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Materials available for members-only conference call on PPACA external review guidance August 26, 2010: For American Benefits Council members participating in today's conference call on guidance regarding interim procedures for federal external review relating to claims and appeals for issuers and health plans under the Patient Protection and Affordable Care Act (PPACA), the following slides are now available: Health Care Reform Compliance Presentation Slides: External Review Procedures for Self-Funded Group Health Plans (Courtesy of Proskauer Rose) In conjunction with the guidance itself, DOL released Technical Release 2010-1 as well as model notices for internal claims and appeals and for external review processes under PPACA:
Council comments on PPACA "grandfather" plan regulations August 16, 2010: The American Benefits Council, joined by the HR Policy Association, has filed a formal comment letter with the U.S. Departments of Labor (DOL), Treasury and Health and Human Services with regard to interim final regulations (IFR) implementing the “grandfather” provisions of the Patient Protection and Affordable Care Act (PPACA). The interim final rules were released on June 17, along with a fact sheet, a table on applicability of provisions to grandfathered plans and DOL model disclosure language. Under PPACA, group health plans or insurance coverage existing on the date of enactment (March 23, 2010) are not required to comply with certain plan requirements. The IFR set out the specific requirements that a group health plan or insurance carrier must observe in order to maintain status as a “grandfathered” plan. In general, the rules provide that grandfather plans will lose their status if “they choose to make significant changes that reduce benefits or increase costs to consumers." Specific requirements with respect to these changes are set out in further detail in the IFR. These include rules with respect to changing benefits, employee cost sharing and employer contributions. The regulations also provide a good faith compliance standard and grace period for plans that may have changed their plans subsequent to March 23, 2010, to allow them to comply with the new IFR. Council comments on PPACA adult child coverage regulations August 11, 2010: The American Benefits Council, in conjunction with the HR Policy Association, has filed a formal comment letter with the U.S. Departments of Labor (DOL), Treasury and Health and Human Services with regard to interim final regulations extending dependent coverage to adult children up to age 26 under the Patient Protection and Affordable Care Act (PPACA). The interim final rules were released on May 10, along with an official fact sheet and a list of frequently asked questions. The Council provided preliminary comments on June 28 with regard to the definition of "adult child". Under PPACA, health plans and issuers that offer dependent coverage must make the coverage available to enrollees' adult children until the age of 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parents' tax return, is no longer a student or is married (though the child's own spouses and children do not qualify). The provision is applicable to plans or policy years beginning on or after September 23, 2010, although the Obama administration has publicly called upon employers and insurers to comply voluntarily with the provisions prior to the official effective date. The comment letter urges that the regulatory agencies provide clarifying guidance on a number of issues as soon as possible, since many employers and issuers are in the process of making final decisions with respect to their plans for the upcoming plan year. Auto-IRA legislation introduced in House, comparison of bills now available August 10, 2010: Representative Richard Neal (D-MA), chairman of the House of Representatives Subcommittee on Select Revenue Measures of the Ways and Means Committee, introduced the Automatic IRA Act (H.R. 6099) during a rare mid-recess session. An official summary of the proposal was also made available. The House version of the bill is based upon President Obama’s Fiscal Year 2011 budget and serves as a companion to the bill introduced last week by Senator Jeff Bingaman (D-NM) also known as the Automatic IRA Act (S. 3760). The Council has prepared, courtesy of the law firm of Davis and Harman, a document comparing the two proposals [For Council members only]. Council applauds passage of pension funding relief; summary of provisions now available July 7, 2010: on June 25, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act (H.R. 3962), a measure providing for a six-month delay in the reduction in Medicare payments to doctors as well as long-awaited defined benefit pension plan funding relief. An updated summary of the relief provisions, prepared by Davis & Harman LLP, is now available. The Council has applauded the efforts of Congress and the Obama Administration for enacting this critical relief and will continue to encourage measures to address the volatility and unpredictability now inherent in funding traditional defined benefit retirement plans. Click here for the full Council statement. PPACA Grandfathered Plan IFR Published in Federal Register June 17, 2010: Today's Federal Register contained the approved interim final regulations for grandfathered health plans, as announced Monday by the Office of Management and Budget. Also available on this topic are slides from the Council's call earlier this week, a fact sheet, an FAQ, and a legal summary on the interim final regulations. |
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Benefits Byte (08/31/10)
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Health Care Reform: Employers Enter Compliance Phase The Council's Health Care Reform Issue Page The U.S. House of Representatives and Senate have voted, and President Obama has signed into law the Patient Protection and Affordable Care Act (PPACA) and the accompanying Health Care and Education Affordability Reconciliation Act (H.R. 4872). This action finalizes the new health care reform law, bringing to a close more than a year of legislative debate. While the Council retains many concerns about certain elements of the final statutory language and will continue to pursue efforts to overturn those elements, we are pleased that we were able to avoid some of the more onerous provisions that had been included in the earlier House bill. We are also now focused on the compliance phase of the law. The Council is hosting a series of membership-wide conference calls to provide a more detailed explanation of select topic areas including tax provisions, employer responsibilities and retiree health reinsurance programs, among others. On April 1, 2010, the Council held the first of these calls on employer responsibility provisions of the new law. Council Materials: A number of summaries of the new law are already available:
For more information, contact Paul Dennett, senior vice president, health care reform, at (202) 289-6700. |
