USA: Alliant’s Employee Benefits Compliance & Fast Facts – April 14, 2017
The following information was provided to us by Asinta Partner in the United States, Alliant.
State Specific All Payer Claims Databases Requests are Voluntary
Historically, at least 17 states maintained state-mandated all payer claims databases (APCD). These states required self-funded plans or their TPAs to report on payments relating to health care claims and other information (including costs, prices, quality, utilization or resources required and certain data relating to health insurance claims and enrollment) relating to health care services. The stated purpose to this reporting is to help states understand rising health care costs. A Vermont disclosure requirement challenged by a self-funded plan sponsor was addressed by the Supreme Court last year (Gobeille v. Liberty Mutual Insurance Company). The Court held that ERISA preempted these state disclosure requirements. Plans and TPAs still receive these requests for disclosure but responding to them is now voluntary. TPAs and plan sponsors should decide collaboratively whether they want to respond to these requests considering time and cost requirements.
Exchange Appeal Materials
Clients are continuing to receive notices from Exchanges saying they may be subject to an Employer Shared Responsibility Payment (e.g. Pay or Play penalty) because an employee has enrolled in subsidized Exchange coverage. Clients should appeal Exchange letters with any incorrect information. As a reminder, HHS has issued an optional appeal form that can be used for appeals in Federally-facilitated exchanges or for Exchange appeals in California, Colorado, District of Columbia, Kentucky, Maryland, Massachusetts, New York or Vermont. Employers can still appeal an Exchange notice by letter but the form simplifies the appeal process. Feel free to share our sample completed appeal form along with our FAQ “What to Do If You Get a Letter from an Exchange”.
Webinar Follow-Up
Thank you to everyone who attended our latest national webinar on Wednesday. The slides along with the applicable HRCI and SHRM certificate information have been posted to the portal. A recording of the webinar can be viewed here. To view the recording, please click on register now and after completing a quick registration, the event will begin. The link to the recording can also be sent directly to clients.
FFF Client Friendly Reminder
Starting in 2017, the compliance team has made a client friendly version of FFF. The client friendly versions are attached each week in a PDF and a Word copy. The client versions remove any staff information or links to our portal. The PDF version can be sent to clients as is, and the Word version is provided if account teams wish to personalize the content. As a reminder, clients do not have access to our portal. If you forward a client the FFF e-mail as it is sent out to staff, any link to the portal will not work for them. Also, the portal underwent a server change on March 18, 2017. Any link to the portal in any e-mail from before March 18, 2017 will no longer work. The content is still available on the portal, but the link is outdated.
FAQ of the Week
- Will the Insurance Providers Fee Resume in 2018?
- Yes. The ACA imposes an annual fee on certain entities engaged in the business of providing health insurance. The fee is assessed and paid on a calendar-year basis using data from the preceding calendar year. Legislation enacted in late 2015 suspended collection of the annual fee that would be due in the 2017 calendar year based on 2016 data. There has been no indication that the moratorium will be extended. The 2017 moratorium will also have no effect on the fee amount for the 2018 fee year. IRS and CMS released FAQs on the moratorium available here and here.
Thanks to Alliant for providing us with this content. If you have any questions regarding compliance in the United States, please get in contact with Alliant via their contact page here.