Compliance Now

JUNE 28, 2023

By: Megan Diehl, MZQ Consulting Late last week, the IRS published additional guidance modifying the COVID-19 coverage that high deductible health plans (HDHPs) can provide while maintaining their HSA-qualified status. This notice was provided in response to the end of the COVID-19 Public Health Emergency (PHE) and National Emergency Period. HSA participants can only contribute to their HSA accounts if they are enrolled in an HSA-qualified HDHP and have no other disqualifying coverage.

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COVID-19 COVID-19 Vaccine Public Health 100

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JUNE 14, 2023

By: Jennifer Berman, CEO, MZQ Consulting Over the past several years, the employer-plan marketplace has seen a rise in “fixed-indemnity wellness policies,” which promise to help both employers and employees save on income and employment taxes. Under these arrangements, employees elect to defer cash on a pre-tax basis through a Section 125 cafeteria plan and then receive reimbursements (that are not taxed) through their employer for participating in certain “wellness-related” activities.

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Hospitals 100

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JUNE 1, 2023

By Jessica Waltman, Principal, Forward Health Consulting The federal Section 125 “cafeteria plan” regulations permit health plans to reimburse participants for qualifying medical and dependent care expenses on a pre-tax basis through health flexible spending accounts (FSAs) and dependent care assistance plans (DCAPs) if those claims are properly and fully substantiated.

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MAY 18, 2023

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting On May 16, 2023, the Internal Revenue Service released updates to the maximum annual 2024 contribution limits for health savings accounts (HSAs) under high deductible health plans (HDHPs). These limits, which have increased slightly from 2023, apply to both individual and family coverage.

Compliance 100

Compliance 100

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APRIL 12, 2023

By Jennifer Berman, CEO, MZQ Consulting On April 10, 2023 , President Biden signed H.J. Res. 7 into law, thereby ending the national state of emergency related to COVID-19 that was declared under the National Emergencies Act. Separately, the Biden Administration has announced that May 11, 2023 will be the last day of the National Public Health Emergency (the “PHE”) declared by the Department of Health and Human Services and its target date for wrapping up other COVID-19-related emergency actions

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COVID-19 Medicaid Medicaid Public Health 189

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DECEMBER 30, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. On December 23, 2022, the Consolidated Appropriations Act, 2023 (CAA23) was signed into law. While this legislation does not include as many health provisions as the CAA of 2021, it does include the anticipated relief on telehealth coverage offered through qualified High Deductible Health Plans (HDHPs) that pair with Health Savings Accounts (HSAs).

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Compliance Now

AUGUST 22, 2022

By: Jennifer Berman, CEO, MZQ Consulting. On Friday, August 19, 2022, the Departments of Labor, Health and Human Services, and Treasury (the Departments) issued updated FAQs addressing the No Surprises Act and the Transparency in Coverage Rules. These FAQs directly address an issue related to the Transparency in Coverage Rules (the TiC Rules) that has been causing consternation for employers across the country—are they really required to post a link to their machine-readable files on their publ

Compliance 100

Compliance 100

Compliance Now

SEPTEMBER 7, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. The Consolidated Appropriations Act of 2021 (CAA) introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, and providers. The federal Departments of Health and Human Services, Labor, and Treasury recently released a document discussing frequently asked questions (FAQs) about these surprise billing protections that provides clarity on a number of topics within

Licensing 100

Licensing Health Insurance Hospitals 100

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SEPTEMBER 9, 2022

Many sponsors of fully insured health plans either already have or will soon receive checks from their insurance carriers, along with a notice informing them that the check is a medical loss ratio (MLR) rebate. Plan sponsors should receive these checks by September 30, 2022. The MLR rules implemented as part of health care reform are designed to ensure that insurance carriers spend no more than a specified percentage of premiums collected on overhead-type expenses.

Health Care Reform 100

Health Care Reform Governance 100

Compliance Now

SEPTEMBER 27, 2022

By: Lee Spiegel, Director, Compliance, MZQ Consulting. The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Coverage that is deemed creditable is expected to cover, on average, at least as much as the standard Medicare Part D prescription drug plan, whereas non-creditable coverage falls below this threshold.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

OCTOBER 13, 2022

By Jessica Waltman. The Biden Administration issued a final regulation and a new IRS notice on October 11, 2022, which eliminate the Affordable Care Act’s (ACA) “family glitch” beginning on January 1, 2023. The “glitch” refers to the fact that the ACA’s current affordability standard is based on what a single person pays for employer-sponsored coverage in all circumstances.

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ACA Health Insurance Hospitals 100

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OCTOBER 19, 2022

By Jessica Waltman, Principal, Forward Health Consulting. On October 18, 2022, the Internal Revenue Service issued Revenue Procedure 2022-38 that sets forth various 2023 tax-related limits that have been adjusted for inflation. The table below identifies updates to the 2023 health and fringe benefit plan limits addressed in the notice. Benefit 2022 2023 Maximum Annual Employee Contribution to a Health Flexible Spending Account (Health FSA) $2,850 $3,050 Health FSA Carryover Limit $570 $610 Adopt

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Compliance Now

NOVEMBER 21, 2022

By: Megan Diehl , Manager, Compliance Consulting, MZQ Consulting. The Patient-Centered Outcomes Research Institute (PCORI) fee established by the Affordable Care Act helps fund research to evaluate and compare health outcomes, clinical effectiveness, risks, and benefits of medical treatment and services. The fee is currently in place through 2029. In Notice 2022-59 , the IRS announced that the PCORI fee for plan years ending between October 1, 2022 and September 30, 2023 is $3.00.

