January 10, 2017

Benefit Implications Contained in New Law (article)

On December 13, 2016, President Obama signed the 21st Century Cures Act (H.R. 34).  Following are highlights of the benefit-related provisions of the law:


  • Qualified Small Employer HRAs.  In part, this law re-establishes the ability of small employers, those not subject to the Affordable Care Act’s employer shared responsibility provisions, to provide their employees a stand-alone health reimbursement arrangement (HRA), known as a “qualified small employer HRA”. In order to establish the qualified HRA, the employer must provide no other health coverage. The HRA can be used to reimburse health insurance premium for individual coverage purchased either through or outside the marketplace. As is true for all HRAs, the plan can only be funded with employer dollars.   For a more detailed discussion about these HRAs, see the CBIZ Health Reform Bulletin 124.
  •  HIPAA privacy rules.  The Cures Act directs the Secretary of HHS and Office of Civil Rights to issue clarification guidance within the next 12 months to assist covered entities in understanding permitted uses and disclosures of protected health information (PHI).  Specifically, this call for guidance is to clarify circumstances that would permit the release of PHI by covered entities, family members or attending caretakers when it involves an individual’s serious mental health issue or substance abuse treatment.  In addition, HHS and OCR, together with other health-related organizations, are directed to develop initial and on-going training materials plus a model program to assist health care providers in determining proper use and disclosure of PHI.
  • Mental Health Parity.  The federal mental health parity rules generally require that mental health services be treated substantially similar as covered medical and surgical services under both individual and group health plans.  These rules have been in effect for many years now, followed by expanded implementation guidance from the tri-governing agencies (Departments of Health and Human Services, Labor and Treasury), most recently as recommendations and FAQs resulting from President Obama’s task force initiative (see Understanding Mental Health Parity, Benefit Beat, 11/7/16) and sub-regulatory guidance issued last summer (see Red Flag Warnings of Noncompliance with Mental Health Parity Laws, Benefit Beat, 6/7/16).

Despite the existing requirements of the law, a section the Cures Act directs the tri-governing agencies to issue a compliance program guidance document within the next 12 months to assist in improving compliance by plans and insurers.  Specifically, the compliance guidance would contain examples illustrating requirements for information disclosures and nonquantitative treatment limitation standards.  Further, the Cures Act requires treatment of eating disorder benefits under a plan to be provided in accordance with the mental health parity rules.


It should also be noted that the Equal Employment Opportunity Commission (EEOC) recently released guidance addressing to mental health issues as it relates to employment and benefit matters.  Specifically, this Q & A guidance focuses on depression, post-traumatic stress disorder, and other mental health conditions.  According to this guidance, individuals are entitled to workplace protections and reasonable accommodation due to a mental condition.  Examples of reasonable accommodation include altered break and work schedules, an office space or device for creating a quiet work environment, changes in supervisory methods, shift assignments or permission to work from home.


The information contained in this article is provided as general guidance and may be affected by changes in law or regulation. This article is not intended to replace or substitute for accounting or other professional advice. Please consult a CBIZ professional. This information is provided as-is with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.     

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