Category — Department of the Treasury

The Department of Health and Human Services and the Department of the Treasury issued three Notices of Proposed Rulemaking (“NPRMs”) on August 12, 2011 on eligibility and enrollment in Insurance Exchanges and the Small Business Health Options Program (“SHOP”), health insurance premium tax credits, and eligibility changes to Medicaid and the Children’s Health Insurance Program (“CHIP”).  

• The Exchange Functions in the Individual Market: Eligibility Determinations and Exchange Standards for Employers (“Exchange Eligibility and Employers”) NPRM proposes processes for individual enrollment in qualified health plans (“QHPs”) and insurance affordability programs as well as standards for employer participation in SHOP. 
   
• The Health Insurance Premium Tax Credit (“Tax Credit”) NPRM outlines proposed eligibility standards for the premium tax credits for coverage purchased through the Exchanges (available to taxpayers with household incomes between 100 percent and 400 percent of the Federal Poverty Level (“FPL”) starting in 2014) and explains how such tax credits will be calculated.  
   
• The Medicaid Program: Eligibility Changes under the Affordable Care Act of 2010 (“Medicaid Eligibility”) NPRM proposes to expand Medicaid  to most adults under  the age of 65 with incomes up to 133 percent of the FPL and consolidate eligibility categories into four groups:  children, pregnant women, parents, and a new adult group.  The NPRM would also increase the Federal Matching Assistance Percentage (“FMAP”) for newly eligible individuals and to states that expanded Medicaid coverage for adults before enactment of the Affordable Care Act. 

Together, the three NPRMs establish coordination across Medicaid, CHIP and the Exchanges and create a system in which Exchanges would conduct eligibility determinations for Medicaid and premium tax credits as well as facilitate enrollment in insurance affordability program.  Comments on all three NPRMs are due by October 31, 2011.

On March 10, the Departments of Health and Human Services and the Treasury issued a proposed regulation implementing the Patient Protection and Affordable Care Act’s (PPACA) provision that allows states to seek waivers of the law’s requirements relating to state-based insurance exchanges, tax credits, the individual and employer mandate and essential health benefits. The proposed rule asks for public input on how states can apply for an “Innovation Waiver,” as well as how the Administration will monitor and evaluate such waivers. In order to apply for a waiver, states must ensure that the coverage will be at least as comprehensive and affordable as the coverage provided under PPACA and must cover the same number of residences as would have been covered under the law. Further, the state plan cannot increase the federal deficit. Currently, the PPACA allows Innovation Waivers to be implemented in 2017. However, President Obama has supported bi-partisan legislation that would allow states to apply for waivers by 2014. Innovation Waivers are provided for up to five years, with the option of renewal.

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 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. 

On May 21, 2010, the Internal Revenue Service (IRS) released Notice 2010-45, providing detailed guidance regarding the therapeutic discovery tax credit program established by the Patient Protection and Affordable Care Act.  The program is aimed at producing new therapies, creating jobs and advancing U.S. competitiveness.  The Notice describes the procedures that companies must follow in order to apply for a credit or a grant under the program and sets forth important filing dates for the 2009-2010 allocation round. 

Under Section 9023 of the Act, Congress created a new section 48D of the Internal Revenue Code to provide a tax credit or grant to each eligible company that makes a “qualified investment” in a “qualifying therapeutic discovery project” in the amount of 50 percent of the investment, up to a cap of $10 million.  To be eligible to participate in the program, a company with no more than 250 employees must make, or have made, such an investment in a qualifying project during 2009 or 2010. 

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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.