Legislative Summaries

Timely Summaries

Overviews of employee benefit and HR legislation and timely topics in one easily accessible location.

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President Trump Ends ACA Cost Sharing Reductions

This ACA Advisor provides background on the recent Executive Order that stops cost sharing reductions for low income Americans in relation to the Patient Protection and Affordable Care Act, including the impact it has on employers.


October 2017 Executive Order on Healthcare

This ACA Advisor explains the recent Executive Order signed by President Trump, titled "Promoting Healthcare Choice and Competition Across the United States."


FAQ on HIPAA Special Enrollment; QSE HRAs Released

This ACA Advisor reviews a new FAQ by the Department of Labor (DOL), Department of Health and Human Services (HHS), and the Treasury, which covers a new HIPAA special enrollment period, an update on women's preventive services that must be covered, and clarifying information on qualifying small employer health reimbursement arrangements (QSE HRAs).


EEOC Guidance on National Origin Discrimination

This HR Advisor reviews the previous rules and new protections related to national origin discrimination issued in new guidance by the Equal Employment Opportunity Commission (EEOC).


Handling of Retaliation Complaints under Section 1558 of the Affordable Care Act

The Occupational Safety and Health Administration (OSHA) recently released a final rule on the procedures for the handling of whistleblower complaints under Section 1558 of the Patient Protection and Affordable Care Act (ACA). This HR Advisor reviews the regulations protecting employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions, or for reporting potential violations of the ACA’s consumer protections.


HIPAA Phase 2 Audits

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) began a pilot program to assess the procedures implemented by covered entities to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA). OCR evaluated the effectiveness of the pilot program and then announced Phase 2 of the program. This Compliance Advisor reviews the Phase 2 Audits, which focus on the policies and procedures adopted by both covered entities and business associates to ensure they meet selected standards and implementation specifications of the Privacy, Security, and Breach Notification Rules.

HIPAA Phase 1 Audits

The Health Insurance Portability and Accountability Act (HIPAA) established national standards to secure and protect the privacy of health information. The Health Information Technology for Economic and Clinical Health Act (HITECH) requires the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) to conduct audits of covered entities and business associates in order to ensure compliance with the HIPAA Privacy, Security, and Breach Notification Rules. This Compliance Advisor reviews the pilot program OCR initiated to assess the processes implemented by 115 covered entities to comply with HIPAA’s requirements.

Employment Eligibility: How to Handle Questions about Worker Identity

Reports submitted to the U.S. government that include both names and Social Security numbers (SSNs), such as 1095 and W-2 forms, are filtered through U.S. Immigration and Customs Enforcement (ICE). In some cases, employers will receive a “No-Match Letter” from the Social Security Administration (SSA) or ICE for certain employees when discrepancies are noted, calling employment eligibility into question. This Compliance Advisor reviews the three-step process employers who receive such notices must use to investigate, remediate, and communicate identified errors within established timelines.

DOL Issues Another FAQ on ACA Implementation

The U.S. Department of Labor (DOL) has issued its 31st FAQ on the implementation of the Patient Protection and Affordable Care Act (ACA). This ACA Advisor summarizes information related to coverage of preventive services, rescissions of coverage, out-of-network emergency services, clinical trial coverage, cost-sharing limitations, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act.

CMS Provides Clarity on PACE Act Implications for States

The Centers for Medicare & Medicaid Services (CMS), in response to the PACE Act, issued an FAQ on the impact of the PACE Act on small group expansion. This ACA Advisor explains clarifications related to CMS notifications, carrier rate filing, SHOP eligibility, and counting methodology.

DOL Issues FAQ on Mental Health Parity and ACA Market Reform Provisions

Non-grandfathered group health plans and individual or group market health insurance must cover a variety of preventive services without any cost-sharing requirements. This ACA Advisor reviews the required preventive services and the latest clarifications from the DOL.

PACE Act Passes House, Senate

The "Protecting Affordable Coverage for Employees Act" or "PACE Act" is expected to be signed into law soon. This ACA Advisor explains how the PACE Act would amend the Patient Protection and Affordable Care Act (ACA), how it redefines small employers, and the impact it will have on states.

IRS Notice on Minimum Essential Coverage Reporting

Minimum essential coverage or "MEC" is the type of coverage that an individual must have under the Patient Protection and Affordable Care Act (ACA). Employers that are subject to the ACA's shared responsibility provisions (often called play or pay) must offer MEC coverage that is affordable and provides minimum value. This ACA advisor reviews IRS proposed regulations as well as the related issues for which they are seeking comments.

IRS Releases Draft 2015 Instructions for 6055/6056 Reporting

The IRS has issued draft 2015 Instructions, which include a variety of changes from the 2014 instructions.

Preventive Services Final Rules

Federal agencies released final regulations on the preventive services mandate of the Patient Protection and Affordable Care Act (ACA) that requires non-grandfathered group health plans to provide coverage without cost-sharing for specific preventive services, which for women include contraceptive services.

