BCRA, AHCA and ACA

If you’re looking for help keeping up with the two bills in Congress about healthcare reform, we can help.

We’ve compiled a chart highlighting certain differences and similarities among provisions contained in the Better Care Reconciliation Act, a bill introduced on June 22, 2017, in the Senate; the American Health Care Act, a bill passed by the House of Representatives on May 4, 2017; and the Affordable Care Act.

Follow this link (revised on July 20, 2017) to review the chart or to print it out and keep it for your reference.

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The Mental Health Parity and Addiction Equity Act

The U.S. Departments of Labor, Health and Human Services and the Treasury have answered a question about the implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, as amended by the Affordable Care Act (ACA) and the 21st Century Cures Act (Cures Act).

Q: Does MHPAEA apply to any benefits a plan or issuer may offer for treatment of an eating disorder?

A: Yes. Eating disorders are mental health conditions, and, therefore, treatment of an eating disorder is a “mental health benefit” within the meaning of that term as defined by MHPAEA.

Comments about eating disorders may be sent to e-ohpsca-mhpaea-eatingdisorders@dol.gov by Sept. 13, 2017.

As required by the Cures Act, the departments also indicated they are soliciting comments about:

  • Questions on non-quantitative treatment limitation model forms and steps to improve disclosures, as well as ways to improve state market conduct examinations and/or federal oversight of compliance by plans and issuers. Comments on these disclosure issues and model forms may be sent to e-ohpsca-mhpaea-disclosure@dol.gov by Sept. 13, 2017.
  • A draft model form that participants, enrollees or their authorized representatives could – but would not be required to – use to request information from their health plan or issuer regarding non-quantitative treatment limitations that may affect their mental health and substance abuse disorder benefits or to obtain documentation after an adverse benefit determination to support an appeal. Follow this link for a copy of the draft model form.

For the complete answer to the question about MHPAEA and for more information about the comments being solicited, read “FAQS about Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 38,” which was released on June 16, 2017.

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Statins Recommended for Certain Adults

Non-grandfathered plans are required to provide 100 percent coverage for some statins for individuals who meet certain criteria, beginning Nov. 15, 2017.

Last year, the U.S. Preventive Services Task Force (USPSTF) recommended that adults without a history of cardiovascular disease (such as coronary artery disease or stroke) use a low- to moderate-dose statin to prevent heart disease and mortality when the following criteria are met:
1) the adult is age 40 to 75 years;
2) has one or more cardiovascular risk factors (such as high cholesterol, diabetes, high blood pressure or smoking); and
3) has a calculated 10-year risk of a cardiovascular event of 10% or greater.

A non-grandfathered plan is required to provide 100 percent coverage for an in-network preventive service beginning with the plan year that begins one year after the date the USPSTF recommendation was issued. USPSTF issued the statin recommendation on Nov. 15, 2016.

For more information on preventive health, follow this link.

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Employers to Receive PCORI Fee Mailing

By the end of next week, Starmark® clients with a self-funded health benefit plan design that are required to pay the Patient-Centered Outcomes Research Institute (PCORI) fee will receive a letter via mail providing their group’s “average covered lives” during the plan year ending in 2016 (using the Snapshot Count method).

As a courtesy, the Broker of Record will receive a duplicate copy of the letter sent to their group(s). The letter will also be posted to the Document Center on the Starmark website for the employer, the Broker of Record and the broker’s managing general agent to view.

The Affordable Care Act and associated regulations require health insurance issuers and plan sponsors of self-funded group health plans to file and pay an annual PCORI fee.

Plan sponsors of self-funded health plan years ending in 2016, are required to pay the fee to the IRS and file Form 720 by July 31, 2017.

Click here to view a sample letter.

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April 2017 Edition of SBC Template and Supporting Documents

Health plans and issuers that maintain an annual open enrollment period will be required to use the April 2017 edition of the SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017, for plan years beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, this SBC template and associated documents are required beginning on the first day of the first plan year that begins on or after April 1, 2017.

View this flyer for more information.

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Feds Answer Questions on Special Enrollment, Women’s Preventive Health

Federal departments have answered common questions about special enrollment for group health plans and coverage of women’s preventive health services. A summary of their responses is below.

Special enrollment for group health plans

Q1: If an individual who enrolled in individual market health insurance coverage, including coverage purchased through a Marketplace, loses eligibility for that coverage, is the individual entitled to a special enrollment period in an employer-sponsored group health plan for which the individual is otherwise eligible and had previously declined to enroll?

A: Yes

Coverage of Preventive Services under the ACA

Q2: The Health Resources and Services Administration (HRSA) updated its Women’s Preventive Services Guidelines on Dec. 20, 2016. When must non-grandfathered group health plans and health insurance issuers begin offering coverage for preventive services without cost sharing based on the updated guidelines?

A: Women’s preventive services are required to be covered without cost sharing in accordance with the updated guidelines for plan years (or, in the individual market, policy years) beginning on or after Dec. 20, 2017. Until the new guidelines become applicable, non-grandfathered group health plans and health insurance issuers are required to provide coverage without cost sharing consistent with the previous HRSA guidelines and the Public Health Service Act section 2713 for any items or services that continue to be recommended.

Based on recommendations developed by the Women’s Preventive Services Initiative, the updated guidelines complement and build upon recommendations from organizations such as the U.S. Preventive Services Task Force. To view the new guidelines, follow this link.

The questions and complete answers are contained in “FAQs about Affordable Care Act Implementation Part 35,” which was released on Dec. 20, 2016, by the U.S. Departments of Labor, Health and Human Services and the Treasury. Follow this link for the complete document.

 

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IRS Stops Rejecting Individual Tax Returns ‘Silent’ on Coverage

As a result of reviewing the Jan. 20, 2017, executive order from President Trump, the Internal Revenue Service is no longer rejecting individual taxpayers’ tax returns that do not indicate, or are “silent,” on whether they complied with the Affordable Care Act’s individual mandate, according to the IRS website.

The individual mandate requires Americans to carry health insurance, qualify for an exemption or pay a penalty. Federal regulations required them to indicate on their tax returns whether they have health coverage. However, the executive order directed federal agencies to exercise authority and discretion to reduce potential burdens to taxpayers.

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