News & Analysis as of

DOL Issues Proposed Updates for Summaries of Benefits and Coverage

The U.S. Department of Labor (DOL) has issued an updated template Summary of Benefits and Coverage (SBC), Glossary of Coverage and Medical Terms, and related materials. The revised materials remain in proposed form, but have...more

CMS Releases Proposed Rule and New Tactics Aimed at Strengthening Provider Enrollment Screening

On February 22, 2016, CMS announced on its blog four new enrollment tactics designed to strengthen provider enrollment screening efforts. Just three days later, on February 25, 2016, CMS released a proposed rule that would...more

Employee Benefits Developments - February 2016

IRS Issues Guidance Regarding Application of ACA Fee to Expatriate Health Plans. Section 9010 of the Affordable Care Act (ACA) imposes an annual fee on covered entities engaged in the business of providing health insurance...more

Obamacare in the Courtroom: In the Matter of Double Recovery

The Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare, was drafted to make health care and health insurance more affordable and more available to more Americans as well as to relieve some of the burden on...more

CMS Finalizes Funding Methodology for ACA Basic Health Program for 2017-2018

On February 29, 2016, CMS is publishing its final methodology for determining federal payment amounts to states that elect to establish a Basic Health Program (BHP) to offer health benefits to low-income individuals otherwise...more

Student Health Plans and ACA Compliance: New Relief for Educational Institutions

Educational institutions face unique issues when complying with the requirements of the Affordable Care Act (ACA). One such issue relates to the administration of student health insurance plans. On February 5, 2016, three...more

If You Blinked You Might Have Missed Important Affordable Care Act Guidance

Notice 2015-87 issued by the IRS on December 16, 2015, provides guidance on numerous Affordable Care Act provisions. Below are some of the highlights....more

Manatt on 1332: Massachusetts Posts State Innovation Proposal to Preserve Merged Market

Massachusetts posted a draft 1332 waiver proposal for public comment on February 2, 2016. The waiver proposes to preserve certain features of the Commonwealth's current small group market, which was merged with the individual...more

Manatt on Medicaid: 10 Trends to Watch in 2016

Medicaid continues to gain scale and importance nationally – as both the leading source of health coverage for Americans, and as a change agent within the healthcare marketplace. With the number of Americans obtaining...more

Important Development in Dave & Buster’s Lawsuit Regarding Whether Cutting Employee Work Hours Violates ERISA

In a case of first impression that is being closely watched by plaintiffs’ attorneys and large employers alike, a federal judge recently ruled against a motion brought by Dave & Buster’s, the restaurant chain, to dismiss a...more

IREG Update - Co-Op member migration: Giving "risk adjustment" a whole new meaning

Co-Op member migration: Giving "risk adjustment" a whole new meaning As the Co-Ops created under the Patient Protection and Affordable Care Act fail one after another and their members enroll in coverage with other...more

Agencies Confirm that Certain Student Health Insurance Subsidies for Student Employees May Violate the Affordable Care Act

Colleges and universities often offer to subsidize the cost of health coverage for student employees, either through the purchase of an individual health insurance policy or through a “premium reduction arrangement” designed...more

A&B Healthcare Week in Review, February 6, 2016

I. REGULATIONS, NOTICES, & GUIDANCE - On February 5, 2016, the Substance Abuse and Mental Health Administration (SAMHSA) issued a proposed rule entitled, “Confidentiality of Substance Use Disorder Patient Records.” ...more

'Right-Sizing' Full-Time Employees to Reduce ACA Obligations May Lead to ERISA Class Action Exposure

Compliance with the Affordable Care Act (ACA) has resulted in increased health benefit costs for many employers. A recent court decision demonstrates that while programs to reduce the number of full-time employees may lower...more

Issue 99: Transition Relief for Student Health Plans and Other ACA Issues Impacting Student Employees

This is the ninety-ninth issue in our health care reform series of alerts for employers on selected topics in health care reform. This series of Health Care Reform Management Alerts is designed to provide a more in-depth...more

Health Coverage Providers: Deadlines for Health Coverage Providers to Report Minimum Essential Coverage are Approaching

Who Must Report? If you are a health insurance issuer, self-insured employer, or other entity that providedminimum essential coverage (MEC) during calendar year 2015, including a state government providing Medicaid or...more

The Affordable Care Act’s Reporting Electronic Backbone—The AIR System

For the last half of 2015, we spent a good deal of time explaining the Affordable Care Act reporting requirements that applied to carriers and large employers. This post examines the how of ACA reporting. In particular, it...more

Subsidizing Student Health Insurance With Stipends – New Agency Guidance and Relief

On February 5, 2016, the Departments of the Treasury, Labor, and Health and Human Services (the Departments) issued guidance addressing the application of market reforms and other provisions of the Affordable Care Act (ACA)...more

ACA Reporting Deadlines Relaxed for 2016

Following complaints, concerns and continuing questions relating to the Affordable Care Act reporting requirements, the IRS has relaxed reporting deadlines for 2016 in the form of IRS Notice 2016-4. As you may be aware,...more

FAQs Regarding the ACA’s Employer Reporting Requirements (Part 1 of 2)

The employer reporting requirements under The Patient Protection and Affordable Care Act (the "ACA") are generally effective beginning January 1, 2015, with the applicable reports filed in early 2016. The purpose of the...more

Is This The Year Florida Recognizes Direct Primary Care?

Florida House Bill 37 and Florida Senate Bill 132, similar bills aiming to expressly authorize and regulate direct primary care medical home plans in the State of Florida (“DPCs”) and both stating that DPCs are not...more

Employee Benefits Developments - January 2016

IRS Guidance Addresses Numerous ACA Issues Related to HRAs. Just before the New Year, the IRS issued Notice 2015-87 (Notice), addressing the application of Affordable Care Act (ACA) market reform rules to different...more

Drug Costs, Risk Adjustment Drive Q2 Health Insurance Rate Increases

The Massachusetts Division of Insurance (DOI) recently held a two-day hearing on rate changes proposed by Massachusetts health insurance plans to be effective for the second quarter of 2016 (Q2). Presentations by carriers, in...more

Extension of ACA 2015 Reporting Deadlines Provides Welcome Relief for Employers

The Affordable Care Act (“ACA”) imposes various reporting requirements on insurers, self-insuring employers, and other providers of “minimum essential coverage" and imposes penalties on coverage providers that do not comply....more

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