Agencies Issue More ACA FAQs

In "FAQs about Affordable Care Act Implementation (Part XXII)", the the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury indicate that:

"[T]hese FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended...On September 13, 2013, DOL and the Treasury published guidance on the application of the market reforms and other provisions of the Affordable Care Act to health reimbursement arrangements (HRAs), certain health flexible spending arrangements (health FSAs) and certain other employer health care arrangements.(1)HHS issued contemporaneous guidance to reflect that HHS concurs in the application of the laws under its jurisdiction as set forth in the DOL and Treasury Department guidance.(2) Subsequently, on May 13, 2014, two FAQs were made available on the IRS website addressing employer health care arrangements.(3)"

To read more, click here.

HHS Delays HPID Requirement for Health Plans

The Department of Health and Human Services recently announced on its website that:

"Effective October 31, 2014, the...Department of Health & Human Services (HHS)...announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F).

This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses."

To read more, click here.

HHS Issues Additional Guidance on HPID Requirements for ERISA Plans

In "Additional Guidance on HPID Requirements for Self-Insured Plans", Buck Consultants, a Xerox Company indicates that:

"Sponsors of self-insured large health plans must apply for an HPID for each controlling health plan by November 5, 2014. Guidance issued yesterday confirms that employers can obtain just one HPID for each ERISA plan."

To read more, click here.

Buck Consultants Analyzes Excepted Benefits Guidance

In "Final Regulations Address Limited-Scope Vision and Dental Benefits and EAPs," Buck Consultants, a Xerox Company indicates that:

"The Departments issued final regulations addressing limited-scope vision and dental, long-term care benefits, and EAPs as HIPAA-excepted benefits. Based on comments regarding the proposed regulations, these final regulations make minor but significant changes. The regulations provide guidance and relief for employers sponsoring these affected benefits and should be carefully reviewed for implementation in 2015. Guidance discussing “wraparound” benefits, introduced in the proposed regulations, will be issued at a future date."

To read more, click here.

ERIC members and trial members can read more here.

Agencies Post New FAQs on Cost-Sharing Limits

In "FAQs About Affordable Care Act Implementation, Part XXI", the U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury state that:

"Based on comments received, set forth below is an additional FAQ regarding the [maximum out-of-pocket] requirements. This FAQ addresses only group health plans’ and group health insurance issuers’ obligations under section 2707(b) of the PHS Act. For non-grandfathered health plans in the individual and small group markets that must provide coverage of the essential health benefit package under section 1302(a) of the Affordable Care Act, additional requirements apply."

To read more, click here.

ERIC Releases Results of Poll on Upcoming HHS Requirement for Group Health Plans

The ERISA Industry Committee (ERIC) released the results of a poll of its members regarding the requirement by the U.S. Department of Health and Human Services (HHS) that large health plans obtain health plan identifiers (HPIDs) by November 5, 2014.

“ERIC’s members are really struggling with the requirements for health plan identifiers,” said ERIC Senior Vice President for Health Policy Gretchen Young. “Regulations issued by HHS were clearly not written with self-insured group health plans in mind.”

To read more, click here.

Buck Discusses Upcoming Deadline for Health Plan Identifiers (HPID)

In "Approaching HPID Deadline Poses Conundrum for Self-funded Plans", Buck Consultants, a Xerox company, explains that:

"Under final regulations issued by HHS in September 2012, a "controlling health plan" (CHP) is required to obtain a health plan identifier to be used on all standard transactions conducted by the plan and its business associates. Large health plans must obtain their HPIDs by November 5, 2014 (small plans have an additional year to comply). All health plans must use the HPID in standard transactions by November 7, 2016.

To read more, click here.

Agencies Publish FAQs on COBRA Notice and Out-of-Pocket Limits

The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury recently published "FAQs About Affordable Care Act Implementation (Part XIX). The FAQs state:

"Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and http://www.cms.gov/cciio/resources/fact-sheets-andfaqs/ index.html), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended." 

The FAQs address "Updated Department of Labor Model Notices" and "Limitations on Cost-Sharing under the Affordable Care Act".

The FAQs are available here.

