CMS, IRS Address Affordable Care Act Issues in Transition

by Ballard Spahr LLP
Contact

Ballard Spahr LLP

The Centers for Medicare and Medicaid Services (CMS) and the IRS have each published guidance on matters arising under the Affordable Care Act (ACA). It is too early to tell whether these measures—some of the first guidance published under the ACA by the new administration—are singular acts or signals of guidance to come, as Congress and the White House consider repeal and replacement of the ACA.

Stabilizing the Marketplace: CMS proposed rules to address concerns raised by insurers participating in marketplace exchanges under the ACA. The proposed regulatory changes aim to promote more continuous coverage of individuals, particularly healthier individuals, with the intent of improving the risk pool in exchange plans and supporting competitive and stable individual and small group markets. The proposed changes include:

  • Shortening the open enrollment period for 2018 exchange plans. The period will now last from November 1, 2017, through December 15, 2017. The period had been set to last until January 31, 2018. Technically, the rule accelerates a change that was to take place the following year.
  • Limiting special enrollment opportunities or individual marketplace coverage; implementing more comprehensive pre-enrollment verification for such special enrollment applications; and allowing an insurer to apply premiums paid by a new enrollee to that enrollee's debt for a failure to pay premiums for a prior period of coverage with the same insurer (generally within the past 12 months).
  • Expanding the de minimis variation in the actuarial values of the metal plan ranges to provide more flexibility to insurers in designing new plans.

CMS also requested comments on proposals for making the network adequacy requirements less burdensome to issuers. The proposals include:

  • Granting states more authority and modifying the process for assessing a plan's network adequacy.
  • Lowering the percentage of essential community providers (ECPs), who primarily serve low-income and medically underserved populations, from the current level of 30 percent back to the 2014 level of 20 percent of the ECPs in the plan's service area.
  • Retaining the write-in process for identifying ECPs.

CMS is also exploring additional policies to promote continuous coverage requirements for enrollment during a special enrollment period, including a requirement to provide evidence of coverage extending over a longer prior period, a required waiting period before new coverage may take effect, and a late enrollment penalty.

The proposed rules do not require state-based exchanges to adopt the pre-enrollment verification requirements for special enrollment periods but encourage the states to adopt similar rules or practices to ensure market stability.

The comment period on the proposed rule is short: comments are due by 5 p.m. on March 7, 2017.

Individual Tax Return Reporting: The IRS has announced that it will not reject individual income tax returns this year because of a failure by individuals to provide information about whether they have obtained coverage under the ACA's individual mandate. The IRS had been planning to reject returns for this failure beginning with this year's filings.

This change in how the IRS processes filings does not remove the item requesting information from the individual return, relieve individuals from the assessments that may apply if they do not obtain health coverage, or alter the reporting obligations that employers, insurers, and other plan sponsors need to meet under the employer and individual mandates.

Changes are imminent for the ACA and a range of other laws and regulations affecting the health care industry.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Ballard Spahr LLP | Attorney Advertising

Written by:

Ballard Spahr LLP
Contact
more
less

Ballard Spahr LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.