Viewing posts from: September 2010

Health Care Reform – News Releases from the US Department of Labor

Posted September 21, 2010 by admin

DOL – FAQs regarding the Affordable Care Act – Implementation
Click here to read the FAQs.

Interim Procedures for Internal Claims and Appeals (Technical Release 2010-02) – When this technical release is read in concert with our September Compliance Chronicle, you’ll see that this release extends the “enforcement grace period” until July 1, 2011 with respect to some of the additional standards set forth in the interim regulations in order to give plans and issuers more time to implement procedures and make changes to computer systems in order to comply fully.
Click here to read the technical release.

Grandfathered Health Plans – Interim Final Rule: Public comments received – Some interesting insight about what providers, carriers and associations think about the Grandfathered status of plans.
Click here to read the public comments.

Dependent Children (coverage to Age 26) – Public comments on the Interim Final Rule – Again, there is some interesting insight here. For example, grandfathered plans can exclude dependents that have access to “other, employment based coverage”, that does not come from either of the dependent’s parents. That would lead you to conclude the coverage comes from the dependent’s employer’s plan, or the dependent’s spouse’s employer’s plan. But, what if that coverage wasn’t active coverage but was COBRA coverage? There is no distinction in the Affordable Care Act between active/COBRA/retiree coverage.
Click here to read the public comments.

September Compliance Chronicles – Health Care Reform Claims & Appeals Process

Posted September 16, 2010 by admin

A new edition of the Compliance Chronicles has been posted in the Compliance Chronicles section of the Crawford Advisors, LLC website. This month’s edition discusses the claims and appeals process as a result of health care reform.

The article begins with a timeline of some of health care reform’s most recent changes:

March 23, 2010: President Obama signs PPACA & HCERA into law (the Patient Protection and Affordable Health Care Act and the Health Care and Education Reconciliation Act of 2010) on 3/23/2010. Many provisions have an effective date six (6) months later, or 9/23/2010, and are therefore applicable for the first plan year after 9/23/2010. Many calendar year plans, for example, will need to comply as of 1/1/2011.

The article also reviews what steps you need to consider taking:

First, carefully determine the effective date of your plan. While your medical/Rx plan may renew each March 1st, the fact that your Plan runs on a calendar year basis, and is described that way in your Summary Plan Description (SPD) and reported that way on your Form 5500, may mean that you need to comply on 1/1/2011 and not on 3/1/2011.

To read the full Compliance Chronicles edition and to sign up to receive Crawford Advisors’ Compliance Chronicles updates, enter your email address in the Compliance Chronicles box on the right hand side of this website.

IRS Issues Guidance Explaining 2011 Changes to Flexible Spending Arrangements

Posted September 3, 2010 by admin

Today, the IRS issued guidance related to using FSAs (and HRAs) to pay for OTC (Over-The-Counter) medicines and drugs. The Affordable Care Act established new standards that, beginning January 1, 2011, apply to HCFSAs and HRAs, namely that the cost of an OTC-medicine/drug cannot be reimbursed from an FSA or HRA unless a prescription is obtained. This guidance does NOT affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eye glasses, contact lenses, co-pays and deductibles.

The new standard applies to purchases made on or after January 1, 2011.

Similar rules goes into effect on January 1, 2011 for Health Savings Accounts (HSAs), and Archer Medical Savings Accounts (Archer MSAs). Employers and employees should take these changes into account as they make health benefit decisions for 2011.

For details on current rules, see Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans. Updates on this and other health care reform provisions can be found on the Affordable Care Act page on IRS.gov. Notice 2010-59 and Revenue Ruling 2010-23, posted today, further explains this change.

UPDATE: The IRS has posted additional details, including a helpful FAQ, about the OTC medicines/drug rule change on its Affordable Care Act website and includes links to the following:

Text of IR-2010-95 is available here.
Text of Rev. Rul. 2010-23 is available here.
Text of Notice 2010-59 is available here.
Text of Affordable Care Act: Questions and Answers on Over-the-Counter Medicines and Drugs is available here.

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