Health Outcomes 100

Health Outcomes Compliance 100

Compliance Now

DECEMBER 20, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The end of the 2022 calendar year is fast approaching, and with it come numerous deadlines that can directly or indirectly impact employer group health plans. Below is an overview of several items that plan sponsors should be mindful of this season. The Affordable Care Act’s Employer Mandate.

Compliance 100

Compliance COVID-19 ACA Governance 100

Compliance Now

DECEMBER 22, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The Department of Health and Human Services has announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2024 plan year. To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below.

ACA 100

ACA Compliance Hospitals 100

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DECEMBER 28, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. Late in the afternoon on December 23, 2022, the Administration issued Affordable Care Act FAQ #56 , and in doing so gave a little holiday gift to all group health plans nationwide. The guidance establishes limited deadline and enforcement relief for the 2020 and 2021 Prescription Drug Data Collection (RxDC) submissions that were due by December 27, 2022.

Health Insurance 100

Health Insurance Compliance Medicaid Medicaid 100

Compliance Now

DECEMBER 22, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The Department of Health and Human Services has announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2024 plan year. To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below.

ACA 100

ACA Compliance Hospitals 100

Compliance Now

DECEMBER 20, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The end of the 2022 calendar year is fast approaching, and with it come numerous deadlines that can directly or indirectly impact employer group health plans. Below is an overview of several items that plan sponsors should be mindful of this season. The Affordable Care Act’s Employer Mandate.

Compliance 100

Compliance COVID-19 ACA Governance 100

Compliance Now

NOVEMBER 21, 2022

By: Megan Diehl , Manager, Compliance Consulting, MZQ Consulting. The Patient-Centered Outcomes Research Institute (PCORI) fee established by the Affordable Care Act helps fund research to evaluate and compare health outcomes, clinical effectiveness, risks, and benefits of medical treatment and services. The fee is currently in place through 2029. In Notice 2022-59 , the IRS announced that the PCORI fee for plan years ending between October 1, 2022 and September 30, 2023 is $3.00.

Health Outcomes 100

Health Outcomes Compliance 100

Compliance Now

OCTOBER 19, 2022

By Jessica Waltman, Principal, Forward Health Consulting. On October 18, 2022, the Internal Revenue Service issued Revenue Procedure 2022-38 that sets forth various 2023 tax-related limits that have been adjusted for inflation. The table below identifies updates to the 2023 health and fringe benefit plan limits addressed in the notice. Benefit 2022 2023 Maximum Annual Employee Contribution to a Health Flexible Spending Account (Health FSA) $2,850 $3,050 Health FSA Carryover Limit $570 $610 Adopt

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Compliance Now

OCTOBER 13, 2022

By Jessica Waltman. The Biden Administration issued a final regulation and a new IRS notice on October 11, 2022, which eliminate the Affordable Care Act’s (ACA) “family glitch” beginning on January 1, 2023. The “glitch” refers to the fact that the ACA’s current affordability standard is based on what a single person pays for employer-sponsored coverage in all circumstances.

ACA 100

ACA Health Insurance Hospitals 100

Compliance Now

SEPTEMBER 28, 2022

By: Lee Spiegel, Director, Compliance, MZQ Consulting. The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Coverage that is deemed creditable is expected to cover, on average, at least as much as the standard Medicare Part D prescription drug plan, whereas non-creditable coverage falls below this threshold.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

SEPTEMBER 9, 2022

Many sponsors of fully insured health plans either already have or will soon receive checks from their insurance carriers, along with a notice informing them that the check is a medical loss ratio (MLR) rebate. Plan sponsors should receive these checks by September 30, 2022. The MLR rules implemented as part of health care reform are designed to ensure that insurance carriers spend no more than a specified percentage of premiums collected on overhead-type expenses.

Health Care Reform 100

Health Care Reform Governance 100

Compliance Now

SEPTEMBER 7, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. The Consolidated Appropriations Act of 2021 (CAA) introduced numerous protections against surprise billing for plan participants that impact group health plans, health insurance issuers, and providers. The federal Departments of Health and Human Services, Labor, and Treasury recently released a document discussing frequently asked questions (FAQs) about these surprise billing protections that provides clarity on a number of topics within

Licensing 100

Licensing Health Insurance Hospitals 100

Compliance Now

AUGUST 22, 2022

By: Jennifer Berman, CEO, MZQ Consulting. On Friday, August 19, 2022, the Departments of Labor, Health and Human Services, and Treasury (the Departments) issued updated FAQs addressing the No Surprises Act and the Transparency in Coverage Rules. These FAQs directly address an issue related to the Transparency in Coverage Rules (the TiC Rules) that has been causing consternation for employers across the country—are they really required to post a link to their machine-readable files on their publ

Compliance 189

Compliance 189

Compliance Now

AUGUST 8, 2022

One of the most well-known components of the Affordable Care Act (ACA) is that it requires applicable large employers (ALEs) to either offer affordable, minimum value medical benefits to their full-time employees or pay tax penalties. The ACA defined a plan as being affordable if the lowest-cost, employee-only option costs less than 9.5% of the employee’s household income.

