News & Analysis as of

The Affordable Care Act—Countdown to Compliance for Employers, Week 15: Can a Plan That Fails to Cover Inpatient Hospitalization...

A recent Washington Post article (“Glitch in health care law allows employers to offer substandard insurance,” September 12, 2014) highlights an Affordable Care Act compliance strategy being marketed heavily (and adopted...more

Final Mental Health Parity Rules Released

The Departments of Health and Human Services, Labor, and the Treasury jointly issued a long-awaited final rule that implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008...more

Health Insurance Exchanges: The Facts Behind the Debate

Health insurance exchanges (commonly called the MarketPlace or the Exchanges) are a complex and highly debated part of the Affordable Care Act (ACA). With the looming January 1, 2014, deadline to open the marketplace for...more

CMS Medicaid Rule Greatly Restricts 2014 Mandatory Prescription Drug Coverage for “Expansion Population” - May Also Impact...

On July 15, 2013, CMS issued its Final Rule addressing prescription drug coverage for the Medicaid expansion population. Among other things, the Final Rule defines the scope of the ten applicable “essential health benefits”...more

Affordable Care Act Standards Related to Essential Health Benefits, Minimum Value, Actuarial Value and Accreditation

On February 25, 2013, the Department of Health and Human Services (HHS) released its final rule (the Final Rule) setting forth standards for health insurance issuers under the Patient Protection and Affordable Care Act (the...more

IRS, Treasury Department Issue Proposed Rules Governing Minimum Value, Affordability, and Wellness Programs

A key policy goal of the Patient Protection and Affordable Care Act (the “Act”) is the expansion of health insurance coverage to all Americans. The concepts of “minimum value” and its correlate “actuarial value” speak to the...more

ACA Affordable Insurance Exchanges and Qualified Health Plans

In This Issue: Exchanges and Types of Plans To Be Offered Through Exchanges; Essential Health Benefits; Premiums; Cost Sharing Reductions; and Other Issues. Excerpt from Exchanges and Types of Plans To Be...more

I’m An Applicable Large Employer – To Whom Must I Offer Health Coverage In Order To Avoid Pay Or Play Penalties?

Beginning in 2014, the employer shared responsibility mandate of the Patient Protection and Affordable Care Act requires applicable large employers (those employing on average at least 50 full-time equivalent employees on...more

HHS Issues Final Rules on Essential Health Benefits, Federal and Partnership Exchange Qualified Health Plan Accreditation Timeline...

Essential Health Benefits - On February 20, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule that set the accreditation standards for qualified health plans (QHPs)—plans that will be...more

Monthly Benefits Update - February 2013

The Department of Health and Human Services issued final regulations on the Affordable Care Act’s standards for essential health benefits, actuarial value, and accreditation. While these regulations primarily affect...more

Proposed And Final Rules Released Regarding The ACA's Individual Mandate

In This Issue: - Minimum Essential Coverage ..HHS Proposed Rule - Shared Responsibility Payments and Exemptions ..HHS Proposed Rule ..IRS Proposed Rule ..IRS Final Rule - Essential Health Benefits ...more

Health Care Reform Implementation Update - February 27, 2013

As Washington and the rest of the country brace for cuts from the sequester to kick in on March 1, Florida Gov. Rick Scott surprised many and confirmed others' predictions by announcing his state will expand its Medical...more

Health Care Reform Update -- February 25, 2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups Scheduled. Excerpt...more

Affordable Care Act: Preparing for 2014

President Obama’s re-election confirmed that the Affordable Care Act will continue to be rolled out, and that its “pay-or-play” rules will become effective on January 1, 2014. These provisions require public and private...more

California Weighs In on Essential Health Benefits for Group Health Plans and Insurers

As a reminder of the significant role that states will play in implementing the provisions of the Affordable Care Act (ACA), we wanted to highlight some recent legislative developments in California that will be of interest...more

Penalties and Measuring Periods for Large Employers - How to Assess Potential Liability under the Affordable Care Act

Under the Affordable Care Act (“ACA”), a large employer is subject to penalties if it fails to offer to full-time employees and their dependents health coverage or if the coverage that it offers is not affordable or does not...more

Health Care Reform Implementation Update - February 13, 2013

In the past week, the Congressional Budget Office (CBO) released an updated federal budget to account for new regulations from the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS),...more

The Affordable Care Act’s Employer Mandate and the Collectively Bargained Workforce

As 2014 rapidly approaches, employers of all sizes and all industries are working hard to avoid the Affordable Care Act’s (the “Act”) Employer Mandate, now appearing in the Internal Revenue Code, Section 4980H. For employers...more

New Guidance Addresses Individual Shared Responsibility Payments and Premium Tax Credits

The IRS and the U.S. Department of Health and Human Services (HHS) have issued two important pieces of guidance under the Patient Protection and Affordable Care Act regarding the responsibilities imposed on individuals to...more

Health Care Reform “Pay Or Play” Guidance Issued

In early January, the Internal Revenue Service published proposed regulations on “Shared Responsibility for Employers Regarding Health Coverage.” These regulations incorporate the provisions of many previous Notices with...more

Implementing the Affordable Care Act: Countdown to 2014 - Affordable Care Act

The countdown to the 2014 implementation of the Affordable Care Act (ACA) has begun. Each week, administrative decisions, guidance, rules and regulations are coming from the federal and state governments to make ACA a...more

Health Care Reform: "Employer Mandate" Guidance Issued

The U.S. Treasury Department recently released new guidance to assist employers (generally those with 50 or more full-time or full-time equivalent employees) in preparing and planning for the 2014 requirement to offer...more

Proposed Rules Implementing Affordable Care Act Rules Prohibit Discrimination by Health Insurers and Set Standards for Essential...

On November 20, 2012, the Department of Health and Human Services (HHS) issued proposed rules under the Patient Protection and Affordable Care Act of 2010, as amended (the Affordable Care Act or the Act), which beginning in...more

Corridors: News for North Carolina Hospitals - Winter 2012

In this issue: - Proposed Affordable Care Act Regulations are Designed to Encourage Participation in Wellness Programs - Proposed Rules Implementing Affordable Care Act Rules Prohibit Discrimination by Health...more

Group Health Plans: Year-End Action Items, Upcoming Changes, New Guidance

As 2012 closes, group health plan sponsors turn their attention to completing 2012 tasks, implementing upcoming 2013 changes, and preparing for the full impact of ACA in 2014. As 2012 draws to an end, employers pass...more

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