Annual Limit Waiver Guidance Updated

in Affordable Care Act

In previous posts I discussed the annual limit waiver process for mini-med plans as well as the upcoming MLR rules regarding mini-med plans.  Today, OCIIO amended the annual limit waiver application process for mini-med plans, including adding a participant notice requirement.  This notice is yet to be posted to the website, but it is required to be sent to participants in a plan that has obtained an annual limit waiver.  OCIIO also announced its intention to provide a special...Continue Reading


in Affordable Care Act

This morning the DOL released three more FAQs dealing with grandfathered plans.  These additional FAQs are referred to as Part IV on the website and linked here:

I certainly hope at one point DOL combines all these FAQs into a single guidance document or includes the guidance in the regulations when the interim final regulations are finalized.

On-Site Medical Clinics

in HIPAA Privacy & Security

Martha Sewell, one of my partners at KS, reminded me of a growing issue for on-site medical clinics.  Currently, on-site medical clinics are a HIPAA excepted benefit and the clinic itself is excepted from HIPAA privacy.  However, HHS has never formally defined an on-site medical clinic.  Many of us have thought that the exception may only apply to traditional on-site clinics, and not the large on-site clinics that are established by employers today that are close to fully functional...Continue Reading

ERRP Reporting Now Live

in Affordable Care Act

I have spent the last few days speaking at the JCEB National Health and Welfare Institute here in DC and have unfortunately not been keeping up with recent events.  One such recent event is that there is much happening with the ERRP right now.  Currently, the cost reporting and reimbursement request features are now live for plan sponsors with approved applications.  If you are waiting for your application to be approved, you should review the requirements so that you are ready to submit...Continue Reading

NAIC Finalizes MLR Rules

in Affordable Care Act

Today, the NAIC finalized its controversial MLR regulations, and have sent them to HHS.  In turn, HHS will turn the MLR rules into regulations under the Affordable Care Act.  In the process, HHS can certainly revise or tweak the MLR rules, including, for example, to make it easier for mini-med plans to pass the requirements.  A few weeks ago we posted a news release by HHS stating that they understood the challenges that mini-med plans face and they intended to revise the MLR rules as...Continue Reading