Transgender Benefits Revisited?

In a series of tweets published on July 26, 2017, President Trump announced a ban on transgender service in the armed forces.  In the wake of this reversal of government policy, employers may question the current state of transgender benefits and whether additional changes are forthcoming.

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act (“Section 1557”), which prohibit, in part, the categorical refusal of coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity.  As a result of these changes, many employer group health plans started covering an array of transgender benefits ranging from mental health counseling to gender reassignment surgery. Read More ›

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2017 HIPAA Enforcement – Appears Not To Be Slowing Down

To state the obvious, there has been some uncertainty regarding how the Trump Administration will affect federal agency enforcement efforts.  However, at least, in regard to HIPAA Privacy and Security, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”), appears to be unchanging in its previous course.

In the first four months of 2017, OCR has already announced seven settlements with covered entities and business associates with fines totaling over $14 million.  For some context, OCR assessed over $23.5 million in 2016, which was a record-breaking year.  These settlements are in addition to Phase 2 of OCR’s Privacy, Security, and Breach Notification Audit Program, which started in 2016 and is likely still underway. Read More ›

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Trumping the Affordable Care Act? Not So Fast – Impact of Executive Order on Employers Unclear

On January 20, 2017, President Trump signed an Executive Order (“Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” hereinafter referred to as the “Order”) relating to the future of the Affordable Care Act (“ACA”).  The stated goal is to direct the agencies (IRS, HHS, and DOL) to waive or defer provisions of the ACA that would “impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products or medications.”  Notoriously absent from this list is any mention of employers or plans.  Read More ›

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A Deeper Dive: Employers Receiving Federal Funding May Be Subject to ACA’s Nondiscrimination Rule and Need to Cover Transgender Benefits

In recent months, we have written a fair amount about providing transgender benefits in light of the nondiscrimination provisions of the Affordable Care Act. Our blogs of March 30, 2016 and June 22, 2016 highlight the key contours of the nondiscrimination rule.  In our June 22 post, we mention in passing that the final nondiscrimination rule applies to any health program or activity, any part of which receives funding from the Department of Health and Human Services (“HHS”).  This blog provides additional clarity on what it means for a group health plan or an employer to receive federal financial assistance (“FFA”) and, by consequence, become subject to the nondiscrimination provisions of the Affordable Care Act. Read More ›

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You Received a Health Insurance Marketplace Notice from HHS – Now What?

Take a deep breath.  The HHS Health Insurance Marketplace Notice (the “Notice”) may seem to be a nuisance, but it does not necessarily mean that you will be subject to employer shared responsibility penalties.

First, the IRS, not HHS, assesses employer shared responsibility penalties, and the IRS does so only after it provides employers with:  (1) a “certification” that one or more employees received a premium tax credit; and (2) an opportunity to respond to the certification.

Second, an individual may have incorrectly reported on his application that he was eligible for a premium tax credit (or cost-sharing reductions) because:  (1) he did not receive an offer of health coverage from you; (2) he did receive an offer of health coverage from you, but it was unaffordable or it failed to provide minimum value, or (3) he was in a waiting period and was unable to enroll in health care coverage.  Read More ›

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Transitioning to Coverage: Three Things to Know About the New Transgender Healthcare Regulations

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act. As we discussed in our March 30, 2016 blog, the rule prohibits discrimination on the basis of sex and gender identity in the provision of health programs.  In application, the final regulations prohibit the categorical refusal of coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity.

  1. When are the final regulations effective?

The final rule generally is effective July 18, 2016. However, group health plans and health insurance need not be modified to comply with the new nondiscrimination rules until the first day of the first plan year (in the individual market, policy year) beginning on or after January 1, 2017. Read More ›

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HHS Extends November 17 Deadline to Submit Covered Lives Data under Reinsurance Program

The Health Care Reform Act created the transitional reinsurance program, which requires most self-insured health plans to make contributions to HHS for the 2014, 2015, and 2016 calendar years, in an attempt to stabilize premiums in the individual market.  The contribution amount is determined by the number of covered lives under each plan.  For 2014, the contribution amount is $63 per covered life.  The number of covered lives must be calculated and submitted to HHS by November 15 of each year.  The first filing was due November 17, 2014 for the 2014 calendar year (November 15, 2014 was a Saturday).

HHS has extended this November 17, 2014 deadline until December 5, 2014Read More ›

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HIPAA Business Associates Agreements – Reminder of September 22 Deadline

On January 17, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule under HIPAA making substantial changes to the rules for vendors that provide services to HIPAA-covered plans, such as third-party administrators, pharmacy benefit managers and certain brokers – known in the HIPAA world as “Business Associates.” Under this final rule, Business Associates are required, for the first time, to comply with the HIPAA Security Rule, many provisions of the HIPAA Privacy Rule and are subject to direct enforcement by HHS. As a brief reminder, and as we discussed in our Employee Benefits Update 2013 End of Year Plan Sponsor “To Do” List Part 2 – Health and Welfare, existing agreements with Business Associates must be amended to comply with the requirements of this final rule on or before September 22, 2014. Read More ›

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