The Washington Report
July 21, 2021
Note to Subscribers
The Washington Report will not be published on July 28, 2021. Look for your next Aon Washington Report on Wednesday, August 4, 2021.
Departments Issue FAQs on ACA Implementation, Part 47
On July 19, 2021, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) published Frequently Asked Questions (FAQs) regarding implementation of the Affordable Care Act (ACA). The FAQs discuss coverage of preventive services and specifically address the following:
Q1: Are plans and issuers required to provide coverage without cost-sharing for items or services that the United States Preventive Services Task Force (USPSTF) recommends should be received by a participant, beneficiary, or enrollee prior to being prescribed anti-retroviral medication as part of the determination of whether such medication is appropriate for the individual and for ongoing follow-up and monitoring?
Q2: May a plan or issuer use reasonable medical management techniques to restrict the frequency of benefits for services specified in the USPSTF recommendation for pre-exposure prophylaxis (PrEP), such as HIV and sexually transmitted infections screening, in a manner specified under other existing USPSTF recommendations, or otherwise?
Q3: When may a plan or issuer use reasonable medical management techniques with respect to coverage of PrEP?
The latest FAQs are available here.
Previous FAQs are available here and here.
CMS Releases Proposed Regulations on PFS and Other Changes to Part B Payment Policies; Addresses Health Equity and Patient Access
On July 13, 2021, the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) released proposed regulations on the annual Physician Fee Schedule (PFS). The rules are meant to “strengthen and build upon Medicare by promoting health equity; expanding access to services furnished via telehealth and other telecommunications technologies for behavioral health care; enhancing diabetes prevention programs; and further improving CMS’s quality programs to ensure quality care for Medicare beneficiaries and to create equal opportunities for physicians in both small and large clinical practices.”
The proposed regulations address: changes to the PFS; other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; Medicare coverage of opioid use disorder services furnished by opioid treatment programs; updates to certain Medicare provider enrollment policies; requirements for prepayment and post-payment medical review activities; requirement for electronic prescribing for controlled substances for a covered Part D drug under a prescription drug plan, or a Medicare Advantage Prescription Drug plan; updates to the Medicare Ground Ambulance Data Collection System; changes to the Medicare Diabetes Prevention Program expanded model; and amendments to the physician self-referral law regulations. The proposed regulations also:
- Seek feedback on health equity data collection;
- Expand telehealth and other telecommunications technologies for behavioral and mental health care;
- Update vaccine payment rates; and
- Propose to phase out coinsurance for colorectal screening additional services.
Please refer to the proposed regulations for details on the various provisions. Comments on the proposed regulations are due by September 13, 2021.
The CMS press release is available here.
The CMS Fact Sheet is available here.
The proposed regulations are available here.
IRS Updates Correction Changes to EPCRS
On July 16, 2021, the Internal Revenue Service (IRS) released Revenue Procedure 2021-30, which makes changes and revisions to the Employee Plans Compliance Resolution System (EPCRS). The EPCRS permits retirement plan sponsors to correct plan failures. The EPCRS offers three correction programs:
- Self-Correction Program (SCP) – To correct certain plan failures without contacting the IRS or paying a user fee;
- Voluntary Correction Program (VCP) – To correct failures not eligible for SCP and to get the written approval of the IRS that the failures were properly corrected; and
- Audit Closing Agreement Program (CAP) – To resolve failures discovered during an IRS audit (that have not been corrected by the VCP or SCP).
Most notably, Revenue Procedure 2021-30 adds two new benefit overpayment correction methods. The new guidance will permit employers to not require participants or beneficiaries to repay the overpayment if the plan satisfies a specified funding level, or the amount to be recouped may be limited to the extent it results in a correction of prior plan contributions. The Revenue Procedure includes information on recoupment efforts that are not permitted, as well as those that are not required.
Additionally, Revenue Procedure 2021-30 eliminates the VCP anonymous submission procedure (effective January 1, 2022) and adds an anonymous, no-fee, VCP pre-submission conference procedure. The Revenue Procedure also expands correction by plan amendment under the SCP, extends the end of the SCP correction period for significant failures by one year, and extends the sunset of the safe harbor correction method for certain missed elective deferrals by three years. To the extent helpful, the Revenue Procedure also increases from $100 to $250 the threshold for certain de minimis amounts for which a plan sponsor is not required to implement correction. With limited exceptions, the Revenue Procedure is effective July 16, 2021.
For specific information on the new correction methods, please refer to Revenue Procedure 2021-30.
IRS Revenue Procedure 2021-30 is available here.
Departments Issue Interim Final Regulations Prohibiting Surprise Medical Bills
Just six months ahead of the effective date for employer group health plans, the Departments of Labor, Treasury, and Health and Human Services (the Departments) have jointly issued interim final regulations (the IFR) implementing portions of the No Surprises Act (the Act), which was enacted as part of last year’s Consolidated Appropriations Act. The Act is intended to protect patients from large “surprise” medical bills incurred from emergencies and from services and procedures that are performed by out-of-network providers at in-network facilities.
This Aon bulletin discusses the following provisions of the IFR as they relate to group health plans:
- Plans to which the requirements apply;
- Prohibition on preauthorization for emergency services;
- Determining cost-sharing amounts for participants;
- Out-of-network rate paid by plans;
- Notice and consent provisions; and
- Other provisions.
The bulletin is available here.
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