Affordable Care Act Review

Affordable Care Act Review

Category Archives: Grandfathered Status

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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

Five Years Later, Final Rules on Grandfathered Plan Status, Etc.

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status
Today, the ACA enforcement agencies (DOL, HHS, IRS) jointly published final rules, effective January 1, 2017, on grandfathered plan status, pre-existing condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals and patient protections. Interim rules and sub-regulatory guidance issued since June 2010 are merged and finalized. On first reading (104 pages), we see no… 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

MOOP and Reference-Based Pricing

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit
With group health plan premium increases limited by market and regulatory forces, insurers and self-insurers have raised deductibles, co-insurance, co-pays and other cost-shifting provisions, subject to the ACA’s 2015 maximum out-of-pocket (“MOOP”) limits – $6,600 per individual, $13,200 per family.  But “reference-based pricing” complicates MOOP enforcement.  In Frequently Asked Questions (“FAQ”) guidance issued October 10,… Continue Reading

Avoid Employer Mandate Myopia

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Taxes
A dangerous notion is afoot – that an employer too small for “employer mandate” taxation under 26 U.S.C. § 4980H is therefore “exempt from Obamacare,” as we have heard it said too often.   That’s wrong for many reasons.  Every employer sponsoring a group health plan is obligated to comply with applicable coverage, cost sharing and anti-discrimination… Continue Reading

ACA Review Research

Posted in Affordable Care Act, Business Organizations, carrots, 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
Recently, we have received requests to re-post prior articles on the 90-day waiting period, the employer mandate final rules (supplemented here, here, here and here), and our pop quiz for ACA consultants.  As we approach our 100th article, some readers apparently find the scroll-down browsing process tedious.  So do we.  Here are two other ways to find… Continue Reading

Small Group Deductible Cap Repeal

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Exchanges, Grandfathered Status, Insurers and Brokers
On April Fools’ Day, HR 4302 officially became Public Law 113-93.  It was the latest in a long line of so-called “Doc fix” bills, delaying scheduled Medicare reductions of payments to physicians.   Few onlookers noticed this, inserted between provisions on ICD-10 Code set delay and a GAO child health care report mandate: SEC. 213. ELIMINATION OF… Continue Reading

ACA Advisor Pop Quiz

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Employee Leasing, Federal Contractors, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
We have been concerned for many months that some of our clients and friends are getting unreliable ACA compliance advice.  This is not a knock on insurance agents, or brokers, or TPA’s or any other class of advisors.  We work with some who are as helpful to our mutual clients as we are to them. … Continue Reading

A Two-Year ACA Coverage Mandate Delay? Not Exactly.

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Grandfathered Status, Insurers and Brokers
If you read only last Thursday’s headlines, you probably concluded that the Administration had decided not to enforce the ACA’s 2014 health care coverage mandates until after the 2016 Presidential election.  If you clicked the hyperlinks and read the actual CMS notices, you got a headache, as did your humble correspondent.  As a supplement to… Continue Reading

Grandfathered Plan Status Forfeiture: The Blind Side

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status, Insurers and Brokers, Taxes
We leave to the media what it does well for you – recent reportage of ACA-induced policy cancellations and premium increases, for example.  This blog examines ACA-related risks and opportunities that our employer, insurer and provider clients have not yet identified or understood adequately.  Here’s a problem that is just coming into focus. Since late… Continue Reading

Insurers May Renew Cancelled Plans

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status, Insurers and Brokers
In recent weeks, media have been abuzz with stories about families whose existing individual health insurance policies are being cancelled because they do not comply with the ACA.  Just moments ago, President Obama announced that health insurance companies, under certain circumstances, will be allowed to renew these plans for one more year. While the President offered few details,… Continue Reading

Notices of Policy Terminations and Substitutions

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status, Insurers and Brokers
Effective for plan years beginning after December 31, 2013, the ACA requires issuers of non-grandfathered group health coverages to renew those coverages at the option of the plan sponsors.  An issuer may refuse to renew a policy that is being withdrawn from the market, as long as ACA-compliant substitutes are offered.  If so, the issuer… Continue Reading

ACA Rulemaking Status Report

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Exchanges, Grandfathered Status, Independent Contractors, Insurers and Brokers, Taxes
Periodically, federal government agencies must disclose the status of all major rulemaking projects, forecasting the dates of expected rule publications.  The Spring 2013 version of this “Semi-annual Regulatory Agenda” was released July 23, 2013.   Here is the reported status of eleven major ACA rulemaking projects. The individual mandate final rule is expected to be published… Continue Reading

M & A and the ACA

Posted in Affordable Care Act, Business Organizations, Grandfathered Status
The Affordable Care Act’s impact on hospital mergers and acquisitions has been duly noted and seriously considered by corporate and bond counsel.  But the ACA’s application to similar transactions not involving health care providers should be getting the attention that it deserves, too.  Of particular concern are anti-abuse rules designed to stop employers from shifting… Continue Reading