U.S. Supreme Court Upholds PPACA Subsidy Eligibility on Federal Exchanges

The Supreme Court issued its opinion in King v. Burwell, holding that the Internal Revenue Service (IRS) may issue regulations to extend tax-credit subsidies to coverage purchased through Exchanges established by the federal government under the Patient Protection and Affordable Care Act.

IRS Releases Draft 2015 Forms for 6055/6056 Reporting

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees.

U.S. Supreme Court Finds Same Sex Marriage Is Protected by the 14th Amendment

The Supreme Court ruled in Obergefell v Hodges, that the 14th Amendment requires a state to license a marriage between two people of the same sex, and to recognize a marriage between two people of the same sex when their marriage was lawfully licensed and performed out of state.

Cost-Sharing Limits; Provider Discrimination FAQ Released

On May 26, 2015, federal agencies, including the Department of Labor (DOL), issued a short five-question FAQ on two ACA-related issues: limitations on cost-sharing and provider discrimination.

Highlights of the Patient-Centered Outcomes (PCORI) / Comparative Effectiveness Fee

The Patient-Centered Outcomes Research Institute (PCORI) fee applies from 2012 to 2019.


Preventive Service Requirement FAQ

On May 11, 2015, the Department of Labor (DOL) along with other federal agencies issues an FAQ regarding the implementation of the Affordable Care Act (ACA) that focused on coverage of preventive services.

Wraparound Excepted Benefits to Launch with Two Pilot Programs

Health plan sponsors would be permitted to offer wraparound coverage to employees purchasing indidviual health insurance in the private market, including the Marketplace, in limited circumstances, under a new Final Rule issued by the Department of Labor (DOL) and other federal agencies.

Cost Sharing Limits Changing for 2016

In the Benefit and Payment Parameters for 2016 Final Rule issued in February of 2015, federal agencies included a clarification that annual cost-sharing limitations for self-only coverage apply to all individuals, regardless of whether the individual is ocvered by a self-only plan or is covered by another kind of plan.

February 2015 IRS Rules and Notices

The regulatory agencies have recently issued guidance that may affect employers that have been reimbursing premiums for individual health coverage or Medicare Part B, Part D or Medigap premiums for active employees.

Highlights of the Excise Tax on High-Cost Plans (the "Cadillac Tax")

The excise tax on igh cost plans (also referred to as the Cadillac tax and the 4980I tax) is scheduled to take effect in 2018.

Highlights of the Wellness Program Requirements

The wellness program rules provide an exception to the general rule that employers may not take a person's health status into account with respect to eligibility, benefits, or premiums under a group health plan.

FAQs about Grandfathered Plans

As employers determine their plan designs for the coming year, those with grandfathered status need to decide if maintaining grandfathered status is their best option.

Highlights of the Summary of Benefits and Coverage Requirement

Highlights of the Summary of Benefits and Coverage Requirement


Highlights of the Patient-Centered Outcomes/Comparative Effectiveness (PCORI) Fee

The Patient-Centered Outcomes Research Institute (PCORI) fee applies from 2012 to 2019.

Additional Medicare Withholding For High Earners

The Internal Revenue Service (IRS) published Final Regulations on the Additional Medicare Tax (AMT) on Nov. 29, 2013, and an updated and comprehensive FAQ on Dec. 2, 2013.


IRS Liberalizes the Health Flexible Spending Account “Use It or Lose It” Rule

On Oct. 30, 2013, the Internal Revenue Service issued a notice that liberalizes the "use it or lose it" rule that applies to health flexible spending accounts (HFSAs) and clarifies that employers of all sizes may choose to amend their Section 125 plan to essentially treat the availability of the health marketplaces/exchanges as a one-time change in status event.


What is my State doing with Exchanges and Medicaid?

States have two major decisions to make with respect to the Affordable Care Act (ACA) - whether they will run the health exchange themselves, and whether they will expand Medicaid to cover most individuals whose income is below 133 percent of the federal poverty level.


DOL Announces Non-Enforcement of Marketplace/Exchange Notice

ACA requires employers covered by the Fair Labor Standards Act to provide a notice about the upcoming health marketplaces (also called exchanges) to their employees.


W-2 Reporting Requirements Summary

Highlights of W-2 Reporting Requirement


Patient-Centered Outcomes Research Institute (PCORI) Fee; Transitional Reinsurance Fee (TRF); Health Insurance Providers (HIP) Fee

The IRS and the Department of Health and Human Services have issued final regulations that provide details on several fees that will be due as part of the Affordable Care Act (ACA).

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Please note that UBA continually updates its compliance library as new notices, rules, proposed rules and other ACA information becomes available, so some of our publications may be superseded by later guidance.

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By bolson@ubabenefits.com (Bill Olson) on May 11, 2018
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