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October 18, 2011
HRB 40 - ACA Updates: CLASS Act Suspended, Increase in ERRP Cost Thresholds, and What Are Essential Benefits?
Long term care needs were addressed in the health care reform law through the Community Living Assistance Services and Supports Act (CLASS Act). The Department of Health and Human Services (HHS) was charged with establishing a national, voluntary long term care insurance program beginning in 2012 whereby a participating individual would contribute to the CLASS Program for 5 years (vesting period) before benefits (up to $50/day cash benefit) became available. The payments could be used to purchase non-medical services and support necessary to maintain community residence, including, home modifications, assistive technology, accessible transportation, homemaker services, respite care, personal assistance services, home care aides, and nursing support.
October 13, 2011
Reporting Welfare Benefit Plan Failures - Updated Form 8928
The IRS has updated its Form 8928 and Instructions. This form is to be used by group health plans and employers to self-report certain welfare benefit plan failures, including but not limited to violations relating to:
Should You Re-Classify Your Employees?
Employment classification has created much angst between government agencies, both federal and state, and employers. At the heart of this conflict is whether an individual should be classified as an independent contractor, or as an employee. Contrary to popular belief, an employer does not necessarily have the discretion to classify employees as independent contractors, or as common law employees; rather, it is determined by the facts and circumstances of the work relationship.
A Final Reminder: Provide Medicare Part D Notices by October 14th
The Medicare Part D enrollment period is October 15 to December 7, 2011. Therefore, all Medicare Part D notices of creditable or non-creditable coverage must be provided prior to October 15, 2011.
Medicare Mandatory Reporting for HRAs: Increased Threshold Levels and Exhausted Account Balances
As a means of enforcing the Medicare Secondary Payer (MSP) Rules, the Centers for Medicare and Medicaid Services (CMS) impose a reporting requirement upon insurers, third party administrators, and plan administrators of self-funded, self-administered group health plans. CMS considers health reimbursement arrangements (HRAs) to be a group health plan for purposes of the MSP rules; and thus, subject to the Medicare Mandatory Reporting Requirement (see prior Benefit Beat articles, Mandatory Medicare Reporting for HRAs Clarified, Aug, 2010, and Updated Information: Mandatory Medicare Reporting for HRAs, June, 2010).
IRS Clarifies Qualified Medical Expenses
The IRS has issued three recent Information Letters relating to the determination of qualified medical expenses. As background, for a medical expense to be reimbursed by certain medical reimbursement plans, such as a flexible medical spending account (FSA), a health savings account (HSA), a health reimbursement arrangement (HRA), or an Archer medical savings account (Archer MSA), the expense must be specifically for the purpose of ”….the diagnosis, cure, mitigation, treatment, or for the purpose of affecting any structure or function of the body…” [IRS Section 213(d)].
August 30, 2011
Updated Medicaid/CHIP Premium Assistance Notice Issued
Individuals who are eligible for employer-sponsored group health coverage, but are unable to afford the premium, may be eligible to receive premium assistance from a state’s Medicaid agency or CHIP program. Employers are required to provide premium assistance information to their employees. This can be accomplished by using a model notice provided by the Department of Labor (see Medicaid/CHIP Premium Assistance Notice Issued, Benefit Beat, 3/4/10). The DOL has recently released its revised Medicaid/CHIP notice that can be obtained from its website (click here for 7/31/11 version).
Reminder: Change in Medicare Part D Open Enrollment Period
As mentioned earlier this year (see Medicare Part D Updates, Benefit Beat, May 2011), the health care reform law changed the Medicare Part D annual enrollment period. Beginning this year, the Medicare Part D enrollment period will take place from October 15, 2011 through December 7, 2011. Therefore, all Medicare Part D notices of creditable or non-creditable coverage must be provided prior to October 15, 2011. CMS issued revised model Notices of Creditable and Non-Creditable Coverage to be used on or after April 1, 2011, in both English and Spanish:
Expiration of COBRA Subsidy
The COBRA premium assistance subsidy ended May 31, 2010, and has not been reinstated. Therefore, individuals who were involuntarily terminated after May 31, 2010, do not qualify for the subsidy. However, individuals who qualified for the subsidy on or before May 31, 2010 could continue to pay reduced premiums for the full subsidy period (15 months), as long as they are not eligible for another group health plan or Medicare. For employees who elected the subsidy in May 2010, and had no access to other health coverage since, their 15 months of COBRA premium subsidies expired at the end of August 2011. There may be some additional months of subsidy available in the limited situations in which a qualifying event on or before May 31, 2010, but COBRA did not commence until some date thereafter.
Keeping Medical Information Confidential
What can employers do with medical information, particularly medical information that is protected by the Americans with Disabilities Act (ADA) or the Genetic Information Nondiscrimination Act (GINA), is an open-ended question. The Equal Employment Opportunity Commission (EEOC) is the division of the Department of Labor responsible for administering both the ADA and GINA. The EEOC has recently issued two informal, non-binding Opinion Letters expressing some thoughts on these matters.