United Benefit Advisors Insight and Analysis Blog

District Court Vacates Parts of ACA Section 1557 Nondiscrimination Rule

Posted by: Karen Hsu    Nov 21, 2019 8:29:00 AM

As background, the Patient Protection and Affordable Care Act (ACA) Section 1557 provides that individuals shall not be excluded from participation in, denied the benefits of, or be subjected to discrimination under any health program or activity which receives federal financial assistance from the Department of Health and Human Services (HHS), on the basis of race, color, national origin, sex, age, or disability. The current rule applies to any program administered by HHS or any health program or activity administered by an entity established under Title I of the ACA. These applicable entities are “covered entities” and include a broad array of providers, employers, and facilities. On May 13, 2016, the Department of Health and Human Services (HHS) issued a final rule (current rule) implementing Section 1557, which took effect on July 18, 2016.

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Topics: ACA, HHS, ACA Section 1557, compliance recap

DOL, HHS, and Treasury Release Final FAQs on Mental Health / Substance Use Disorder Parity

Posted by: Karen Hsu    Nov 14, 2019 9:30:00 AM

The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the “Departments”) released final FAQs About Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 39. The Departments respond to FAQs as part of implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Patient Protection and Affordable Care Act (ACA) and the 21st Century Cures Act (Cures Act). The FAQs contain a model disclosure form that employees can use to request information from their group health plan or individual market plan regarding treatment limitations that may affect access to mental health or substance use disorder (MH/SUD) benefits.

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Topics: ACA, HHS, DOL, mental health, compliance recap, MHPAEA

Treasury, DOL, and HHS Issue FAQs on Enforcement of Final 2020 Benefit and Parameters Rule

Posted by: Karen Hsu    Sep 6, 2019 3:52:44 PM

On August 26, 2019, the Treasury, Department of Labor (DOL), and the Department of Health and Human Services (HHS) (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 40 (FAQs) regarding enforcement of the final rule.

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Topics: HHS, DOL, compliance recap

HHS Releases Inflation-Adjusted Federal Civil Penalty Amounts

Posted by: Karen Hsu    Nov 29, 2018 2:36:55 PM

The Department of Health and Human Services (HHS) issued its Annual Civil Monetary Penalties Inflation Adjustment. Here are some of the adjustments:

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Topics: HHS, Medicare, compliance recap

Top 10 Blogs of 2014

Posted by: Bill Olson    Jan 16, 2015 1:00:00 PM

 

We’ve rounded up the most popular UBA blogs of 2014, which have garnered thousands of views.

 

10. UBA Releases 2014 Health Plan Survey Executive Summary.

Recent survey data from the 2014 United Benefit Advisors Health Plan Survey, the nation's largest health plan survey, shows that employers continue to shift a greater share of expenses to employees through out-of-pocket cost increases and reductions in family benefits, as well as delay many effects of the Patient Protection and Affordable Care Act (PPACA) by utilizing an early renewal strategy. More

 

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Topics: health plan survey, UBA, section 125 plans, PPACA Affordable Care Act, IRS, Self-Funded, HHS, EEOC, blog, Skinny Plans, out-of-pocket limits, top 10

Proposed 2016 Benefit and Payment Parameters

Posted by: Linda Rowings    Dec 23, 2014 1:00:00 PM

The Department of Health and Human Services (HHS) has issued its proposed Benefit and Payment Parameters for 2016. While these amounts and dates are not yet final, they may be of help for planning purposes. At this time, HHS expects:

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Topics: Linda Rowings, HHS, 2016, Benefit, Payment, Parameters, UBA PPACA Advisor

Can Employers Assist Employees with Premiums for Individual Plans?

Posted by: Carol Taylor    Nov 13, 2014 8:56:00 AM

On November 6, 2014, the collective Departments of Health and Human Services (HHS), Labor (DOL) and the Treasury released three Frequently Asked Questions (FAQs) directed at employer payment plans for the purchase of individual insurance. While the departments had previously released several other pieces of guidance about these arrangements, this latest round exclaimed an emphatic no!

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Topics: HHS, DOL, employers, employees, premiums, individual plans, Carol Taylor, FAQ

Reference-Based Pricing and Cost-Sharing Limits

Posted by: Linda Rowings    Nov 11, 2014 10:19:00 AM

The Department of Labor (DOL), the IRS, and the Department of Health and Human Services (HHS) have jointly issued a FAQ that addresses how "reference-based pricing" works with the Patient Protection and Affordable Care Act's (PPACA) restrictions on out-of-pocket maximums. PPACA limits the out-of-pocket maximum a non-grandfathered plan may impose, and generally requires that co-pays, coinsurance, and deductibles be counted toward this limit. However, premiums, balance billed amounts for non-network providers, and non-covered services do not need to be applied to the out-of-pocket limit. (For 2015, the limits are $6,600 per individual or $13,200 per family.) The new FAQ explains how the out-of-pocket limit applies to plans that use reference-based pricing--i.e., a design under which the plan pays a fixed amount for a particular procedure (such as a knee replacement), which certain providers have agreed to accept as full payment.

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Topics: Linda Rowings, IRS, HHS, DOL, Reference-Based, Pricing, Cost-Sharing, Limits, Department of Labor, Department of Health and Human Services

Deadline Approaching for Larger Self-Funded Health Plans To Obtain a Health Plan Identifier Number

Posted by: Linda Rowings    Oct 21, 2014 11:08:00 AM

To meet federal requirements, large health plans must obtain a national health plan identifier number (HPID) by November 5, 2014. For this requirement, a large health plan is one with more than $5 million in annual receipts. The Department of Health and Human Services (HHS) has said that since health plans do not have receipts, insured plans should look at premiums for the prior plan year and self-funded plans should look at claims paid for the prior plan year. Small health plans (those with less than $5 million in claims during the prior plan year) have until November 5, 2015, to obtain an HPID.

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Topics: Self-Funded, HPID, Deadline, HHS, Centers for Medicare and Medicaid Services, Form 5500