Implementing Health Reform

The Internal Revenue Service (IRS), the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) have issued interim final rules and requests for information on several provisions of the health reform law. This page tracks new regulations, and opportunities to comment.

Fact Sheet on Establishing the Web Portal

http://www.hhs.gov/ociio/Documents/factsheetwebportal.pdf

The Affordable Care Act establishes an internet portal to help individuals and small businesses identify insurance options in their state.

The web portal will help consumers navigate their options in the individual and

small business private market and help them determine if they may be eligible

for a variety of existing public programs, including existing state high risk

pools, new high risk pools, Medicaid, Medicare and the Children’s Health

Insurance Program (CHIP). The new web portal will provide information on: the small business tax credits available for 2010 and beyond; and the Early Retiree Reinsurance Program including instructions on how businesses that provide coverage to non-Medicare retirees age 55 and older can enroll to receive reinsurance payments to stabilize coverage for this at-risk population.

Small Business Tax Credit and Related Tax Information

http://www.irs.gov/newsroom/article/0,,id=223666,00.html
Eligibility Rules

  • Providing health care coverage. A qualifying employer must cover at least 50 percent of the cost of health care coverage for some of its workers based on the single rate.
  • Firm size. A qualifying employer must have less than the equivalent of 25 full-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
  • Average annual wage. A qualifying employer must pay average annual wages below $50,000.
  • Both taxable (for profit) and tax-exempt firms qualify.

Amount of Credit

  • Maximum Amount. The credit is worth up to 35 percent of a small business’ premium costs in 2010. On Jan. 1, 2014, this rate increases to 50 percent (35 percent for tax-exempt employers).
  • Phase-out. The credit phases out gradually for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 25 full-time workers.

Related taxes and tax credits:
http://www.irs.gov/newsroom/article/0,,id=220809,00.html?portlet=6

Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26; Interim Final Rule and Proposed Rule

2.37 million young adults might be affected by this provision, or approximately 8% of the 29.5 million young adults in the age group. Approximately 1.83 million are currently uninsured, and 0.55 million are currently covered by their own nongroup coverage. Mid-range estimate: 1.24 million will enroll in 2011, at a cost of $3380 a year.

Federal Register: http://edocket.access.gpo.gov/2010/pdf/2010-11391.pdf

The First Reforms that Will Take Effect

from Families USA: http://www.familiesusa.org/health-reform-central/implementing-the-new-law/implementation-advocates-to.html

Temporary Coverage for Uninsured People with Pre-Existing Conditions
(Section 1101 of the Patient Protection and Affordable Care Act)

Grants for Consumer Assistance Offices or Health Insurance Ombudsman Programs
(Section 1002 of the Patient Protection and Affordable Care Act; Creates Part C, Section 2793 of the Public Health Services Act)

Grants for Rate Review
(Section 1003, as amended by section 10101, of the Patient Protection and Affordable Care Act; Creates Section 2794 of the Public Health Services Act)

Small Business Tax Credit
(Section 1421, as amended by section 10105, of the Patient Protection and Affordable Care Act; Creates Section 45R(d)(3) of the IRS Code of 1986)

Medicaid and CHIP Maintenance of Effort (MOE) Requirements
(Section 2001(b) of the Patient Protection and Affordable Care Act; Amends Section 1902 of the Social Security Act)

Option to Expand Medicaid Before 2014

(Section 2001(a)(4), as amended by Section 10201(b), of the Patient Protection and Affordable Care Act; Amends Section 1902 of the Social Security Act)

Changes to Community Benefit Requirements for Nonprofit Hospitals

(Section 9007, as amended by Section 10903 of the Patient Protection and Affordable Care Act; Amends Section 501(r)(5) of the Internal Revenue Code of 1986)

Other Reforms That Go into Effect Later This Year:

http://www.familiesusa.org/health-reform-central/implementing-the-new-law/implementation-to-do-other.html

Rescissions (Section 1001 of the Patient Protection and Affordable Care Act, Section 2301 of the Health Care and Education Reconciliation Act of 2010; Creates Section 2712 of the Public Health Services Act): The federal health reform law protects against unfair rescissions of health plans, which typically occur only after an enrollee submits expensive claims for care. The law states that rescissions may occur only in cases of fraud or intentional misrepresentation and that insurers must provide advance notice to policyholders if they intend to rescind their plans.

Internal and External Appeal Rights (Section 1001, as amended by section 10101, of the Patient Protection and Affordable Care Act; Creates Section 2719 of the Public Health Services Act)

The Department of Health and Human Services, together with other federal agencies, will be promulgating regulations and guidance on a number of reforms this year:

  • Restrictions on annual limits on benefits;
  • Prohibitions on pre-existing condition exclusions for children;
  • Protections against higher cost-sharing for out-of-network emergency care;
  • Access to pediatricians and women’s health providers;
  • Minimum medical loss ratio requirements;
  • Transparency in health insurance data;
  • Closing the Medicare Part D doughnut hole; and
  • Changes to Medicare Part D rules that are designed to reduce the number of low-income beneficiaries that are forced to change plans each year.

IRS Legal Guidance

http://www.irs.gov/newsroom/article/0,,id=222814,00.html

  • TD 9486, Indoor Tanning Services; Cosmetic Services; Excise Taxes
  • Notice 2010-39, Request for Comments Regarding Additional Requirements for Tax-Exempt Hospitals
  • TD 9482, Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 under the Patient Protection and Affordable Care Act
  • Notice 2010-44, Tax Credit for Employee Health Insurance Expenses of Small Employers
  • Notice 2010-38, Tax Treatment of Health Care Benefits Provided With Respect to Children Under Age 27
  • Revenue Ruling 2010-13, Section 45R—Average premium for small group market for determining the small employer health insurance credit

Dept. of Labor, EBSA Final Rules

Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act; Interim Final Rule and Proposed Rule   [6/17/2010]
[PDF]

[Federal Register: June 17, 2010
(Volume 75, Number 116)]
[Rules and Regulations] [Page 34537-34570]
http://www.dol.gov/federalregister/HtmlDisplay.aspx?DocId=23967&AgencyId=8

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