The Washington Report
April 11, 2018
Congress Resumes Session
The House and Senate returned to the Hill this week after a two-week spring recess.
Congress Resumes Session
On April 9, 2018, the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) issued final regulations that establish payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, cost-sharing parameters, and user fees for federally facilitated Exchanges and state Exchanges on the federal platform. The regulations finalize changes that provide additional flexibility to states to apply the definition of essential health benefits to their markets, enhance the role of states regarding the certification of qualified health plans (QHPs), and provide states with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. The regulations also include changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics. The final regulations become effective on June 18, 2018.
In addition to the final rule, on the same day CMS issued the following Affordable Care Act (ACA) guidance:
A Final Annual Issuer Letter: This letter provides operational and technical guidance to issuers that want to offer QHPs in the federally facilitated Exchanges for plan years beginning in 2019.
Guidance Expanding Hardship Exemptions: Under this hardship exemption guidance, individuals who live in counties with no issuers or only one issuer, will now qualify for a hardship exemption from paying the ACA’s penalty for not having coverage. According to CMS, the guidance also allows the agency to consider a broad range of circumstances that result in consumers needing hardship exemptions.
Guidance Extending the Transitional Policy for One Additional Year: This latest policy allows for the transition to fully ACA-compliant coverage in the individual and small group health insurance markets until 2019. CMS released this bulletin to provide states additional flexibility and control over their health insurance markets.
The CMS final regulations on the 2019 Notice of Benefit and Payment Parameters is temporarily available here.
(The final rule will be published in the April 17, 2018, Federal Register.)
A fact sheet on the 2019 Notice of Benefit and Payment Parameters is available here.
The CMS news release is available here.
The CMS Final Annual Issuer Letter is available here.
The CMS Guidance Expanding Hardship Exemptions is available here.
The CMS Guidance Extending the Transitional Policy is available here.
CMS Releases Final Rule on Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program
On April 6, 2018, CMS released a final rule that will revise the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Comprehensive Addiction and Recovery Act to further reduce the number of beneficiaries who may potentially misuse or overdose on opioids while still having access to important treatment options; implement certain provisions of the 21st Century Cures Act; support innovative approaches to improve program quality, accessibility, and affordability; offer beneficiaries more choices and better care; improve the CMS customer experience and maintain high beneficiary satisfaction; address program integrity policies related to payments based on prescriber, provider, and supplier status in the MA, Medicare cost plan, Medicare Part D, and Programs of All-Inclusive Care for the Elderly (PACE); provide an update to the official Medicare Part D electronic prescribing standards; and clarify program requirements and certain technical changes regarding treatment of Medicare Part A and Part B appeal rights related to premiums adjustments. The final rule becomes effective on June 15, 2018.
The CMS final rule is temporarily available here.
(The final rule will be published in the Federal Register on April 16, 2018.)
IRS Releases Notice on Expansion of Pension Plan Determination Letter Program
On April 5, 2018, the Internal Revenue Service (IRS) released Notice 2018-24. The Notice requests comments on the potential expansion of the scope of the determination letter program for individually designed plans during the 2019 calendar year, beyond provision of determination letters for initial qualification and qualification upon plan termination. According to the latest Notice, the Treasury Department and the IRS will review comments and then consider the factors regarding the scope of the determination letter program set forth in Section 4.03(3) of Revenue Procedure 2016-37, 2016-29 I.R.B. 136. The Treasury Department and the IRS will then issue guidance if they identify any additional types of plans for which plan sponsors may request determination letters during the 2019 calendar year. Comments on Notice 2018-24 are due by June 4, 2018.
IRS Notice 2018-24 is available here.
Now Available: Aon's 2018 U.S. Annuity Settlement Market Update
Aon’s 2018 U.S. Annuity Settlement Market Update provides a detailed overview of how innovation is driving market growth and shares insights for pension plan sponsors, as they continue to address cost and risk in an ever evolving market.
Key highlights include:
- Review of 2017 market activity
- Analysis of insurer pricing competitiveness
- Thoughts on market-driving themes for 2018
The Aon 2018 U.S. Annuity Settlement Market Update is available here.
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