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Changes in the way Medicare pays physicians are set out in a final rule released Oct. 14 by the Centers for Medicare and Medicaid Services (CMS). The rules will increasingly base doctors’ pay on their efficiency and quality of care. Effective Jan. 1, 2017, the rules begin phasing in Medicare’s Quality Payment Program (QPP) which generally offers two approaches to physician compensation: the Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS). Providers participating in APMs will get higher payments. 

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Final Department of Labor rules explain the nonretaliation protections for employees seeking subsidized health coverage from a public exchange, reporting certain ACA violations by an employer's group health plan, cooperating in ACA investigations or enforcement proceedings, or refusing to engage in activities that could violate the ACA. The rules leave intact interim regulations from 2013, with a few clarifications about complaint procedures and the scope of the law's protections.

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The reports of steep premium hikes in the public exchanges keep rolling in, raising concerns about their long-term viability. But should we really be worried?  Two recent news items make the case for and against a pessimistic view. 

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Proposed IRS regulations address several Affordable Care Act (ACA) reporting issues for group health plan sponsors and other providers of minimum essential coverage (MEC). The proposals give more detail on MEC providers' obligations to request covered individuals' taxpayer identification numbers (TINs), explain when supplemental MEC doesn't need to be reported, and address the use of truncated TINs, among other things. Employers that sponsor self-funded health coverage and have MEC reporting responsibilities will want to review the proposed rules, particularly the provisions on TIN solicitations. 

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First, let’s put public exchange enrollment in perspective. It’s a relatively small piece of the pie, although you wouldn’t know it from the amount of attention it gets. In a Wall Street Journal article, Drew Altman reminds us “about 11 million people are enrolled in the marketplaces. More than 13 times that many, around 150 million, have coverage through employers, and there are 66 million people in Medicaid and 55 million in Medicare.  The marketplaces are an important part of Obamacare. However, more uninsured people have been covered by Medicaid expansions than in the marketplaces, even though 19 states have not expanded Medicaid. Millions of young adults have been covered on their parents’ employer plans.”  Another important point: 24 million Americans still do not have coverage, a number that would be smaller if all states had expanded Medicaid.

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Annual cost-sharing limits for nongrandfathered group health plans would increase to $7,350 for individuals and $14,700 for families in 2018, under a recent CMS proposal. This marks a 2.8% increase from the 2017 limits, which cap out-of-pocket costs for in-network covered essential health benefits under nongrandfathered group health plans at $7,150 for self-only coverage and $14,300 for broader coverage.

 

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The IRS has released draft instructions for 2016 Forms 1094-B and 1095-B, confirming that health insurers and self-insured employers can expect few changes when reporting minimum essential coverage (MEC) provided to individuals in 2016. The Service posted preliminary 2016 versions of these forms in June, but instructions noting what's new became available only last week. The IRS uses data from this reporting to administer assessments under the Affordable Care Act’s individual mandate provisions. Separately, the IRS earlier released draft 2016 employer shared-responsibility forms and instructions that applicable large employers will use to report coverage offered to employees and their dependents.  

 

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The IRS has released draft instructions for 2016 Forms 1094-C and 1095-C, highlighting changes that employers can expect when reporting health coverage offered to full-time employees and dependents in 2016. The instructions give more detail about the minor revisions shown on the 2016 draft forms issued last month. The IRS uses data from this reporting to administer Affordable Care Act (ACA) assessments on employers and individuals, as well as eligibility for premium subsidies on the public insurance exchanges.

 

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Employee Benefits News posted a slideshow illustrating the differences between Clinton and Trump on the current state of healthcare in the US. Spoiler alert: there are not that many differences! The areas where they are aligned include:

  • Cadillac tax – both want it repealed
  • Cost – both think it needs to go down
  • Prescription drug costs – both want Medicare to set drug prices
  • Insurer consolidation – both oppose
  • Transparency – both support
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Mental health parity is nowhere close to the top of most lists of benefit concerns. After all, the Mental Health Parity and Addiction Equity Act (MHPAEA) is eight years old and has never received the attention paid to other laws. Its rules are complex, requiring comparison of mental health/substance use disorder benefits with medical/surgical benefits in six separate classifications.

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Democrats convene this week at their national convention in Philadelphia on the heels of last week’s Republican gathering in Cleveland, and while no issue divides the parties as starkly as healthcare, they agree that states should take a leading role in healthcare reform.

 

The Democrats' platform pledges to “empower the states” to use the Affordable Care Act’s Section 1332 “innovation waivers.” Starting in 2017, these waivers can – if approved by federal regulators – exempt states from one or more key ACA reforms such as the employer mandate, individual mandate, or public health insurance exchanges. The waiver lets a state tailor its own health reform initiative, provided it doesn't reduce the number of insured individuals and adheres to certain other restrictions. States that secure waivers receive federal funds that otherwise would have been spent on public exchange subsidies. Colorado and New York, for example, are considering proposals to pursue waivers to launch single-payer healthcare initiatives.

 

Other items in the Democratic platform call for allowing people to buy into Medicare starting at age 55, reducing prescription drug costs, capping consumers’ out-of-pocket costs, creating a public insurance plan option, and giving states new incentives for Medicaid expansion.

 

While the Republican platform calls for repeal of the ACA, it urges restoration of states’ “historic role” as regulators of health insurance and limited federal involvement. The platform also contains several familiar themes including broader distribution of tax breaks for the purchase of healthcare, greater price transparency, and purchasing pools for small businesses and individuals.

 

The party platforms are more wish lists than to-do lists for a new administration, but they provide key messaging points ahead of the elections and will help frame the policy debate next year.

 

Before leaving for the conventions, Congress left behind a number of bills with implications for employer health care plans. Lawmakers return after Labor Day for a brief work period before leaving again to campaign ahead of the November election. Certain proposals with bipartisan backing could cross the finish line this year as part of larger tax or spending bills, but most bills, such as one liberalizing HSA rules, face dim prospects.

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Mercer’s Washington Resource Group recently released our top 10 compliance priorities for 2017 health benefit planning. There aren’t any surprises on this list. In fact, we’ve recently blogged about many of them. Employee Benefit News created a slide show on our Top 10 and here is a list of related posts and podcasts if you want to take a deeper dive into a topic. 

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