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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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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 House Republicans released a white paper outlining their plan to provide “High Quality Health Care for All” – the GOP’s proposed approach to replace the ACA. While it lays out some interesting strategies that could potentially be attractive to employers, the paper lacks the details necessary to be able to evaluate the impact on employer-sponsored health benefits as we know them today. And we all know the devil is in the details.

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The beginning of June serves as a reminder that we’re approaching the halfway point of 2016. Now is a great time to pull out those strategic plans and assess what you've accomplished and what's left to do. And don't forget to do a mid-year compliance check. I know, it's not the most exciting task, but it is a necessary evil. To make it a little easier, I’ve asked Mercer's compliance experts to describe – in just two minutes each – the top 10 compliance issues on their checklists. Here’s what they had to say.

 

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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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In an unprecedented move, JAMA published President Obama’s status report on the ACA. In it, the President details the impact of the ACA using charts and data from various sources and offers up some suggestions for what should happen next.

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Public exchange notices are coming soon to a mailbox near…well, we’re not really sure where they will land, but they are coming soon.

 

The 38 federally run public health insurance exchanges are preparing to send employer notifications when their employees have enrolled in individual exchange coverage and claimed advance premium tax credits (APTCs) under the Affordable Care Act. To receive APTCs an individual completes an application for health coverage that asks for employment status, employer contact information, and details about employer-provided coverage and how much the employee must pay for the lowest-cost self-only coverage option with minimum value. Where the exchange mails the employer notice depends on the address the applicant puts on the form. If the employee provides an incomplete address, the employer may not receive a notice at all.

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New tri-agency proposed regulations implementing the Expatriate Health Coverage Clarification Act of 2014 (EHCCA) outline the conditions an expatriate medical plan or policy must meet to exempt the plan, sponsoring employer, and expatriate health insurers from certain Affordable Care Act (ACA) requirements. Generally, EHCCA exempts plans or policies that meet the law's definition of an "expatriate health plan" from certain ACA market reforms, fees, and aspects of the "Cadillac" excise tax on high-cost health benefits. The proposal clarifies which individuals are qualified expatriates, which insurers can issue qualified expatriate coverage, as well as other important requirements to take advantage of the EHCCA relief.

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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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