Scott Austin David Mustone Leslie Okinaka Hunton & Williams LLP Health Care Reform – Employer...

13
Scott Austin David Mustone Leslie Okinaka Hunton & Williams LLP Health Care Reform – Employer Update 201 0

Transcript of Scott Austin David Mustone Leslie Okinaka Hunton & Williams LLP Health Care Reform – Employer...

Scott AustinDavid MustoneLeslie OkinakaHunton & Williams LLP

Health Care Reform – Employer Update

2010

2

L. Scott Austin, PartnerTax & ErisaDallas/Atlanta Offices(214) [email protected]

David Mustone, PartnerTax & ErisaMcLean Office(703) [email protected]

Leslie A. Okinaka, PartnerTax & ErisaNew York Office(212) [email protected]

Presenters

3

Hunton & Williams’ Health Care Reform Initiative

The Firm’s Healthcare Reform Group – The Group’s website -- www.Huntonhealthcarereform.com --

is now fully operational Contains –

Final consolidated version of health care reform legislation

All government guidance issued to date, and H&W client alerts and other client updates

4

Overview/Introduction

Initial WebinarFocus of this Webinar –

Significant developments since last webinar Other Issues/Items of interest Opportunity for you to ask questions about

matters/issues of concern to you

5

Compliance Items

Compliance/Enforcement -- Government’s announced approach on initial compliance

Exempt Programs – Additional Thoughts Retiree plans – Restructure into separate plan (if needed) to

take advantage of exemption Separate dental/vision programs

Upcoming Notice Requirements – Reminder Availability of adult child coverage, elimination of lifetime

limits, maintenance of grandfathered status etc. Chart on notice requirements

6

Immediate Reforms/Changes-- Recent Developments

Adult Child Coverage FAQ guidance on covered “children” -- a “safe

harbor” Generally, natural children, stepchildren, adopted

children (including children place for adoption), and foster children

Requirement also applies to minors Adult child health care costs can be reimbursed

under a flexible spending account (even though FSA exempt)

7

Immediate Reforms/Changes-- Recent Developments (Cont’d)

Lifetime/Annual Dollar Limits -- Limited to “essential” health benefits What are essential benefits – Scope/application

Ambulatory patient services, emergency services, hospitalization, maternity/newborn care, mental health & substance use disorder services, lab services, prescription drugs, preventive/wellness/chronic disease management & rehab/habilitative services & devices

Pending guidance, reasonable good faith interpretation

8

Immediate Reforms/Changes -- Recent Developments (cont’d)

Coverage rescissions -- Recent FAQ guidance on administrative processing & other

delays

Reimbursement of OTC medicines under healthcare FSAs, HSAs and HRAs – Recent government guidance

New W-2 reporting of cost of employer-provided health coverage -- Postponed for 2011 State tax issues

9

Grandfathered Status

Maintaining Grandfathered status -- FAQ guidance/clarifications Impact of plan changes on continued grandfathered status

Coverage tier, prescription drug formulary & network changes Roll of wellness programs Impact of “anti-abuse” rule – eliminating a plan option Change in insurance carriers – new gov’t position? Relief for insured/multiemployer plans Application of Notice Requirement

10

Immediate Reforms/Changes – Recent Developments for Non-

Grandfathered Plans

Patient protections – Expanded claims review process Must have an internal claims review process that complies

with ERISA claims process rules Compliance with additional standards postponed in some

respects until 7/1/2011 (DOL Tech Rel 2010-02) Must have an external claims review process

For insured (and nonERISA plans) – must comply with applicable state external review rules (that meet certain minimum standards for PYs beg. on/after 7/2011)

All other plans (including self-insured ERISA plans) – must follow federal standards “Safe harbor” requirements in DOL Tech Rel 2010-01

11

Immediate Reforms/Changes – Recent Developments for Non-Grandfathered Plans (cont’d)

Patient Protections – No-cost preventive healthcare Limits on usage etc.- reasonable medical management

techniques okay New HHS Reporting Requirements

Effective date? New nondiscrimination rules for insured plans

Generally prohibits providing coverage/benefits for only (or are skewed in favor of) high-paid employees

Outstanding issues

12

Retiree Reinsurance Program – Recent Developments

Early retiree reinsurance program – Recent Developments Program now open for reimbursement requests

Recent guidance on reimbursable expenses and submission of eligible retiree lists/cost data

New participant notice requirement Use of reinsurance proceeds

13

L. Scott Austin, PartnerTax & ErisaDallas/Atlanta Offices(214) [email protected]

David Mustone, PartnerTax & ErisaMcLean Office(703) [email protected]

Leslie A. Okinaka, PartnerTax & ErisaNew York Office(212) [email protected]

Questions