Comprehensive health care reform (PPACA) was enacted with the passage of two new laws: the Patient Protection and Affordable Care Act (HR 3590), signed into law on March 23, 2010 and the Health and Education Affordability Reconciliation Act of 2010 (HR 4872), signed on March 30, 2010.
Government Agency Web Sites
Health Care Accounts and Over-the-Counter Drugs
The IRS has released guidance revising the definition of medical expenses, specifically for over-the-counter drugs, for employer-provided accident and health plans, including health flexible spending arrangements (health FSAs), health reimbursement arrangements (HRAs), Health Savings Accounts (HSAs) and Archer Medical Savings Accounts (Archer MSAs).
Health Insurance Exchanges
On July 29, 2010, HHS announced the availability of grants to help states begin work to establish health insurance exchanges. HHS also is requesting public input on developing standard for the exchanges.
Internal Claims and Appeals and External Review Processes
The OCIIO has released additional guidance on the external review process required by PPACA.
On August 23, 2010, the EBSA, IRS and OCIIO released additional guidance and model forms related to the rules on claims, appeals and external reviews for nongrandfathered health plans.
On July 22, 2010, the EBSA, IRS and OCIIO released interim final regulations implementing rules on internal claims and appeals and external review processes for new (nongrandfathered) health plans.
Group Health Plan Coverage of Preventive Services
On July 14, 2010, the EBSA, IRS and OCIIO released interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services. These rules spell out the requirements for health plans to cover preventive services without employee/participant cost sharing. These rules do not apply to grandfathered plans. The regulations are expected to be published in the July 19, 2010 edition of the Federal Register. These interim final regulations will be effective 60 days after publication in the Federal Register and public comments will be accepted until the effective date.
Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections
The OCIIO has released guidance on obtaining a waiver of the restricted annual limits required by the health care reform law. The regulations on annual limits provided that these restrictions may be waived by the Secretary of Health and Human Services if compliance with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums. This guidance is especially relevant to limited benefit/mini-med plans.
The EBSA, IRS and OCIIO have released interim final rules to implement the health care reform provisions related to preexisting condition exclusions, lifetime and annual limits, rescissions, and patient protections. These regulations are effective on August 27, 2010. Public comments on the regulations will be accepted until August 27, 2010 as well.
Grandfathered Plans
The HHS, EBSA and IRS have released interim final regulations that outline what is required to maintain grandfathered health plan status under the Patient Protection and Affordable Care Act. Public comments on the regulations will be accepted until August 16, 2010.
Coverage for Adult Children Up to Age 26 and Tax Benefits Up to Age 27
The EBSA, IRS and HHS have released regulations and explanatory aids on the health care reform provisions for coverage of adult children up to age 26.
The recently enacted Affordable Care Act allows health coverage provided for an employee's children under 27 years of age to be generally tax-free to the employee, effective March 30, 2010. The Internal Revenue Service (IRS) has announced that these changes immediately allow employers with cafeteria plans to permit employees to begin making pre-tax contributions to pay for this expanded benefit.
Assistant Secretary of Labor Phyllis C. Borzi issued a statement calling on employers and benefit plans to make young adult coverage available immediately. 5/11/10
HHS Secretary Kathleen Sebelius sent a letter to health insurance companies asking them to voluntarily begin offering health coverage to adult children up to age 26 before the September effective date required by the new health reform law. Several companies have agreed to this request. Giving Young Adults More Peace of Mind, 4/20/10
Reinsurance Program for Early Retirees
HHS has identified the first round of applicants accepted into the Early Retiree Reinsurance Program. Nearly 2,000 employers, representing large and small businesses, state and local governments, educational institutions, non-profits, and unions have been accepted into the program and will begin to receive reimbursements for employee claims this fall.
Also, the HHS has announced the creation of a new Web site that brings together all the relevant information on the Early Retiree Reinsurance Program.
The HHS Office of Consumer Information and Insurance Oversight (OCIIO), announced that applications will be accepted starting June 29, 2010. Also, the OCIIO has posted the official version of the application and its instructions.
HHS published an interim final rule with comment period that implements the Early Retiree Reinsurance Program. Congress appropriated funding of $5 billion for the temporary program. The program is scheduled to begin in June 2010 and ends no later than January 1, 2014. It provides reimbursement to participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses and dependents. 5/4/10
Tax Reporting (Forms W-2, 1099, etc.)
Form 1099 Information Reporting Requirements as Modified by the Patient Protection and Affordable Care Act, Congressional Research Service, 8/6/10
The IRS confirms that the requirement to report the value of health benefits on Form W-2 does NOT mean that health benefits will be taxable.
Health Care Reform Insurance Web Portal Requirements
The HHS unveiled its on-line tool, HealthCare.gov, to help consumers connect to new information and resources that will help them access affordable health care coverage. 7/1/10
The HHS has released interim final rules with a public comment period on the requirement for the establishment of an internet website/web portal through which individuals and small businesses can obtain information about the insurance coverage options that may be available to them in their state. These regulations are effective on May 10, 2010. 5/3/10
Small Business Tax Credits
The IRS released a draft version of the form that small businesses and tax-exempt organizations will use to calculate the small business health care tax credit when they file income tax returns next year. The IRS also announced how eligible tax-exempt organizations -- which do not generally file income tax returns -- will claim the credit during the 2011 filing season.
