Monday, December 1, 2014

New Deadline For Transitional Reinsurance Fee - 12/5/15

From Scott Benefit Services

The Affordable Care Act (ACA) imposes a fee on health insurance issuers and self-funded group health plans in order to fund a transitional reinsurance program for the first three years of Exchange operation (2014-2016). The fees will be used to help stabilize premiums for coverage in the individual market.
Entities that must pay these fees, called “contributing entities,” are generally required to submit their annual enrollment count to the Department of Health and Human Services (HHS) by Nov. 15 of each benefit year. To do this, contributing entities must register on and complete a contribution form for the year.

For the 2014 benefit year, the regulatory deadline for submitting the reinsurance fee contribution form is Nov. 15, 2014. An FAQ initially extended this deadline until Monday, Nov. 17, 2014, since Nov. 15 was a Saturday. However, on Nov. 14, 2014, the Centers for Medicare & Medicaid Services (CMS) further extended the regulatory deadline for contributing entities to submit their 2014 enrollment counts until 11:59 p.m. on Dec. 5, 2014. The payment deadlines (Jan. 15, 2015, and Nov. 15, 2015) remain the same.
The contribution form that will be used to submit annual enrollment counts became available Oct. 24, 2014. HHS also provided an Annual Enrollment and Contributions Submission Form Manual and a Supporting Documentation Job Aid Manual.

Contributing Entities

A contributing entity is defined as a health insurance issuer or a third-party administrator (TPA) on behalf of a self-insured group health plan. However, certain types of coverage are excluded from paying reinsurance fees.

·      Fully-insured Group Health Plans—For insured health plans, the issuer of the health insurance policy is required to pay reinsurance fees. However, issuers will likely shift the cost of the fees to sponsors through premium increases.

·      Self-insured Group Health Plans—For self-insured group health plans, the plan sponsor is liable for paying reinsurance fees, although a TPA or an administrative-services-only (ASO) contractor may pay the fee at the plan’s direction. For a plan maintained by a single employer, the employer is the plan sponsor.

Wednesday, November 5, 2014

Thoughts on the Election

After the election results last night many people will wonder  how the shift in power in the senate will impact the ACA legislation. It will certainly be interesting to see how aggressive the GOP is out of the gate in attacking the ACA. One thing is certain, and that is that it won’t be repealed. Even though the GOP has the majority they don’t have a veto-proof majority and the President will certainly veto any attempts to repeal the law and in on record stating as much.  The thought is that the GOP will attempt to defund aspects of the ACA as opposed to attempting to repeal it.

The challenge for the GOP is that the proverbial “toothpaste” is already out of the tube. 8 million people received subsidies this year so to take that away poses a pretty significant political challenge. I imagine the GOP will attempt to rewrite certain aspects of the law that fit its agenda but again, the veto pen looms if it isn’t something that the President can agree with.

All in all we can expect a bit of chaos once again relative to the ACA legislation, which means now more than ever it will be important to stay on top of the latest developments with ACA to stay compliant and in the know. At Scott we are positioned well and ready for the challenge will continue to be a leader in our market relative to ACA compliance and information.
Greg Stancil
Director of Healthcare Reform

Saturday, November 1, 2014

HPID Requirement Delayed Until Further Notice

Statement of Enforcement Discretion regarding 45 CFR 162 Subpart E - Standard Unique Health Identifier for Health Plans

Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F). This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.

On September 23, 2014, the National Committee on Vital and Health Statistics (NCVHS), an advisory body to HHS, recommended that HHS rectify in rulemaking that all covered entities (health plans, healthcare providers and clearinghouses, and their business associates) not use the HPID in the HIPAA transactions. This enforcement discretion will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps.

Monday, September 22, 2014

IRS releases notice 2014-55

The IRS recently issued notice 2014-55

This notice expands the application of the permitted change rules for health coverage under a § 125 cafeteria plan (cafeteria plan). In particular, this notice addresses two specific situations in which a cafeteria plan participant may wish to revoke, during a period of coverage (commonly a plan year), the employee’s election for employer-sponsored health coverage under the cafeteria plan in order to purchase a Qualified Health Plan through a competitive marketplace established under § 1311 of the Patient Protection and Affordable Care Act, commonly referred to as an Exchange or a Health Insurance Marketplace (Marketplace). The first situation involves a participating employee whose hours of service are reduced so that the employee is expected to average less than 30 hours of service per week but for whom the reduction does not affect the eligibility for coverage under the employer’s group health plan. (This may occur, for example, under certain employer plan designs intended to avoid any potential assessable payment under § 4980H of the Internal Revenue Code.) The second situation involves an employee participating in an employer’s group health plan who would like to cease coverage under the group health plan and purchase coverage through a Marketplace without that resulting either in a period of duplicate coverage under the employer’s group health plan and the coverage purchased through a Marketplace or in a period of no coverage.

