As outlined in our prior Alert, the Obama administration recently announced a one-year delay in the effective date of three key provisions of the Patient Protection and Affordable Care Act (ACA): (1) the annual information reporting requirements applicable to insurers, self-insuring employers and certain other providers of minimum essential coverage, (2) the annual information reporting requirements applicable to large employers (i.e., those with 50 or more full-time equivalent employees); and (3) the employer shared responsibility provisions. These provisions of the ACA will now be fully effective for 2015.
Click here to read the full Alert, which provides highlights from the IRS Notice 2013-45.
In a July 2, 2013, blog posting on the U.S. Department of the Treasury website titled “Continuing to Implement the ACA in a Careful, Thoughtful Manner” the Obama administration announced that it will provide an additional year before the Patient Protection and Affordable Care Act’s (ACA) mandatory employer and insurer reporting requirements begin. These reporting requirements, which were originally scheduled to go into effect on January 1, 2014, will now be delayed until January 1, 2015. More significant is the fact that the Obama administration acknowledges that the delay in the reporting requirements will make it impractical to determine which employers owe shared responsibility payments for 2014. Therefore, the employer shared responsibility provisions will also not be applicable until 2015.
Click here to read the full Alert.
Mobile health (“mHealth”, “telehealth” or any other terms for health care delivered wirelessly) is revolutionizing the health care industry. That message resounded at last week’s mHealth Summit, which gathered roughly 4,000 investors and angel-funders, telecom and software companies, and entrepreneurs and developers to share ideas and display new mHealth products. Hot mHealth areas include data analytics, texting and medical records. Home health and medical homes also stand to benefit with the introduction of products designed to submit protected health information (“PHI”) and other data between patient and provider. Continue reading mHealth/Telehealth Investors and Entrepreneurs: The Generational Divide
Health care payors (plans, insurers) are emerging quickly as one of the dominant players in the mobile health (mHealth) marketplace. Apps to exchange information with patients regarding appointment reminders, to coordinated care among various providers for diabetes and other conditions, and to provide patients with personal health records (PHRs) are becoming all the rage. Payors command a unique place in the healthcare industry; not only do they receive and distribute the healthcare dollars but they maintain deep files of information on the consumers whose care they pay for. With their reserves of funds, payors are also uniquely positioned to invest in the use of mobile health in the delivery of health care. They can develop and distribute apps from basic-to-sophisticated, from those that merely provide good diet tips to beneficiaries, to those that collect and transmit critical health data to physicians and other providers. They can also incentivize beneficiaries to adopt mHealth solutions by, for instance, offering to reduce premiums in exchange for compliant behavior. Further, the employers who pay for health coverage may incentivize, or penalize, employees that do not utilize mHealth tools offered by payors.
Continue reading Health Plans Jump Into The Mobile Health (mHealth) Market – How Much Will Providers Have To Pay?
On March 12, 2012, the U.S. Department of Health and Human Services (HHS) released the long-anticipated Final Rule and Interim Final Rules (the “Rules”) on the Patient Protection and Affordable Care Act’s (ACA) state health insurance exchanges (“Exchange(s)”), a key element of President Obama’s healthcare reform plan. Set to go into effect on January 1, 2014, the goals of the Exchanges are to enhance competition, improve availability of affordable health insurance options and allow small businesses the same purchasing power that large businesses currently enjoy. As described in the Rules, the Exchanges will operate as competitive marketplaces, allowing individual consumers and small businesses to directly compare pricing and quality of health insurance options, among other factors.
Continue reading HHS Releases Final Rule and Interim Final Rules on Affordable Care Act’s State Health Insurance Exchanges
The Centers for Medicaid & Medicare Services (“CMS”) recently released a final rule establishing the new medical loss ratio requirements under the Affordable Care Act (“ACA”). Under the ACA, individual and small group market insurers are required to spend at least 80 percent of premium dollars on medical care and quality improvement, and large group market insurers must spend at least 85 percent of premium dollars on the same services. The final rule describes the technical process for calculating medical loss ratio and also provides details on insurers’ annual medical loss ratio reporting requirements, as well as the ACA’s requirement that insurers grant rebates to consumers in the event the insurer fails to meet the required medical loss ratio.
Read the full text of the rule here, or HHS’ fact sheet on the ACA’s changes to medical loss ratios here.