HcTrends RSS Article Feed https://www.hctrends.com/rss/rss.aspx HCTrends.com - Resource Postings en-us All materials © Copyright 2002 - 2017, HCTrends.com 3941 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=B3EE9320-E415-4E44-BDFE-5C594FB92092 webmaster@hctrends.com Medical Loss Ratio (MLR) Rebates and Employer Responsibilities (9/2017) A medical loss ratio (MLR) is the amount of health insurance premiums that an insurer spends on health care and activities to improve health care quality. It is expressed as a percentage: for example, an MLR of 90% means 9 out of 10 of all premium dollars the insurer receives are spent on health care and quality improvement, with the other dollars spent on overhead, profits, and administrative costs. Starting in 2012, an insurer that does not spend enough of its premium dollars on health care must provide a rebate to the insured individual or to the policyholder, which may be the employer that purchased the insurance. Note: Due to the complexity of the law in this area, it is necessary for employers receiving rebates to consult with legal counsel to ensure full compliance with all applicable requirements. You may also wish to check with your carrier as there may be additional guidance available specific to your plan. These rules do not apply to employers who operate self-insured plans. 2017-09-13T06:59:27-05:00 3940 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=638B04D2-C758-477C-8F09-9054B4EE091D webmaster@hctrends.com Court Requires EEOC to Substantiate 30% Limit on Wellness Program Incentives (9.2017) On August 22, 2017, a federal court in the District of Columbia ordered the Equal Employment Opportunity Commission (EEOC) to reconsider the limits it placed on wellness program incentives under final regulations the agency issued last year under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). As part of the final regulations, the EEOC set a limit on incentives under wellness programs equal to 30% of the total cost of self only coverage under the employer’s group health plan. The court found that the EEOC did not properly consider whether the 30% limit on incentives would ensure the program remained “voluntary” as required by the ADA and GINA and sent the regulations back to the EEOC for reconsideration. 2017-09-11T12:43:07-05:00 3939 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=CC9CF4D5-AC22-46B0-97CC-C6C18E2A1F62 webmaster@hctrends.com FORM TO REQUEST DOCUMENTATION FROM AN EMPLOYER-SPONSORED HEALTH PLAN OR AN INSURER CONCERNING TREATMENT LIMITATIONS Background: This is a tool to help you request information from your employer-sponsored health plan or your insurer regarding limitations that may affect your mental health or substance use disorder benefits. You can use this form to request general information about coverage limitations or specific information about limitations that may have resulted in denial of your benefits. Your plan is required by law to provide you this information in certain instances, and the information will help you determine if the coverage you are receiving complies with the law. 2017-06-30T08:22:16-05:00 3937 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=A08672DD-11CF-4D2D-AC19-950B1B228E04 webmaster@hctrends.com BETTER CARE RECONCILIATION ACT (Section Summary) SECTION BY SECTION SUMMARY BETTER CARE RECONCILIATION ACT [LYN17343] 2017-06-28T06:06:47-05:00 3936 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=33B23CC5-95CD-41E8-8707-052425A2C459 webmaster@hctrends.com REMINDER: PCORI Fees Due by July 31, 2017 Employers that sponsor self-insured group health plans, including health reimbursement arrangements (HRAs) should keep in mind the upcoming July 31, 2017 deadline for paying fees that fund the Patient-Centered Outcomes Research Institute (PCORI). As background, the PCORI was established as part of the Affordable Care Act (ACA) to conduct research to evaluate the effectiveness of medical treatments, procedures and strategies that treat, manage, diagnose or prevent illness or injury. Under the ACA, most employer sponsors and insurers will be required to pay PCORI fees until 2019. 