Posts Categorized: Health Benefits

Medicare Data Rules Finalized

in Affordable Care Act, Health Benefits

On Monday, the Centers for Medicare and Medicaid Services (CMS) issued final regulations making claims data from Medicare available to “qualified entities.”  The rule gives qualified entities, like employers, insurers, consumer groups and their contractors, access to data that can help them identify high quality health care providers or create online tools to help consumers make educated health care choices.  Information that could identify specific patients, however, will not be publicly released and strong penalties will be in place for any misuse of data.  CMS hopes that the final regulations will make health care information more available and allow consumers… Continue Reading

MEWA Update

in Affordable Care Act, Health Benefits

Today, the DOL announced two proposed rules under the Affordable Care Act with respect to multiple employer welfare arrangements (MEWAs).  The proposed rules call for MEWAs to adhere to enhanced reporting requirements.  The rules also will increase DOL’s enforcement authority to protect participants in such plans and allow the DOL to shut down MEWAs engaged in fraud or other activities that present an immediate danger to the public safety or welfare. Under the proposals issued today: MEWAs must register with DOL prior to operating in a state or be subject to substantial penalties. This step will allow the DOL to track MEWAs as they… Continue Reading

DOL Audits

in Health Benefits, Welfare Benefits

The Department of Labor’s initiative to review the quality of employee benefit plan financial audits has been in place for many years, but there are signs that it has recently intensified. We have heard that the DOL is starting to dig deeper into the financial audits that are filed with the Form 5500 and in some cases have rejected the audits and imposed penalties. Because the audit report is considered an integral part of a Form 5500 filing for funded plans with at least 100 participants, plan administrators are at risk if the DOL determines that audit procedures were inadequate. The… Continue Reading

Transgender Medical Expenses

in Health Benefits, Tax Issues

Many employer health plans have started paying for hormone therapy, sex reassignment and other gender identity expenses.  In prior years, the issue has been whether these services are medical expenses under Code Section 213, and thereby could be provided tax-free to participants.  In 2006, IRS Chief Counsel issued an opinion providing that these expenses were not medical expenses under Code Section 213.  However, in 2010, a Tax Court decision provided that in the facts of that case, the services were medical expenses under Code Section 213.  Last week, the IRS issued Action on Decision 2011-03, effectively ending this almost decade-long back… Continue Reading

JCEB Health and Welfare Annual Meeting

in Affordable Care Act, Health Benefits

The JCEB Health and Welfare annual meeting just concluded in DC today.  We had some great discussions, which I will pass on in the coming days.  However, I want to thank all my colleagues in CMS, EBSA, HHS, IRS and Treasury for their participation.  We all appreciated the time you took from your busy schedules to attend.  The information you shared was very helpful.