News & Analysis as of

CMS Now Requiring Qualified Health Plans To Accept Premium Payments From Certain Third Parties

As previously reported on November 13, 2013 and February 20, 2014, the Centers for Medicare and Medicaid Services ("CMS") has attempted to provide guidance as to when it is appropriate for issuers of "qualified health plans"...more

The Elevator Speech Overview

The House and Senate were both on recess this week. On Tuesday, the U.S. suspended the operations of Syria’s U.S. embassy and consulates as the Syrian civil war enters its fourth year. Also Tuesday, details of an NSA...more

Affordable Care Act Redux

Another delay in implementation of the Affordable Care Act (“ACA” or “Obamacare”) has prompted PK Law to update our material on the Act. Here are some points to bear in mind as March 31 approaches...more

Imputed Income and Health Insurance in Divorce Settlements, Part 2

With most Massachusetts health insurance plans, provided he/she has not yet remarried, an employee with at least one dependent child can add a former spouse to the coverage for no additional cost, so there is no additional...more

Feds’ Argument in Favor of Premium Tax Credit Gains Momentum, Still Under Attack in Federal Courts

A second federal district court judge has ruled in favor of the government on one of the most serious challenges to the Patient Protection and Affordable Care Act of 2010 (ACA). The court dismissed a challenge to the...more

District Court Upholds Validity of IRS Rule Authorizing Premium Tax Credits to Individuals Who Enroll in Health-Care Coverage...

A district court in the District of Columbia recently held that the Internal Revenue Service’s (“IRS”) rule authorizing premium tax credits to individuals who enroll in health-care coverage through federal exchanges was...more

Recent Guidance on Wellness Programs Clarifies Premium Surcharges for Tobacco Use

As previously reported, the federal agencies responsible for drafting the rules implementing the Affordable Care Act (ACA) (the U.S. Labor Department, the U.S. Department of Health and Human Services and the U.S. Treasury...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 50: Wellness Programs, Affordability, and Premium Tax Credits

The Affordable Care Act imposes a series of interrelated requirements on individuals, employers and providers. Individuals must maintain coverage or face the prospect of a tax penalty; carriers must offer and renew coverage....more

Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law

Royal Oakes was quoted in a Jan. 5th, 2014, Business Insurance article, Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law, by discussing a pair of lawsuits aimed at limiting availability of premium...more

Health Care Reform Implementation Update - December 19, 2013

The deadline to enroll in coverage for January 1 was officially extended by a week, but the new December 23 deadline is fast approaching, and premium payments are required to be paid by the last day of 2013 for January 2014...more

Connecticut Law Requires Employers to Adopt Cafeteria Plans

In 2007 Connecticut adopted a law requiring employers to adopt cafeteria plans if their employees are required to pay a portion of the health insurance premium for employer-sponsored health insurance through payroll...more

Health Insurance Premium Regulation Bid Draws Criticism

Barger & Wolen partners Richard De La Mora and Richard Hopkins were both quoted in a Nov. 14, 2013, Daily Journal article, Hospital insurance premium regulations bid draws criticism, about a proposed ballot initiative...more

May Providers Pay Health Insurance Premiums for HealthCare.gov Plan Enrollees?

Following last week's declaration that Qualified Health Plans (QHPs) on HealthCare.gov are not "Federal health care programs," and thus are not subject to the federal Anti-Kickback Statute, CMS released additional guidance...more

Dodging the AKS: Marketplace Plans Are Not "Federal Health Care Programs"

In an October 30th letter addressed to Congressman Jim McDermott, the Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, left little to interpretation: Qualified health plans (QHPs) purchased through...more

CMS Attributes Significant Out-of-Pocket Savings for Medicare Beneficiaries to Health Care Reform Efforts

On October 28, 2013, CMS announced that Medicare beneficiaries are realizing significant out-of-pocket savings as a result of health care reform efforts. The savings are based on cumulative savings in the prescription drug...more

Important Changes Relating to Section 125 Plans May Require Immediate Action

Last week, there were two important developments relating to Section 125 cafeteria plans. First, Massachusetts announced that employers will no longer be required to maintain a Section 125 plan. Second, the IRS has modified...more

Health Reform + Related Health Policy News - October 2013 - Issue 3

In This Issue: - Top News ..Deal to Raise Debt Ceiling, End Shutdown Yields No Major Changes to Health Care Law ..Problems with HealthCare.gov Website Continue; HHS Working to Fix Issues ..Kaiser Study...more

California Insurance Laws Enacted in 2013

October 13, 2013 was the deadline for Governor Jerry Brown to act on bills passed by the California Legislature this year. Here are summaries of noteworthy insurance-related bills which Governor Brown signed into law. Unless...more

More About HRAs And Some About EAPs

I blogged recently about IRS and Department of Labor (DOL) guidance restricting the ability of employers to subsidize individual health insurance premiums for their employees after December 31, 2013. That IRS and DOL guidance...more

No More Pre-Tax Premiums For Individual Insurance Policies?

Over the years we have seen some employers, particularly small employers, choose to provide health coverage to their employees by paying all or part of the premium for individual insurance policies that the employees have...more

Solution To The “Obamacare” Fiasco?

One of the main complaints about the Affordable Care Act, or Obamacare is it is bad for business. The cost of requiring health insurance is just too high, and will lead to businesses either 1) shutting down or 2) never...more

Don't Cry for Me Argentina! Beating the High Cost of Obamacare - Finding a Solution Path for Small Business Owners

Overview - The combination of the federal government shutdown along with the roll out of Obamacare is a once in a lifetime event - sort of like a Lunar Eclipse or Haley's Comet. Or is it is more like the time that you...more

Insights on Arkansas’s “Private Option” Medicaid Expansion

On September 27, 2013, the Centers for Medicare and Medicaid Services (CMS) approved Arkansas’s waiver to implement the Affordable Care Act (ACA) Medicaid expansion by using premium assistance to purchase QHPs in the Health...more

Agencies Release Guidance on HRAs, FSAs, and Employer Payment Plans

On Friday, September 13, 2013, the IRS released Notice 2013-54 and the DOL issued Technical Release 2013-03 in substantially identical form. This guidance, which is generally effective January 1, 2014, provides much needed...more

Healthcare Law -- Sep 26, 2013

Engaging Consumers to Improve Integrated Care Models - Integrated care is a growing trend in health reform, as states seek to improve care quality, health outcomes and patient satisfaction while containing healthcare...more

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