Category — Department of Labor

The Department of Health and Human Services, the Department of Labor and the Internal Revenue Service issued a Request for Information (RFI) on December 28, 2010 on how group health plans and health insurance providers can deliver high-quality preventive care services cost-effectively under the Patient Protection and Affordable Care Act.  The agencies are interested particularly in suggestions on how welfare benefit plans can encourage use of the most beneficial preventive services and discourage use of the least beneficial services.  Public comments must be submitted before February 28, 2011.

The Departments of Health and Human Services, the Treasury and Labor (DOL) posted on the DOL website answers to new questions about the Patient Protection and Affordability Act and earlier healthcare legislation.  Previously issued answers are also available on the website.  The new  guidance addresses the design of preventive health care benefits; automatic enrollment in group health plans; notices to participants about material modifications in individual or group plans; coverage of dependent children up to age 26; pre-existing condition exclusions for children in the individual health insurance market; and grandfathered health plans.  The agencies anticipate issuing further guidance in response to stakeholder questions.

The Department of Health and Human Services (“HHS”) and the Department of Labor (“DOL”) on November 12, 2010 issued a Request for Information on operational issues associated with implementing a federal external review process for health plan claims and coverage denials.  The federal review process would apply in states whose external process does not meet minimum federal standards under the Patient Protection and Affordable Care Act as described in July 23, 2010 Interim Final Regulations issued by HHS, DOL, and the Internal Revenue Service.  Comments in response to the Request for Information are due on December 8, 2010.

The Department of Labor (DOL) posted  a factsheet on its website on September 21, 2010, clarifying its interpretation of several provisions in the Affordable Care Act relating to grandfathered health plans, coverage of dependents up to age 26, and out-of-network coverage.  DOL stated that it plans to issue final regulations relating to grandfathered plans in early 2011.

The departments of Health and Human Services (HHS), Labor and the Treasury issued interim final regulations on July 14, 2010 requiring health plans beginning on or after September 23, 2010 to cover certain recommended preventive services.  Under the new regulations, such health plans may not charge patients copayments, coinsurance or deductibles for these services when they are delivered by a network provider.  Covered preventive services include—

• evidence-based items or services with an A or B rating in the U.S. Preventive Services Task Force recommendations with respect to the individual involved
• immunizations for routine use in children, adolescents and adults with a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved
• evidence-informed preventive care and screenings for infants, children and adolescents that are included in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)
• Evidence-informed preventive care and screening for women included in the comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force). HHS expects to issue these guidelines by August 2011.

Click here for a complete list of recommendations and guidelines that are required to be covered under the new regulations.  Click here to view the new regulations.

The departments of the Treasury, Labor and Health and Human Services have released an Interim Final Rule that implements health care reform provisions that intend to provide consumer protections against certain insurance policies.  The regulation, nicknamed the ‘Patient’s Bill of Rights’, implements reforms that restrict the use of annual limits and prohibit insurers from rescinding coverage, imposing lifetime limits and excluding children due to pre-existing conditions.  The regulation also protects the right for individuals to choose their primary care doctor and removes barriers to emergency services.  

Link to the Interim Final Rule:  http://www.federalregister.gov/OFRUpload/OFRData/2010-15278_PI.pdf

The departments of the Treasury, Labor and Health and Human Services have released an Interim Final Rule clarifying under what circumstances grandfathered health plans, which are exempt from certain health care reform requirements, will lose this status and be required to comply with insurance provisions such as providing coverage for approved clinical trials.  The rule restricts grandfathered plans’ ability to increase co-pays and deductibles, reduce benefits and raise co-insurance charges as well as prohibiting these plans from adding or tightening annual limits and changing insurance companies.  Grandfathered plans will be able to make cost adjustments to keep pace with inflation and may make changes to premiums without jeopardizing their status.  Opponents of the rule argue that its strict requirements will cause a significant percentage of plans, especially in the small group market, to lose grandfathered status over the next few years.

Click here to view a fact sheet and here to view a question and answer sheet about the grandfathered health plans. 

The departments of the Treasury, Labor and Health and Human Services have released an Interim Final Rule implementing the Patient Protection and Affordable Care Act’s requirements that group health plans, health insurance issuers offering group or individual health insurance and grandfathered plans that provide coverage for a beneficiary’s dependents continue to offer coverage until the child reaches the age of 26.  The rule clarifies that staring in 2014 plans may not deny coverage of young adults even when the child is eligible to enroll in an employer-sponsored health plan.

Please click here to read more.  

The departments of Health and Human Services, Treasury and Labor have issued a solicitation for comments with regard to changes affecting medical loss ratio reporting for individual and group coverage, as a result of  Sections 1001 and 10101 of the Patient Protection and Affordable Care Act .  The legislation added provisions to the Public Health Service (PHS) Act (Section 2718), ERISA (Section 715) and the IRS Code (Section 9815). 

Written or electronic comments should be submitted by May 14, 2010.

The departments of the Treasury, Labor and Health and Human Services have issued a request for public comment on the Patient Protection and Affordable Care Act’s requirement for group health plans and health insurance issuers offering group and individual coverage to annually report the medical loss ratio (MLR) to the Secretary of HHS and remit payments to enrollees if the ratio falls below a minimum standard for a given plan year.  Comments are encouraged to address the calculation of MLR and if minimum standards established in the new law compare to existing MLRs in the individual, small group and large group markets.

Please click here to view the request.