ERIC Urges HHS to Rule That Self-Funded Plans Should Not Be Subject to HIPAA Certification Requirements

The ERISA Industry Committee (ERIC) on April 3 urged the Department of Health and Human Services (HHS) to modify proposed rules that would require employer group health plans to certify compliance with standards and operating rules adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for certain electronic transactions.

ERIC's press release is available here.
For ERIC's comment letter, click here.
The proposed regulations are available here.

ERIC Offers Recommendations on Proposed Changes to Excepted Benefits Definition

In a recent press release, the ERISA Industry Committee (ERIC) states that:

"The ERISA Industry Committee (ERIC) on March 7 offered a series of recommendations to make sure that plan sponsors may continue to make their employee assistance programs available to all of their employees.

The proposed regulations issued in December 2013 by the Departments of Treasury, Labor, and Health and Human Services address concerns raised by ERIC that limited Employee Assistance Programs (EAPs) and similar benefits are considered group health plans and, thus, would have been required to comply with the market reform and minimum essential coverage (MEC) provisions under the Affordable Care Act (ACA), which would have disadvantaged many employees."

To read more, click here.
For a copy of ERIC's comment letter, click here.

HHS posts more information about HIPAA on its website

HHS posts "HIPAA Privacy Rule and Sharing Information Related to Mental Health", which provides that:

"In this guidance, we address some of the more frequently asked questions about when it is appropriate under the Privacy Rule for a health care provider to share the protected health information of a patient who is being treated for a mental health condition."


To read more, click here.

HHS Proposes Rule to Require Health Plans to Verify Compliance with Electronic Data Standards

The Department of Health and Human Services (HHS) on January 2 published in the Federal Register a proposed rule that would require a controlling health plan (CHP) to submit information and documentation demonstrating that it is compliant with certain standards and operating rules under the Health Insurance Portability and Accountability Act (HIPAA). The proposed rule would also establish penalty fees for a CHP that fails to comply with the certification of compliance requirements.

ERIC members and trial members can read more here.

ERIC Asks that Transitional Reinsurance Fee Be Implemented on Fair and Impartial Basis

The ERISA Industry Committee (ERIC) indicated in a press release that:

"The ERISA Industry Committee (ERIC) today submitted comments to the Department of Health and Human Services (HHS) urging the agency to ensure that the method for computing the transitional reinsurance fee under the Affordable Care Act (ACA) not impose unnecessary administrative burdens or costs on employers, and that the fee be applied on a fair and impartial basis."

For a copy of ERIC's comment letter, click here.
For ERIC's press release, click here.

HHS Finds OCR Did Not Meet all Requirements for Enforcing HIPAA

The Department of Health and Human Services's Office of Inspector General recently issued a report titled "The Office for Civil Rights Did Not Meet All Federal Requirements in its Oversight and Enforcement of the Health Insurance Portability and Accountability Act Security Rule". The report stated that:

"OCR met some Federal requirements for oversight and enforcement of the Security Rule. OCR made available to covered entities guidance that promoted compliance with the Security Rule and OCR established an investigation process for responding to reported violations of the Security Rule. OCR also followed Federal regulations when imposing penalties for Security Rule violators. However, OCR did not meet other Federal requirements critical to the oversight and enforcement of the Security Rule..."

To read more, click here.

Government Issues Final Mental Health Parity Rules

The government just issued the final mental health parity rules. In "Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Technical Amendment to External Review for Multi-State Plan Program", the government states:

"This document contains final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations under group health plans and group and individual health insurance coverage. This document also contains a technical amendment relating to external review with respect to the multi-state plan program administered by the Office of Personnel Management."

The Final regulation is available at www.dol.gov/ebsa/pdf/mhpaeafinalrule.pdf
FAQs about ACA Implementation Part XVII and Mental Health Parity Implementation are available at http://www.dol.gov/ebsa/faqs/faq-aca17.html
U.S. Department of Health and Human Services’ Study: Consistency of Large Employer and Group Health Plan Benefits with Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 is available at www.dol.gov/ebsa/pdf/hhswellstonedomenicimhpaealargeemployerandghpbconsistency.pdf
DOL news release is available at http://www.dol.gov/ebsa/newsroom/2013/13-2158-NAT.html

HIPAA Violation Results in $1.2 Million Settlement with HHS

The U.S. Department of Health and Human Services, Office of Civil Rights (HHS) issued a press release announcing:

"Under a settlement with the U.S. Department of Health and Human Services (HHS), Affinity Health Plan, Inc. will settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules for $1,215,780. Affinity Health Plan is a not-for-profit managed care plan serving the New York metropolitan area.

