Thursday, May 10, 2018


If your organization offers, or is in the process of considering a Wellness Program…HOLD THE PHONE!  There is pending litigation involving the American Association of Retired Persons (AARP) and the U.S. Equal Employment Opportunity Commission (EEOC) that could profoundly alter the regulatory and compliance requirements associated with certain Wellness Programs. Generally speaking, the rules and regulations affecting Wellness Programs, apply to those defined as “health contingent” and “outcome based”.

Thursday, May 25, 2017

ACA Update – Phase 1 of 3 Toward Change

On May 4, 2017, the U.S. House of Representatives passed an amended version of the “American Health Care Act” or AHCA, on a 217-213 vote tally. In and of itself, this vote DOES NOT ALTER THE HEALTHCARE/HEALTH INSURANCE LANDSCAPE! There are a number of phases (at least 3, but likely several more procedural steps) that must be completed in order for the Affordable Care Act (ACA) to be partially repealed. And to be clear, the AHCA would represent a partial, piecemeal repeal of the ACA, and would in fact, retain much of the ACA. So here’s where we are and what we know, as of today…

Saturday, October 1, 2016

Medicare Part D Notice Requirement

Each year, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D to the Centers for Medicare and Medicaid Services (CMS) whether their health plan’s prescription drug coverage is creditable. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2016,the start date of the annual enrollment period for Medicare Part D.

Thursday, March 3, 2016

2016 ACA Compliance Updates

By one count (The Galen Institute); there have been seventy (70) significant changes, delays, modifications, and partial repeals of the Affordable Care Act (ACA)/Obamacare to date. (For those keeping score at home, 43 have come from the White House; 24 from Congress; and 3 from the Supreme Court.) The challenges for stakeholders lie not only in developing sound, effective compliance strategies, but in keeping up with the various fits and starts of the law. In addition, various penalties, fees, taxes, limits, and safe harbors are indexed for inflation, and thus, subject to change on an annual basis. Listed below are some of the more relevant and timely announcements which impact ACA compliance in 2016 and beyond:

Saturday, August 8, 2015

Important ACA Modification Law Passed – PACE Act

Yesterday (October 7, 2015) the President signed the Protecting Affordable Coverage for Employees, or PACE Act, giving states the flexibility to define “small employer group”, for purposes of the Affordable Care Act (ACA). The PACE Act also redefines the definition of small employer to 1 – 50 employees. This is an extremely important tweak to the ACA, especially for employer groups that employ between 50 – 100 full and part-time employees.

Wednesday, July 15, 2015

ACA 2016 Maximum Out of Pocket Limit and CDH Plans

Recent guidance issued by the trilogy of Affordable Care Act (ACA) compliance and enforcement -Departments of Labor/Treasury/Health Human Services; could have a major impact on many of the Consumer Driven Health Plans (CDHPs) currently in force, starting in 2016. In short, the recently published guidance (released in the form of an FAQ) indicates that the annually published ACA out of pocket maximums affect so called aggregate family deductibles that are a part of many CDHPs. CDHPs that utilize embedded family deductibles and grandfathered plans would not be impacted by the change. Here’s what all of this means…

Wednesday, July 8, 2015

Supreme Court Rulings Affecting Employee Benefits

The Supreme Court of the United States (SCOTUS) recently issued separate rulings affecting the health insurance and employee benefits sectors. The “King v. Burwell” decision assures that health insurance subsidies will continue to be provided to eligible individuals in all states, even those that don’t have a “state based health insurance exchange”. And the “Obergefell v. Hodges” ruling held that state laws (in 14 states) banning same sex marriages were unconstitutional. While the former ruling affecting ACA subsidies will primarily assure continuation of previously implemented aspects of the law, and prevent what could have been serious disruption, chaos, and premium rate impact; the later ruling will require examination of, and changes to many policies and procedures. Here’s a brief overview of the more pertinent areas deserving attention…

Tuesday, June 2, 2015

Disproportionate Hospital Share (DSH) Payment Change

The Affordable Care Act (ACA) changed the method used to compensate hospitals for disproportionate share, sometimes referred to as DSH. This new method applies to charges “effective on or after fiscal year (FY) 2014. Under the new method, eligible hospitals receive 25% of the former “DSH” amount, and additional funds as follows:

Wednesday, April 29, 2015

Redefinition of Small Group

2016 is shaping up to be yet another impactful Affordable Care Act (ACA) year, particularly for employers with 51-100 employees (full and part-time). The two year reprieve from the ACA’s employer mandate/share responsibility for such employers ends beginning in 2016. But perhaps more importantly, and having a potentially greater impact, is the redefinition of what constitutes a so called SMALL EMPLOYER. Plans that begin or renew on or after 1/1/2016 that are: (i) fully insured; (ii) non-grandmothered*; and (iii) have 1-100 employees, will be required to comply with certain ACA regulations heretofore applicable only to fully insured groups with fewer than 51 employees. Let’s take a look at the impact of this redefinition…

Wednesday, April 15, 2015

Healthcare Payment Alternatives

Back in the 1960’s, the average cost of an overnight hospital admission was around $100. Not coincidentally, most health insurance plans at the time set their deductible amounts somewhere between $0 and $100. Today, adjusting for geographical differences, PPO discounts, etc., an overnight stay in a hospital will run you between $1,700 – $2,500. According to the Kaiser Family Foundation (KFF), the average health insurance plan deductible in 2014 for an individual covered by employer based coverage was $1,214 (up from $826 in 2009). Smaller employers (fewer than 200 employees) tend to have higher deductibles (nearly $1,800); while larger employers lean toward lower deductibles ( $971). Clearly, there is a relationship between health insurance deductible amounts, and the average cost of an overnight hospitalization.