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On October 1, 2014, the Departments of Health and Human Services (“HHS”), Labor (“DOL”) and Treasury (collectively, the “Departments”) published regulations finalizing a proposed amendment to the “excepted benefit” rules, i.e., the rules that govern when certain types of benefits are exempt from HIPAA’s portability rules as well as various requirements under ERISA (including applicability of the Mental Health Parity and Addiction Equity Act) and the Affordable Care Act (“ACA”), including the ACA’s market reforms (such as the prohibition on lifetime and annual limits, etc.). These final rules largely adopted proposed rules from December 2013, with a few clarifications and changes.

After the enactment of the ACA, various stakeholders became increasingly concerned about whether or not an employee assistance program (“EAP”) would be considered to be a “group health plan” under the ACA, and thus subject to all of the ACA’s market reforms. Because the benefits provided under an EAP are generally very limited, most (if not all) EAPs would have difficulty meeting these market reforms (including, particularly, the ACA’s prohibition on annual dollar limits). The final rules largely adopted the provisions of the proposed rule that specify that EAPs will be considered to be excepted benefits (and thus not subject to the ACA’s market reforms) if they meet four criteria (which, the Departments make clear, are intended to ensure that EAPs are supplemental to other coverage offered by employers):Continue Reading HHS, Labor, and Treasury Issue Proposed Amendments to “Excepted Benefit” Rules

The Congressional Research Service published a report detailing more than a dozen pending ACA-related rulemakings. The report comes on the heels of the Spring 2014 Unified Agenda and identifies 14 proposed rules and 17 final rules regarding the ACA that are expected during the next twelve months. Notable expected proposed rules include:

  • CY 2016 Notice of Benefit and Payment Parameters (CMS-9933-P) (0938-ASI9)—Expected in November 2014, this rule would provide the CY 2016 payment parameters for Exchanges, including cost-sharing reductions, advance premium tax credits, reinsurance, and risk adjustment.
  • Application of the Mental Health Parity and Addiction Equity Act to Medicaid Programs (CMS-2333-P) (0938-AS24)—Expected in December 2014, this rule would specify how MHPAEA would apply to Medicaid (including managed care), CHIP, and other benefit programs.
  • Nondiscrimination Under the Patient Protection and Affordable Care Act (0945-AA02)—Expected in August 2014, this rule would implement the ACA Section 1557’s prohibitions against discrimination in health programs and activities by covered entities on the basis of race, color, national origin, sex, age, and disability.
  • State Option to Provide Health Homes for Enrollees With Chronic Conditions (CMS-2331-P) (0938-AQ48)—Expected in October 2014, this proposed rule would provide guidance for development of a Medicaid State Plan option to provide health homes for enrollees with chronic conditions.

Continue Reading ACA Regulatory Preview: CRS Teases Upcoming ACA Rulemakings