This notice permits a cafeteria plan to allow an employee to revoke his or her election under the cafeteria plan for coverage under the employer’s group health plan (other than a flexible spending arrangement (FSA)) during a period of coverage in each of those situations provided specified conditions are met. The Treasury Department and the IRS intend to modify the regulations under § 125 consistent with the provisions of this notice, but taxpayers may rely on this notice immediately.

To access the full notice click here.

Thursday, September 18, 2014

Understanding the Health Plan Identifier Requirement

By now, most of us have heard about the HPID and if you’ve tried to ascertain if or how it applies to you or your client, you’ve come up with more questions than answers. 

Why an HPID?
In 2012 the Affordable Care Act required the adoption of a standard Unique Health Plan Identifier (HPID) to be used in covered HIPAA standard transactions.  There are currently many different health plan number combinations in regards to length, number and letter combination which can make identification a frustrating process.  The HPID ten-digit number will be a standardized number to identify a health plan.  HHS foresees a publicly accessible searchable database where these numbers can be looked up for billing information, eligibility, and other high level information. 1 

Part of the complexity with this rule includes an intentional ambiguity on the part of HHS.  The goal is for controlling health plans and subhealth plans to obtain an HPID in a way that best fits their business model. 2

Who needs an HPID and when?

Large Health Plans (receipts of $5M or greater) need to obtain their HPID by November 5th, 2014.
Small Health Plans (receipts of less than $5M) need to obtain their HPID by November 5th, 2015.
Full implementation for using HPID in standard transactions is November 7th, 2016.3
The carriers for most Fully Insured health plans have or are releasing information about their plans to apply for an HPID.  Self-funded health plans need to apply for their own HPID if they meet the definition of a Controlling Health Plan as defined below. 4 

Am I a Controlling Health Plan (CHP) or a Subhealth Plan (SHP)?

Controlling Health Plan (CHP): a health plan that—
1. Controls its own business activities, actions, or policies; or
2. Is controlled by an entity that is not a health plan; and if it has a subhealth plan, exercises sufficient control over the subhealth plan(s) to direct its/their business activities, actions, or policies.
If either or both of those statements apply to you, you meet the requirements of a Controlling Health Plan.

Subhealth Plan (SHP): a health plan whose business activities, actions, or policies are directed by a controlling health plan. 5
Subhealth Plans are not required to apply for their own HPID.  Their CHP may apply for an HPID for their SHP or require the SHP to apply for their own HPID. 

Commonly Asked Questions:

Q. I got my HPID number.  Now what?
A. The HPID will be used in HIPAA standard transactions so that health plans can be identified.

Q. The HPID Application asks for a Payor ID or NAIC number and I don’t have either?  What should I put in the field and will it cause issues with my application?
A. If you do not have a Payor ID or NAIC number, CMS has advised that an applicant fill in “not applicable” in the field.  It should not cause issues with your application.  If an issue does arise, contact the HIOS Help Desk at 1-877-343-6507 or email at

Q. How long should the application take for me to complete?
A. There are 4 steps to the application and you will have to wait to receive approval after each step which can take up to 24 hours at this time. 

Q. Under the User Roles section of the application, am I a Submitter or an Authorizing Official?
A. There are 2 applicable HPOES user roles in regards to completing your HPID application.  You can only select to be one role at a time and both roles need to be filled by an applicable party.  If you register as a Submitter, you can enter the Authorizing Official’s information on a later screen.
Submitter User: A representative of a health plan or other entity that submits an application.
Authorizing Official User: A company executive that has the authority to approve applications, including CEOs and CFOs.



1 Federal Register Vol. 77 No. 172; 45 CFR Part 162 II.2.C
NCVHS Meeting Notes from 9/20/12
Federal Register Vol. 77 No. 172; 45 CFR Part 162 Chart 1
Federal Register Vol. 77 No. 172; 45 CFR Part 162 II.2.A.
5 Federal Register Vol. 77 No. 172; 45 CFR Part 162 II. A.

Friday, September 12, 2014

Virginia Governor Abandons Plan for Large Medicaid Expansion

Virginia Gov. Terry McAuliffe announced this week a plan to expand medicaid to around 25,000 uninsured Virginians.  This is a much smaller group than the 400,000 he had previous hoped to offer coverage.

For the Washington Post Article click here.

Tuesday, July 29, 2014

IRS Releases Draft Forms for Employer Reporting of Health Coverage

The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056. Under these new reporting rules, certain employers must provide information to the IRS about the health plan coverage they offer (or do not offer) to their employees.

On July 24, 2014, the Internal Revenue Service (IRS) released draft versions of the following forms that employers will use to report under Sections 6055 and 6056:

To view the Scott Healthcare Reform Bulletin click here.