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ACA 100

Compliance Now

AUGUST 1, 2022

By: Jennifer Berman, CEO, MZQ Consulting. On July 28, 2022, the Departments of Labor, Health and Human Services, and Treasury (the “Departments”) issued new FAQs clarifying their interpretation of the ACA’s requirement that non-grandfathered health plans provide contraception to participants at no cost. The new FAQs were issued in response to President Biden’s recent Executive Order on reproductive health.

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FDA Medicare Medicare Governance 100

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JULY 15, 2022

In the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization , there have been two notable federal efforts to establish or reaffirm access to women’s reproductive healthcare services. First, the Departments of Health and Human Services, Labor and the Treasury (collectively, the Departments) released a letter at the end of June reiterating health plan responsibilities surrounding access to contraceptives under the ACA.

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ACA FDA Compliance 100

Compliance Now

JULY 11, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The Supreme Court has been the focus of a great deal of the national discourse over the past several weeks. In addition to the cases making headlines, the Court also issued a 7-2 ruling in a case directly related to employer sponsored health plans, Marietta Memorial Hospital Employee Health Benefit Plan v.

Medicare 100

Medicare Medicare Compliance Hospitals 100

Compliance Now

JUNE 27, 2022

By Jennifer Berman, CEO, MZQ Consulting. On Friday, June 24, the Supreme Court released its decision in Dobbs v. Jackson Women’s Health Organization finding that the United States Constitution does not guarantee a right to abortion access. This decision effectively overturns its prior decisions in Roe v. Wade and Planned Parenthood v. Casey. The decision will result in near immediate abortion bans in thirteen states.

ACA 100

ACA HIPAA Governance Compliance 100

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MAY 23, 2022

By: Jennifer Berman, CEO, MZQ Consulting. On May 10, Delaware Governor Carney signed the Healthy Delaware Families Act establishing a mandatory paid leave program, making Delaware the eleventh state to enact such a program. Contributions towards the program will begin on January 1, 2025. Benefits will be available starting January 1, 2026. The available benefits under this program are keyed to employer size.

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Compliance Now

MAY 5, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. The Centers for Medicare and Medicaid Services recently opened the much-anticipated federal Independent Dispute Resolution (IDR) Portal , a component of the No Surprises Act section of the Consolidated Appropriations Act of 2021 (the Act). The opening of the portal and newly released guidance are part of the implementation of the balance billing protections contained in the Act.

Medicaid 189

Medicaid Medicaid Medicare Medicare 189

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MAY 3, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. Late last week, the Internal Revenue Service released updates to the maximum annual 2023 contribution limits for health savings accounts (HSAs) under high deductible health plans (HDHPs). These adjustments, which have increased slightly from 2022, apply to both individual and family coverage.

Compliance 100

Compliance 100

Compliance Now

APRIL 13, 2022

Jennifer Berman, CEO, MZQ Consulting. On April 9, 2022, the Maryland General Assembly overrode Governor Larry Hogan’s veto of the Time to Care Act of 2022 to establish a mandatory paid leave program. This program will provide for up to 12 weeks of paid leave for all employees in the State who meet minimum eligibility criteria. Such benefits will be provided either through a State-based program known as the Family and Medical Leave Insurance (FAMLI) Program or by private employers who elect to op

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Compliance Now

APRIL 6, 2022

Jennifer Berman, CEO, MZQ Consulting. On April 5, 2022, the Administration issued new proposed regulations changing certain aspects of the affordability and minimum value rules under the Affordable Care Act (“ACA”). Notably, the rules only impact whether an individual is eligible for federally subsidized health insurance; they DO NOT change the affordability requirements for applicable large employers under the ACA’s employer mandate.

Health Insurance 189

Health Insurance ACA Hospitals 189

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MARCH 15, 2022

By: Jessica Waltman, Principal, Forward Health Consulting. Last week, Congress passed the Consolidated Appropriations Act (CAA) of 2022, a $1.5 trillion governmental funding package. Among its many provisions, the bill extends access to telehealth services for individuals who are covered under a health savings account (HSA)-qualified high deductible health plan (HDHP).

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COVID-19 Telemedicine Medicare Medicare 189

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MARCH 8, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. Under the ACA, non-grandfathered group health plans must provide benefits for “preventive care” on a first-dollar basis. This means such coverage must be provided at no cost to participants (i.e., no co-payments, co-insurance, or deductibles may be applied). For this purpose, preventive care includes: Evidence-based items or services with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF); Im

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ACA FDA Compliance 188