch In the Giddy-up: Round-up of Developments January 19 – 27

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
As previously reported, § 2001 of the 2017 budget bill required all ACA repeal/replace bills to be filed and reported from assigned committees by Friday, January 27, 2017.  That didn’t happen.  Since our last posting, the bills listed below have been filed and assigned to committees, but no ACA bill has emerged from committee in either… Continue Reading

On Your Mark, Get Ready, to Go . . . Somewhere: Congressional Developments January 12-18

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Taxes
On January 13, the House passed the 2017 budget resolution (S. Con. Res. 3), which should be found on President Trump’s desk Monday morning.  As previously explained, this sets the stage for a filibuster-proof, budget reconciliation bill that can repeal and replace spending and tax provisions of the ACA. S. 106,  introduced January 12 by… Continue Reading

Fitness Enthusiasm Wanes Early: ACA-Related Congressional Actions January 5 – 12

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
On January 5, the House passed the “Regulations from the Executive in Need of Scrutiny Act of 2017” (H.R. 26), streamlining the process for Congressional review and rejection of administrative agency rules, including a 10-year sunset provision for rules that Congress has not expressly approved. In a late night “vote-a-rama” held January 11-12, the Senate… Continue Reading

ACA Repeal Reality Check

Posted in Affordable Care Act, carrots, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
We didn’t take ten weeks off because there was nothing to talk about.  Rather, we concluded around Labor Day that anything useful to be said about ACA compliance, pre-election, would be interpreted as political advocacy, so we decided to watch and wait.  The anti-ACA candidate won, and his party carried Congress, too.  That settles that,… Continue Reading

2016 Draft Forms 1094-C and 1095-C and Instructions: What’s New, Page-by-Page

Posted in Affordable Care Act, Employee Leasing, Government Employers, Independent Contractors, Insurers and Brokers, Private Employers, Taxes
In the ACA realm, change is the only constant, so don’t take this to the bank.  We’re telling you what we see for the first time, on a first reading of the draft 2016 Forms and Instructions that the IRS has released since July 7.  “Applicable Large Employers,” their contractors and consultants will use these… Continue Reading

Stand Alone, Fixed-Indemnity Plans Are Back, Maybe

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Insurers and Brokers, Taxes
In Central United Life Ins. Co. v. Burwell, D.C. Cir. No. 15-5310 (July 1, 2016), a D.C. Circuit panel affirmed, 3-0, a trial court injunction barring enforcement of the 2014 HHS regulation permitting individual fixed-indemnity policies to be sold only as supplements to ACA minimum essential coverage. You’ve heard this theme before. The Public Health… Continue Reading

House v. Burwell: Insurer Cost-Sharing Subsidies Unauthorized

Posted in Affordable Care Act, Exchanges, Insurers and Brokers
A U.S. District Judge has ruled that HHS unlawfully has spent billions of dollars to reimburse insurers for cost-sharing reductions granted to individuals who bought health insurance through an ACA Exchange such as Healthcare.gov. U.S. House of Representatives v. Burwell, D.D.C. No. 1:14-cv-01967 (May 12, 2016). The Court stayed its ruling pending review by the… Continue Reading

So I Made This Little 1095-C Mistake. Big Deal?

Posted in Affordable Care Act, Government Employers, Insurers and Brokers, Private Employers
The 2015 Instructions for Forms 1094-C and 1095-C tell Applicable Large Employers how to furnish and file corrections to incorrectly filed Forms 1095-C. They don’t answer these two questions that arise between the March 31, 2016 deadline for furnishing Forms 1095-C to full-time employees and the May 31 paper filing deadline or the June 30 e-filing deadline. What… Continue Reading

How (and How Not) to Read This Blog

Posted in Affordable Care Act, Business Organizations, Community Health Needs Assessments, Coverage Mandates, Employee Leasing, Exchanges, Federal Contractors, Government Employers, Grandfathered Status, Independent Contractors, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes, Uncategorized
Nearly three years ago, having spent hundreds of hours immersed in ACA minutiae, we anticipated that clients would not react well to fees for services that consisted principally of telling them that they had asked the wrong question. So we decided, against tradition and much conventional wisdom, to sink lots of unpaid partner time into… Continue Reading

ACA Information Return Deadlines Extended

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Government Employers, Insurers and Brokers, Private Employers, Taxes
On December 28, 2015, the IRS released its Notice 2016-4, granting much needed time for employers and their filing services to catch up to Affordable Care Act Information Return (AIR) Program developments. Here (nearly verbatim) are the extensions: The deadline for furnishing to individuals the 2015 Form 1095-B, Health Coverage, and the 2015 Form 1095-C,… Continue Reading