2017-06-28T04:24:11-05:00 3935 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=4C038661-FD4A-4954-9B4C-55171AE7CD8B webmaster@hctrends.com Senate Republicans Release Healthcare Bill; Largely Mirroring House Bill but with Some Key Differences On Thursday, June 22, 2017, Senate Majority Leader Mitch McConnell of Kentucky released a 142- page healthcare “Discussion Draft” of legislation, called the Better Care Reconciliation Act of 2017 (BCRA), which is the Senate version of the Affordable Care Act (ACA) “repeal-and-replace” legislation American Health Care Act (AHCA) passed by the U.S. House of Representatives last month. An updated “Discussion Draft” of the BRCA was released on June 26, 2017. A summary of the updated June 26 draft of the BCRA by the U.S. Senate Committee on the Budget is available here and a section-by-section summary of the June 26th version is available here. 2017-06-28T04:21:48-05:00 3931 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=7DF28CCA-FFE2-42C9-989B-F67BE669CE68 webmaster@hctrends.com Building blocks: Block grants, per capita caps, and Medicaid reform Recent changes in the U.S. political environment have once again stirred up discussions of major reforms to the healthcare market. While a main topic in news discussions has been proposed reforms to health insurance exchanges created by the Patient Protection and Affordable Care Act (ACA), Medicaid reform has the potential to affect more people than any other source of coverage. By Justin Birrell, Jennifer L. Gerstorff, Nicholas Johnson, Brad Armstrong | 31 January 2017 PDF Download the PDF Recent changes in the U.S. political environment have once again stirred up discussions of major reforms to the healthcare market. While a main topic in news discussions has been proposed reforms to health insurance exchanges created by the Patient Protection and Affordable Care Act (ACA), Medicaid reform has the potential to affect more people than any other source of coverage. 2017-02-09T12:29:31-06:00 3929 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=F2D5E54A-29F3-4BAF-97FB-DD5E045220CB webmaster@hctrends.com FAQs about Affordable Care Act Implementation - Part XXXVII (1/2017) ACA FAQ Part 37 Addresses HRAs, Interpretation of "Health Insurance Coverage" The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released Affordable Care Act (ACA) Implementation Frequently Asked Questions (FAQs) Part 37 discussing four specific questions related to health reimbursement arrangements (HRAs) and interpretation of "health insurance coverage". The four questions address: •Integration of HRAs with group health plans sponsored by the employer of a spouse of an employee; and •Coordinated and Consistent Interpretation of "Health Insurance Coverage" Other included discussions relate to: •HRAs and employer payment plans; •Code Section 162(m)(6); •Application of Code Section 162(m)(6) to Certain Clinical Risk-Bearing Entities; and •Medical Loss Ratio (MLR) Guidance Provided in CCIO Technical Guidance 2012-002. 2017-01-13T06:23:21-06:00 3928 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=A1BFBE67-E159-4038-B206-EC8828F07407 webmaster@hctrends.com FAQs about Affordable Care Act Implementation - Part XXXVI (1/2017) COVERAGE OF PREVENTIVE SERVICES - Section 2713 of the Public Health Service Act (PHS Act), as added by the Affordable Care Act and incorporated into the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code (the Code), requires that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage provide coverage of certain specified preventive services without cost sharing. The Senate adopted a “Women’s Health Amendment,” adding a new category of preventive services specific to women’s health. This provision requires coverage without cost sharing of preventive care and screenings for women provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). Supporters of the Women’s Health Amendment emphasized that it would reduce unintended pregnancies by ensuring that women receive coverage for “contraceptive services” without cost-sharing. 155 Cong. Rec. at 29,768 (Sen. Durbin). 2017-01-13T06:20:55-06:00 3925 https://www.hctrends.com/library/lib_article_display_by_id.aspx?id=DFF2EDD2-E9CD-4998-BAE5-2EA56334E2AE webmaster@hctrends.com FAQs about Affordable Care Act Implementation - Part XXXV (12/2016) This set of FAQs addresses the following: HIPAA Special Enrollment when there is a loss of coverage from a Marketplace plan; Qualified Small Employer Health Reimbursement Arrangements (QSEHRA) | Employer Payment Plans (EPP); Updated Women's Preventive Services guidelines. 2016-10-28T05:06:37-05:00