Affinity filed a breach report with the HHS Office for Civil Rights (OCR) on April 15, 2010, as required by the Health Information Technology for Economic and Clinical Health, or HITECH Act. The HITECH Breach Notification Rule requires HIPAA-covered entities to notify HHS of a breach of unsecured protected health information. Affinity indicated that it was informed by a representative of CBS Evening News that, as part of an investigatory report, CBS had purchased a photocopier previously leased by Affinity. CBS informed Affinity that the copier that Affinity had used contained confidential medical information on the hard drive."

The full press release is available here.

HHS Launches New Website to Begin Education Effort for Enrolling in Exchanges

The Department of Health and Human Services recently launched a new version of HealthCare.gov to begin the PR process of educating Americans and raise awareness about the exchanges under the Affordable Care Act that are supposed to be open for enrollment beginning October 1. HHS also opened a call center for people with questions about their insurance coverage options under the ACA.

The website, HealthCare.gov, is available here.

The Wellness Regulations are Finally Here!

The Departments of Health and Human Services (HHS), Labor, and Treasury issued the final regulation under the Affordable Care Act (ACA) to implement the Act’s increase in permissible wellness program rewards from 20% to 30% (and to 50% for smoking cessation programs).

Based on reading the regulation and conversations with several government officials, it appears that the new version is a considerable improvement from last Thanksgiving’s proposed regulation. In particular, it would appear that the rules have been considerably tightened with respect to when alternative pathways to obtain a reward must be provided and when the “medical appropriateness standard” comes into play.

ERIC members and guests can read more here.

The final regulations are available here.

Workplace Wellness Programs Study: Final Report is available here.

HHS cover letter is available here.

News release is available here.

Wellness, wellness, wellness!!!

Wellness programs have been gaining a lot of attention. The Equal Employment Opportunity Commission (EEOC) recently held a hearing to explore wellness programs in greater detail. The speakers included Amy Moore on behalf of the ERISA Industry Committee (ERIC). The EEOC has posted a video of the hearing as well as materials on their website. EEOC Commissioners also issued statements about the need for the EEOC to issue guidance in this area. ERIC members can read a more in-depth analysis of the hearing here.

Wellness has also been the focus of several different studies. One of these studies found that 82% of companies offer some form of incentives and/or disincentives in their wellness programs. Companies indicated that 98% of the feedback they received from employees was “somewhat positive” to “very positive.” Another study found a 9% increase in the number of companies offering wellness programs since 2009.

A recent article in the American Journal of Preventive Medicine also focused on wellness programs. It reviews Johnson & Johnson’s wellness program, and the increasing role of wellness programs in improving employee health and morale, while also reducing health care costs.

Additionally, the Internal Revenue Service (IRS), U.S. Department of Labor, and U.S. Department of Health and Human Services are expected to finalize their proposed regulations on wellness very soon.

ERIC members and guests can learn more about the latest news on wellness on the FocusOn Conference Call: Wellness – the New and Continuing Challenges on May 21st at 2 pm – 3 pm ET. ERIC members and trial members can sign up here. If your company is not yet an ERIC member and you would like to request to attend the call, please contact Adreanne Cooper at acooper@eric.org.

For more information:

• EEOC Hearing Materials
• In-Depth Analysis of Hearing (ERIC Members only)
• ERIC Testimony at EEOC Hearing
• American Journal of Preventive Medicine Article
• Wellness Study - For Many Employers, Employee Wellness is No Longer Merely an Option
• Wellness Study - New Employer Survey Finds Growing Use of Outcomes-Based Incentives, Majority Using Either Carrot or Stick to Motivate Healthy Employee Behaviors
• FocusOn Conference Call: Wellness – the New and Continuing Challenges