n March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. On March 30, he signed the Reconciliation Bill. Collectively, they represent Health Care Reform. With over 2,000 pages of new legislation, Health Care Reform will affect virtually every corner of the health care industry, including several near- and longer-term changes that will impact employers.
Laurus Strategies is committed to providing clients with ample information and guidance as details unfold. A Health Care Reform Task Force has been established to field questions, review new legislation, and provide answers/information based on trusted resources and their own knowledge of the new legislation. We will also be providing public access to a regularly updated list of FAQs. More details are forthcoming.
In the meantime, we invite you to review our latest materials/resources regarding Health Care Reform.
The recently enacted Patient Protection and Affordable Care Act raises a question about the treatment of stand-alone retiree health plans under some provisions of the Employee Retirement Income Security Act of 1974, as amended, the Public Health Services Act, as amended, and the Internal Revenue Code of 1986, as amended. As discussed in this Commentary, the Departments of Labor, Treasury, and Health and Human Services have addressed this question in the preamble to the Interim Final Rules regarding "grandfathered" health plans under PPACA, issued on June 14, 2010, and in the preamble to Interim Final Rules issued on June 22, 2010, relating to various PPACA provisions on patients’ rights.
However, a position taken by the Agencies in a preamble to a regulation may not limit the authority of states to enforce PPACA or existing health coverage mandates with respect to health insurance issuers or nonfederal governmental plans. Nor is it certain that the Agencies’ position will prevent an individual from maintaining a private cause of action to enforce those mandates through the courts. In this Commentary, Jones Day discusses the law prior to PPACA, the effect of PPACA, the Agencies’ interpretation of the changes, and what the current state of affairs means for employer-sponsored group health plans.
The Patient Protection and Affordable Care Act, as amended, contains several provisions designed to ensure greater individual access to health care. These provisions have been dubbed the "Patient’s Bill of Rights." On June 22, 2010, the Departments of Labor, Treasury, and Health and Human Services issued interim final regulations implementing the Patient’s Bill of Rights.
This Commentary from Jones Day discusses the various requirements set forth in the regulations, their impact on plan design, and the obligations of plan sponsors to provide notice and special enrollment opportunities. Plan sponsors will need to be mindful of these rules as they prepare for the upcoming open enrollment season.
The Patient Protection and Affordable Care Act, as amended, contains a provision titled "Preservation of Right to Maintain Existing Coverage." This provision, known as the "Grandfathered Plan Rule," provides that while "grandfathered" group health plans are exempt from some of the provisions of PPACA, they must still make many of the changes required by PPACA. PPACA also contains a related rule applicable to employer group health plans that are maintained pursuant to one or more collective bargaining agreements.
On June 14, 2010, the Departments of Health and Human Services, Treasury, and Labor issued interim final regulations regarding the Grandfathered Plan Rule and the related collective bargaining exception. Remarkably, the regulations provide virtually no relief for collectively bargained plans, and no meaningful exception for self-insured collectively bargained plans. This has the potential to raise significant labor relations issues for employers, especially larger employers that self-insure their group health plans.
Read more in this Commentary from Jones Day.
The Patient Protection and Affordable Care Act, as amended, contains a provision titled "Preservation of Right to Maintain Existing Coverage." This provision, also known as the "Grandfathered Plan Rule," exempts certain preexisting group health plans from complying with certain provisions of PPACA and postpones the effective date for other provisions.
PPACA is silent regarding the changes that group health plan sponsors can make to group health plans while retaining Grandfathered Plan status, leaving that question to be addressed by regulatory guidance. On June 14, 2010, the Departments of Health and Human Services, Treasury, and Labor issued interim final regulations setting forth the requirements that group health plans must follow to retain Grandfathered Plan status. This Commentary from Jones Day focuses on how Grandfathered Plans may maintain their status (apart from the special collective bargaining rules) and the benefits of maintaining that status.
The Patient Protection and Affordable Care Act, as amended ("PPACA"), requires group health plans that offer health coverage to employees’ or subscribers’ children to make such coverage available until the child’s 26th birthday.1 PPACA’s extended coverage mandate for children applies to insured and selfinsured group health plans and to insurance issuers in both the individual and group markets. On May 10, 2010, the Departments of Labor, Health and Human Services, and Treasury issued regulations, effective May 12, 2010, implementing the dependent coverage mandate under PPACA. The regulations require group health plans and issuers to offer a special enrollment opportunity for children who are newly eligible for dependent coverage under the plan as a result of this mandatory expansion of coverage on the terms in this White Paper from Jones Day for further details.
The Patient Protection and Affordable Care Act creates the Early Retiree Reinsurance Program. On May 5, 2010, the Department of Health and Human Services published interim final regulations setting forth the requirements for the Program. The purpose of the new Program is to encourage employers to continue to offer health plan coverage to early retirees by providing reimbursements to the employers for a portion of the claims paid for the covered early retirees. Under the Program, $5 billion in federal funds is made available to reimburse employers that provide retiree health care coverage to early retirees. The reimbursements will be paid, on a first-come, first-served basis, to employers that apply for the federal funds. Refer to this discussion and analysis contained in this White Paper from Jones Day for further details.
Health Care Reform makes a remarkable number of changes to the U.S. health care system, many of which directly affect employers in their role as sponsors of group health plans offered to current and former employees and their dependents. The New Law also significantly alters many other facets of the U.S. health care delivery and payment system, such as Medicare, Medicaid, and community health services. The discussion and analysis contained in this White Paper from Jones Day focus almost exclusively on the changes that will be of interest to employers, both large and small.
Health Care Reform will provide many challenges for employer-sponsored health coverage. This Jones Day’s Commentary addresses the many different effective dates that apply to the key changes for employer-sponsored group health plans under the Act. Jones Day’s Health Care Reform task force is crafting a more detailed analysis of the Act. If you would like to receive a PDF of that analysis, please advise one of the Lawyer Contacts identified at the conclusion of this Commentary.
Utilize this resource to provide your employees with a high-level Health Care Reform overview and understanding of how they will be affected, as well as a general idea of timing surrounding key requirements.
Because legislation is continually evolving and being defined, some information may be subject to change. We will continue to be engaged in reviewing the legislation on an ongoing basis to determine further developments and implications.
Obtain a high-level overview of Health Care Reform, designed to educate employers on what they need to know immediately, give them insight as to what their employees want to know, as well as address the short- and long-term decisions employers are facing. Listen to the audio presentation and view the PDF presentation as well, if you like.