The IRS issued Notice 2010-44 that provides detailed guidance, including more than a dozen examples, to help small employers determine whether they qualify for the credit and estimate the amount of the credit. The notice also requests public comment on issues that should be addressed in future guidance. (Press Release 5/17/10)
The IRS issued Revenue Ruling 2010-13 providing the average premiums in each state for the small group market for determining the small employer health insurance credit. 5/4/10
The IRS has created a video explaining the small business health care tax credit. 4/23/10
The Internal Revenue Service (IRS) is mailing postcards to more than four million small businesses and tax-exempt organizations to make them aware of the benefits of the recently enacted small business health care tax credit. 4/19/20
The IRS has issued a press release announcing available guidance on the new tax credits available to small businesses and tax-exempt organizations that provide health insurance coverage to their employees. 4/1/10
Insurance Premium Rate Review
HHS issued a news release on the grant awards of $46 million to states to promote improvements in the oversight of health insurance premium increases and take action against insurers who raise premiums unreasonably. 8/16/10 (New)
HHS announced in a news release the availability of $51 million in Health Insurance Premium Review Grants through the Affordable Care Act. These funds are the first round of grants available to states through a new grant program to create and strengthen insurance rate review processes. 6/7/10
Wellness, Prevention and Health Promotion Initiatives
The HHS issued a press release outlining prevention and health promotion initiatives that will be implemented due to the Affordable Care Act. 6/22/10
Temporary High Risk Pool/ Preexisting Condition Insurance Plan
HHS has released an interim final rule detailing features of the Pre-existing Condition Insurance Plan (PCIP). Issues addressed in the regulations include premiums charged, eligibility, program funding and benefits provided. The program is temporary and will last until 2014 when discriminating against anyone with a preexisting condition will be illegal. These rules take effect on July 30, 2010. Public comments are welcome through September 28, 2010.
Breaks for Nursing Mothers
The PPACA created a requirement mandating breaks for nursing mothers. The Wage and Hour Division of the Department of Labor has released a Fact Sheet on break time for nursing mothers under the Fair Labor Standards Act incorporating the new PPACA requirement. 7/15/10
COBRA and Health Reform
The EBSA has created an FAQ web page to address questions concerning the effect of the health reform laws on COBRA. 4/16/10
Congressional Hearings
The House Energy & Commerce Committee's Subcommittee on Oversight and Investigations cancelled a hearing scheduled for April 21, 2010, regarding claims by Caterpillar, Verizon, and Deere and other large employers that provisions in the new health care reform law could adversely affect their company's ability to provide health insurance to their employees. 4/14/10
Text of Legislation
Summaries of the Legislation
- Health Care: Constitutional Rights and Legislative Powers, Congressional Research Service (CRS), 5/18/10
- Summary of Potential Employer Penalties Under the Patient Protection and Affordable Care Act (PPACA), CRS, 5/14/10
- Private Health Insurance Provisions in the Patient Protection and Affordable Care Act, CRS, 5/14/10
- Regulations Pursuant to the Patient Protection and Affordable Care Act (P.L. 111-148), CRS, 4/13/10
- Section-by-Section Analysis
- Key Changes to the Senate Bill
- Key Provisions That Take Effect Immediately
- Technical Explanation Of The Revenue Provisions Of The “Reconciliation Act Of 2010,” As Amended, In Combination With The “Patient Protection And Affordable Care Act”, Joint Committee on Taxation, 3/21/10
Cost and Revenue Estimates of the Legislation
- Analysis of a Proposal to Offer a Public Plan Through the New Health Insurance Exchanges, Congressional Budget Office, 7/22/10
- Additional Information on the Potential Discretionary Costs of Implementing the Patient Protection and Affordable Care Act (PPACA) Letter, Congressional Budget Office, 5/11/10
- Payments of Penalties for Being UninsuredUnder the Patient Protection and Affordable Care Act, Congressional Budget Office, 4/22/10
- Estimated Financial Effects of the "Patient Protection and Affordable Care Act," as Amended, CMS Office of the Actuary, 4/22/10
- Estimated Effects of the “Patient Protection and Affordable Care Act,” as Amended, on the Year of Exhaustion for the Part A Trust Fund, Part B Premiums, and Part A and Part B Coinsurance Amounts, CMS Office of the Actuary, 4/22/10
- Estimated Revenue Effects of the Amendment in the Nature of a Substitute To H.R. 4872, the "Reconciliation Act Of 2010," As Amended, In Combination With the Revenue Effects of H.R. 3590, the "Patient Protection and Affordable Care Act ('PPACA')," As Passed by the Senate, and Scheduled for Consideration by the House Committee on Rules on March 20, 2010, Joint Committee on Taxation, 3/20/10
- H.R. 4872, Reconciliation Act of 2010, Cost estimate for the amendment in the nature of a substitute for H.R. 4872, incorporating a proposed manager's amendment made public on March 20, 2010, 3/20/10
- H.R. 4872, Reconciliation Act of 2010, Estimate of direct spending and revenue effects for the amendment in the nature of a substitute released on March 18, 2010, Congressional Budget Office, 3/18/10
- Updated Cost Estimate for H.R. 3590, Patient Protection and Affordable Care Act, as passed by the Senate on December 24, 2009, Congressional Budget Office, 3/11/10
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