IROs – Relief or Confusion?

in Affordable Care Act

Late Tuesday, DOL released FAQs regarding various miscellaneous ACA issues.  DOL also released additional guidance on the claims and appeals procedures in Technical Release 2010-02.   THe FAQs can be seen here:

http://www.dol.gov/ebsa/faqs/faq-aca.html

The FAQs are a strange aggregation of items.  One of the FAQs states that with respect to IRO contracts that the earlier DOL guidance never required a contract between a plan and an IRO.  This is in direct contradiction with Technical...Continue Reading

Nondiscrimination for Insured Plans – Update

in Affordable Care Act

A few weeks ago we informed you of the delay in regulations regarding the insured plan nondiscrimination rules.  Yesterday, the IRS published Notice 2010-63, requesting information regarding how the new nondiscrimination rules should apply to insured plans and the interaction with 105(h).  Comments are due by November 4, 2010.  The IRS is likely looking at how it can combine nondiscrimination testing when a single sponsor has multiple insured options and/or multiple insured and...Continue Reading

GINA – More than an Interesting First Name

in Health Benefits

Just in time for annual enrollment, the DOL has issued a number of FAQs on the Genetic Information Nondiscrimination Act (GINA).  Remember, if you have health risk assessments for your medical plan, the questionnaires must be voluntary and you must decouple the genetic information questions from any monetary or other incentive that is paid to complete them.  You can still pay a monetary incentive but your health risk assessment must make it clear that the incentive is only paid for...Continue Reading

Business Associate Agreements

in HIPAA Privacy & Security

Some controversy has erupted regarding the status of business associate agreements, when the business associate refuses to enter into a business associate agreement. The preamble to the HHS July 14, 2010 proposed regulations provides that - if a covered entity and business associate have failed to enter into a business associate agreement, then the business associate may use or disclose protected health information only as necessary to perform its obligations for the covered entity (pursuant...Continue Reading

Nondiscrimination for Insured Plans

in Affordable Care Act

New PHSA Section 2716 adopts new nondiscrimination rules on insured health plans beginning with the first plan year after September 23, 2010 (or January 1, 2011 for calendar year plans). The statute provides that rules similar to the Code Section 105(h) rules for self-insured plans shall apply for this purpose. We thought that the regulations implementing this new requirement were to be released soon. However, last week we heard, unofficially, that the regulations have been delayed, meaning...Continue Reading