Affordable Care Act Review

Affordable Care Act Review

Category Archives: Uncategorized

Subscribe to Uncategorized RSS Feed

CMS’ New Initiative Intended to Transform Primary Health Care

Posted in Uncategorized
CMS’ efforts to improve the delivery of primary health care moved into new territory this week when the agency announced a new five-year delivery model, Comprehensive Primary Care Plus (CPC+), which CMS’ chief medical officer described as “the future of health care.” CMC+ will launch in January 2017, and evolves from the Comprehensive Primary Care… 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 Menu Labeling Requirements: Draft FDA Guidance

Posted in Affordable Care Act, Business Organizations, Uncategorized
The FDA’s 105-page final rule on chain restaurant nutrition labeling of menu items now has an associated, 53-page, draft guidance document, supplementing the FDA’s 132-page Food Labeling Guide, we learned from the September 16 Federal Register. And you thought the ACA was only for hospitals, doctors and insurers. Silly you. Need a drink? Here are… Continue Reading

SBC FAQ

Posted in Affordable Care Act, Uncategorized
Yesterday, the Departments of Labor, Health & Human Services, and the Treasury (collectively, the “Departments”) issued a new FAQ. As with prior FAQ’s, this FAQ is intended to answer a question in order to help people understand the Affordable Care Act and its implementation. The question this FAQ addresses is in regard to the proposed… Continue Reading

Deadline Extended For Reinsurance Enrollment Information

Posted in Uncategorized
The Affordable Care Act, among other things, established a reinsurance program, which is a three-year transitional program designed to stabilize premiums in the individual market. Because insurers can no longer charge a higher premium for individuals with a potentially costly pre-existing condition, this reinsurance program was created to lessen the impact of adverse selection in… Continue Reading

CMS Extends Deadline For Annual Reinsurance Enrollment

Posted in Uncategorized
The Affordable Care Act, among other things, established a reinsurance program, which is a three-year transitional program designed to stabilize premiums in the individual market. Because insurers can no longer charge a higher premium for individuals with a potentially costly pre-existing condition, this reinsurance program was created to lessen the impact of adverse selection in… Continue Reading

Supreme Court to Hear Case ACA Subsidies

Posted in Uncategorized
As a follow up to our Blog dated 10/21/14 (blog), earlier today, the U.S. Supreme Court agreed to consider a challenge to the premium tax credits (subsidies) that are a key component of the ACA.  King v. Burwell challenges whether the tax credits apply only to consumer marketplaces established by a state or if they… Continue Reading

Draft Instructions for ACA Forms Released

Posted in Affordable Care Act, Uncategorized
A few months ago, the Internal Revenue Service released draft versions of Forms 1094-B, 1095-B, 1094-C and 1095-C (Click here for our prior post).  The final versions of these forms are expected later this year.  Pursuant to Code Section 6055, health insurance issuers, plan sponsors of self-insured health plans, government agencies that administer government-sponsored health insurance… 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

New FAQ Clarifies Policies Covering Same-Sex Spouses

Posted in Affordable Care Act, Exchanges, Uncategorized
The ACA generally requires issuers of non-grandfathered health insurance coverage offered in the group and individual markets to guarantee availability of coverage. The final regulations related to this requirement equate discrimination in marketing practices or benefit designs with a violation of the guaranteed availability requirement. Specifically, 45 CFR § 147.104(e) states that: (e) Marketing. A health… Continue Reading

On-Site Health Clinic Considerations

Posted in Uncategorized
Due to rising health care costs, employers are seeking ways to offset these costs.  One of the many things employers are considering is on-site health clinics.  While on-site health clinics are often viewed as a way to supplement an employer’s current health plan for employees, there are many issues that must be considered when deciding… Continue Reading

OIG’s 2014 Work Plan: A Provider “Must-Read”

Posted in Affordable Care Act, Providers - For Profit, Providers - Not-for-Profit, Uncategorized
On January 31, 2014, the Office of Inspector General (“OIG”) for the Department of Health and Human Services released its Work Plan for Fiscal Year 2014. The Work Plan sets forth OIG’s audit and enforcement priorities for the coming year and, as such, is a must read for health care providers.  The success of OIG’s… Continue Reading

ACA Individual Penalties: Many Will Pay More Than $95

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Independent Contractors, Uncategorized
With January 1, 2014 getting closer every day, and the federal Marketplace still not working, people are faced with big decisions about their health care for 2014.  We want to help.  We thought it would be a good time to explain exactly how the individual penalty works. How to Calculate the Penalty It’s really hard… Continue Reading

Exchange Pricing: Go Straight to the Source

Posted in Affordable Care Act, Exchanges, Insurers and Brokers, Uncategorized
We have little to add to the widespread, mostly accurate descriptions of the dysfunction, to date, of www.healthcare.gov as a health plan purchase portal.  Three weeks in, the biggest observable change has been the addition of new buttons to this welcome screen, allowing visitors to call or click to obtain quick, ballpark price “estimates” for… Continue Reading

A First Morning Misfire for the Federally Facilitated Exchange

Posted in Affordable Care Act, Exchanges, Uncategorized
Before dawn October 1, twelve Balch ACA Strategists and colleagues started trying to create accounts on the Federally Facilitated Exchange serving Alabama, Florida, Georgia and Mississippi, so that we could view our QHP options, compare them to existing employer-sponsored insurance, and report our observations here, in the standard, summary format shown below.  The system failed.  The required security question drop down menus… Continue Reading

Let’s Wait for the Fine Print about ACA Enforcement Delay

Posted in Coverage Mandates, Taxes, Uncategorized
At 6:00 pm EDT on July 2, 2013, Presidential Advisor Valerie Jarrett published a blog post* pre-announcing two things about the Affordable Care Act:  (1) “the reporting called for under the law about each worker’s access to and enrollment in health insurance [is suspended] for 2014,” and (2) “employer responsibility payments . . . won’t… Continue Reading

FFE and Subsidies Unavailable In 44% of Mississippi Counties

Posted in Uncategorized
It’s old news that only two insurers signed-up to sell health insurance policies through the Federally Facilitated Exchange serving Mississippi. It was widely rumored at the time that neither had a truly statewide provider network.  Media reports in late June added clarifying details.  Magnolia Health Plan will offer policies to residents of 46 Mississippi counties. … Continue Reading