Coming Down Your Chimney: Market Reform Guidance, Information Reporting Penalty Relief and Cadillac Tax Delay

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Federal Contractors, Government Employers, Independent Contractors, Insurers and Brokers, Private Employers, Taxes
It’s the “silly season” on the Hill and a busy season for ACA regulators. This article gives you brief notes about Notice 2015-87, information reporting relief and the § 4980I delay buried in the omnibus spending bill. IRS Notice 2015-87 first answers questions on the periphery of earlier guidance effectively killing stand-alone HRAs. Most notably, an… Continue Reading

HHS 2017 Notice of Benefit and Payment Parameters

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
This is the annual hodge-podge of changes to the risk adjustment, reinsurance, and risk corridors programs, cost sharing parameters, cost-sharing reductions, and Healthcare.gov user fees, usually filling hundreds of Federal Register pages. Stuff gets buried deep, scattered among 45 CFR Parts 144, 146, 147, 153, 154, 155, 156 and 158. Yesterday (101 pages) was no… Continue Reading

DOL Tightens Disability Claim Processing Rules

Posted in Affordable Care Act, Government Employers, Insurers and Brokers, Private Employers
“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources of severe hardship for many individuals, the Department thinks that disability benefit claimants deserve protections equally as… Continue Reading

RIP, Automatic Enrollment

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers, Taxes
Sixty-seven months ago, Congress ordered employers of 200 or more full-time employees to switch from opt-in to opt-out enrollment. See 29 U.S.C. § 218a. But the enforcement agencies could not write a rule that did more good than harm, so they gave up. A lame duck Senator killed a bipartisan repeal bill in his committee last… Continue Reading

House Passes Significant ACA Amendment by Voice Vote

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers
With little apparent Democrat opposition, the U.S. House of Representatives on September 28 routinely passed a bill to allow employers of 50 to 100 employees to avoid the ACA’s especially heavy regulation of small group health plans beginnning in 2016, subject to state rules to the contrary. The lack of controversy suggests that this bill… Continue Reading

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers
On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions: 2015 Instructions for Forms 1094-C and 1095-C; 2015 Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; 2015 Form 1095-C Employer-Provided Health Insurance Offer and Coverage; 2015 Instructions for Forms 1094-B and 1095-B; 2015 Form 1094-B Transmittal of… Continue Reading

Nondiscrimination in Health Programs and Activities: Proposed Rules from HHS

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
ACA § 1557(a) (42 U.S.C. § 18116(a)) says: Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681… Continue Reading

Draft 2015 Forms and Instructions for ACA Coverage Offer Information Reporting: Forms 1094-B, 1095-B, 1094-C, 1095-C and 8809

Posted in Affordable Care Act, Government Employers, Insurers and Brokers, Private Employers, Taxes
At about the same time as last year, the IRS has released draft ACA coverage information reporting Forms and Instructions to be used early next year. There are many small differences and one HUGE difference. The IRS decided not to enforce the 2014 reporting requirements, essentially giving covered employers a practice year, if they wanted… Continue Reading

King v. Burwell Forecast: Cloudy with a Chance of Panic

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
This is a compliance blog; we don’t do politics. But we can’t explain compliance consequences of the Supreme Court’s King v. Burwell opinion without acknowledging the political context. Here’s the June calendar of the Supreme Court of the United States.               Opinions are posted online on Monday or Tuesday, typically. As early as… Continue Reading

EEOC Wellness Incentive Rules: Damned If You Do, Maybe

Posted in Affordable Care Act, Government Employers, Insurers and Brokers, Private Employers
Almost two years ago, the ACA enforcement agencies jointly published a set of lengthy, detailed, final rules applying the ACA’s enhanced health status discrimination prohibition to employer-administered wellness incentives. On April 16, 2015, the EEOC declared those rules insufficient to satisfy the Americans with Disabilities Act, proposing enhanced ADA rules to be codified at 29 CFR… Continue Reading

HDHP Family Coverage Cost Sharing Limit Put Simply

Posted in Affordable Care Act, Coverage Mandates, Insurers and Brokers
The HHS 2016 Notice of Benefit and Payment Parameters was the usual grab bag of regulatory minutiae, but some things were more easily grabbed than others. So, HHS has published a good, simple explanation of how the annual cost sharing limit applies to high deductible health plan coverage of a family. We quote it here,… Continue Reading