Healthcare Reform Update - August 15, 2013

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Split Appellate Decisions on Contraceptive Coverage and For-Profit Businesses Likely to End with Supreme Court

Several dozen cases have been filed around the country challenging a portion of PPACA’s mandate requiring employers to provide preventive services with no cost-sharing. Included among preventive services is the requirement to provide contraceptive coverage without any cost-sharing (this is popularly referred to as the “contraceptive mandate”), which certain organizations object to providing on religious grounds. Recently, the government has provided relief to religious-based, nonprofit organizations; however, no relief has been provided to private, for-profit employers. With regards to for-profit companies, a recent split in the courts has led many experts to believe this issue will ultimately be decided before the Supreme Court.

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California Imposes 60-Day Limit on Eligibility Waiting Periods

States have been passing legislation to bring their respective state insurance laws into parity with rules under PPACA. In California, Assembly Bill 1083 brings state insurance laws into agreement with PPACA. Although some differences still exist between the state law and PPACA, one difference in particular has caused some confusion until now. Specifically, AB 1083 limits the waiting period before an otherwise eligible employee can enroll in an employer’s group health coverage to 60-days from the date of hire, as opposed to the 90-days mandated by PPACA.

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2013 Culturally and Linguistically Appropriate County List Updated

PPACA mandates a number of new notices to be sent to health plan participants, as well as employees, in a culturally and linguistically appropriate manner. Specifically, insurers and sponsors of non-grandfathered group health plans are required to adopt culturally and linguistically appropriate claim appeals processes for participants living in a county where 10% or more of the population residing in that county are literate only in the same non-English language. Additionally, insurers and group health plans are required to provide culturally and linguistically appropriate SBC to individuals living in a county where 10% or more of the population residing in that county are literate only in the same non-English language. The list of counties has been updated for 2013, and will continue to be updated annually.

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DOL Releases Modifiable Notice of Coverage Options for Employer Use

The DOL issued a modifiable version of the model notices that satisfy the requirement under PPACA to provide notice to employees about coverage options that are available through the employer and through the Marketplaces. The notice is required to be provided by October 1, 2013.

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New Healthcare Reform Website Targeted at Employers Launched by Government

This month, the federal government launched a new website directed at small employers in an attempt to direct them to useful resources. A section of the website, found here, is devoted to helping small employers better understand the healthcare reform requirements that they must comply with. The website begins by asking the user several questions, and based on the responses, the website will generate a series of links to resources to educate the user.

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CMS Releases FAQ on Marketplace Income Verification

On August 6, 2013, CMS released an FAQ addressing the methodology that will be used to verify income on the Marketplaces. Last month, CMS released final rules on eligibility and enrollment in the Marketplaces, which made the suggestion that the Marketplaces would, in some circumstances, grant the premium tax credit or cost-sharing reduction without verification of the applicant’s income beyond the applicant’s attestation - leading to worries of fraud. As a result, the recent FAQ was released to clarify the Marketplace income verification process that will be used for advance payments of the premium tax credit

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HHS Requests Comments to Help Develop PPACA Nondiscrimination Regulation

On August 1, 2013, HHS published a request for information regarding nondiscrimination in certain health programs or activities. PPACA prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. The request for information seeks information on a variety of issues dealing with discrimination in health programs. At this time, no action steps are required from employers.

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Questions and Answers for Employers

GBS's Healthcare Reform FAQs for Employers has been updated to reflect the recent government delay of the employer mandate. To access the FAQs, please click "Read More" below.

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