A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) on October 26, 2018, would revise the way the agency validates the risk adjustment data and collects repayments from Medicare Advantage (MA) organizations. With the new methodology, CMS is expecting to return $4.5 billion in savings to the Medicare Trust Fund over 10 years, according to an October 26 CMS news release. Continue Reading CMS Issues Proposed Rule Addressing Payment Error in Medicare Advantage, Expects to Recover $4.5 Billion Over 10 Years

Anticipating open enrollment season for coverage in 2019, the Centers for Medicare and Medicaid Services (CMS) released coverage and premium information that will factor into consumer decisions about Medicare and individual commercial plans offered through exchanges. Enrollment and premium trends also inform regulatory and broader policy decisions at both federal and state levels. Continue Reading Open Enrollment Update: CMS Releases Benefit and Market Data

A federal court decision to vacate regulations concerning “overpayments” to Medicare Advantage plans has left open questions about the way the government pays the insurers and pending cases brought by the U.S. Department of Justice. Continue Reading Court Decision on Overpayment Rule Leaves Uncertain Future for Medicare Payment Methodology and Pending Justice Department Lawsuits

This is the third article in our series on Association Health Plans (AHP). This week’s discussion focuses on the mixed reaction to the recent Department of Labor (DOL) AHP.

In the health benefits market, some state-based associations, such as Wisconsin’s largest business association, have announced their intent to create an AHP. On the other hand, the National Federation of Independent Business (NFIB), a long-time advocate of AHPs, is declining to establish an AHP because the rule falls short of what the NFIB felt was needed to establish an AHP, according to reports.   Continue Reading Association Health Plans Are Drawing A Lot of Attention, Including Some Pushback

This is the second article in our series on Association Health Plans (AHP). This week’s discussion focuses on the potential impact of the Department of Labor’s (DOL) decision to relax some AHP requirements.

The U.S. Department of Labor (DOL) recently expanded the ability of small groups and the self-employed to obtain health coverage through AHPs. A final rule published June 21 eases certain AHP requirements and restrictions. Continue Reading DOL Rule Relaxes Some AHP Requirements, Points to Other Protections

A new federal rule gives small employers and the self-employed an additional avenue for obtaining group health coverage.

The final rule, released by the U.S. Department of Labor (DOL) June 19 and published June 21, broadens the definition of “employer” for purposes of determining who can establish multiple employer group health plans under section 3(5) of the Employee Retirement Income Security Act of 1974 (ERISA). Continue Reading New Labor Department Rule Expands Group Health Coverage Option

On October 17, 2017, the IRS announced that it will not accept electronically filed tax returns for the year 2017 (to be filed in 2018) that fail to address the health coverage requirements of the Affordable Care Act (“ACA”). The “IRS Statement on Health Care Reporting Requirement” notes that “‎[t]axpayers remain obligated to follow the law and pay what they may owe at the point of filing‎. The 2018 filing season will be the first time the IRS will not accept tax returns that omit this information.” The prior guidance called into question whether the IRS would enforce the individual mandate provisions of the ACA. The new guidance makes clear that it will do so.

Continue Reading IRS Issues New Statement Regarding Health Care Reporting Requirements

After a month of spirited efforts to accommodate the disparate interests of the Freedom Caucus and the Tuesday Group, Amendments offered by Representatives Tom MacArthur (R-NJ) and Fred Upton (R-MI) facilitated the hurried House passage of H.R. 1628 – – the American Health Care Act of 2017. Passed as a “reconciliation bill” (more on that later), the House voted 217-213 on May 4, 2017, to dismantle the Affordable Care Act (ACA) and make sweeping changes to the nation’s health care system.

Continue Reading From Slow Repeal to No Repeal to “Amended” Repeal

The decision by the House Leadership to choose not to bring the American Health Care Act (AHCA) to a vote left industry analysts speculating both about the fate of “Obamacare,” and the prospects for narrower reforms. With bipartisan support to reduce prescription drug prices, it appears as though Democrats and Republicans are working on plans to fix drug prices. This tenth article in our series on the effect of a “slow repeal” of the ACA updates our January 12, 2017, article on the pharmaceutical industry and addresses current efforts aimed at reducing drug prices in the U.S.

Continue Reading Slow Repeal of the ACA: Efforts to Reduce Prescription Drug Prices

On March 20th, House Republicans rolled out a number of changes to their bill, the American HealthCare Act (AHCA), seeking to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare. Although the House Leadership ultimately chose not to bring the AHCA to a vote, this ninth article in our series on the effect of a “slow repeal” of the ACA unpacks the Manager’s Amendment, and offers insights on what may still form the basis for health care legislation.

Continue Reading Slow Repeal of the ACA Just Got Slower…