Octo­ber was a busy month in the employ­ee ben­e­fits world. Pres­i­dent Trump announced a new Act­ing Sec­re­tary for the U.S. Depart­ment of Health and Human Ser­vices (HHS). Eric Har­gan fills the posi­tion vacat­ed by Tom Price, who resigned in late Sep­tem­ber 2017. The U.S. Depart­ment of Labor (DOL) issued a pro­posed rule to delay a dis­abil­i­ty claims pro­ce­dure reg­u­la­tion’s applic­a­bil­i­ty date and HHS released its pro­posed rule on ben­e­fits and pay­ment para­me­ters for 2019. The U.S. Depart­ment of the Trea­sury (Trea­sury) issued its Pri­or­i­ty Guid­ance Plan for projects it intends to com­plete dur­ing the first half of 2018.

DOL Pro­pos­es Delay to Final Dis­abil­i­ty Claims Pro­ce­dures Reg­u­la­tions’ Applic­a­bil­i­ty Date

The DOL issued a pro­posed rule to delay the applic­a­bil­i­ty date of its final rule that amends the claims pro­ce­dure require­ments applic­a­ble to ERISA-cov­ered employ­ee ben­e­fit plans that pro­vide dis­abil­i­ty ben­e­fits. The DOL’s Fact Sheet con­tains a sum­ma­ry of the final rule’s requirements.

The DOL is delay­ing the applic­a­bil­i­ty date from Jan­u­ary 1, 2018, to April 1, 2018, to con­sid­er whether to rescind, mod­i­fy, or retain the reg­u­la­tions and to give the pub­lic an addi­tion­al oppor­tu­ni­ty to sub­mit com­ments and data con­cern­ing the final rule’s poten­tial impact.

CMS Releas­es 2019 Ben­e­fits Pay­ment and Para­me­ters Pro­posed Rule

The Cen­ters for Medicare & Med­ic­aid Ser­vices (CMS) released a pro­posed rule and fact sheet for the 2019 Ben­e­fit Pay­ment and Para­me­ters. The pro­posed rule is intend­ed to increase indi­vid­ual mar­ket flex­i­bil­i­ty, improve pro­gram integri­ty, and reduce reg­u­la­to­ry bur­dens asso­ci­at­ed with the Patient Pro­tec­tion and Afford­able Care Act (ACA) in many ways, includ­ing updates and annu­al pro­vi­sions to:

  • Essen­tial health benefits
  • Small Busi­ness Health Options Pro­gram (SHOP)
  • Spe­cial enroll­ment peri­ods (SEPs)
  • Exemp­tions
  • Ter­mi­na­tion effec­tive dates
  • Med­ical loss ratio (MLR)

CMS usu­al­ly final­izes the Ben­e­fit Pay­ment and Para­me­ters rule in the first quar­ter of the year fol­low­ing the pro­posed rule’s release. Novem­ber 27, 2017, is the due date for pub­lic com­ments on the pro­posed rule.

Almost all the top­ics addressed in the pro­posed rule would affect the indi­vid­ual mar­ket and the Exchanges, par­tic­u­lar­ly the Small Busi­ness Health Options Pro­gram (SHOP) Exchanges.

Of inter­est to small group health plans, CMS pro­pos­es to change how states will select essen­tial health ben­e­fits bench­mark plans. If CMS keeps this change in its final rule, then it will affect non-grand­fa­thered small group health plans for ben­e­fit years 2019 and beyond.

Trea­sury Issues its Pri­or­i­ty Guid­ance Plan

The Trea­sury issued its 2017–2018 Pri­or­i­ty Guid­ance Plan that lists projects that it intends to com­plete by June 30, 2018, including:

  • Guid­ance on issues relat­ed to the employ­er shared respon­si­bil­i­ty provisions
  • Reg­u­la­tions regard­ing the excise tax on high cost employ­er-pro­vid­ed cov­er­age (“Cadil­lac tax”)
  • Guid­ance on Qual­i­fied Small Employ­er Health Reim­burse­ment Arrange­ments (QSE HRAs)

By Danielle Capilla

Orig­i­nal­ly post­ed by www.UBABenefits.com