The Washington Report
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July 12, 2023
Note to Subscribers
While we do our best to provide timely updates, it is possible that the information shared in the newsletter may change after our publication deadline.
Legislative
Congress Reconvenes; Summer Recess Scheduled for August
Congress returned to the Hill this week after its holiday recess. The House and Senate are scheduled to adjourn the month of August for summer recess.
Health
HHS Releases Proposed Rules on STLDI; Publishes New Report on Projected Prescription Drug Cost Savings
On July 7, 2023, the Department of Health and Human Services (HHS), announced proposed rules on short-term, limited-duration insurance (STLDI) meant to “protect consumers from junk health plans, surprise medical bills, and excess costs that lead to medical debt.” The proposed rules would amend the definition of STLDI, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. The rules also include proposed amendments to the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets. The rules further establish proposed amendments to clarify the tax treatment of certain benefit payments in fixed amounts received under employer-provided accident and health plans. Finally, the proposed rules solicit comments regarding coverage only for a specified disease or illness that qualifies as excepted benefits, and comments regarding level-funded plan arrangements. Comments on the proposed rules are due by September 11, 2023.
Coinciding with the release of the proposed rules, HHS also released a new report (Evaluation of the Impact of the No Surprises Act on Health Care Market Outcomes: Baseline Trends and Framework for Analysis - Report One) projecting prescription drug costs savings due to recent legislation. Please see the resources provided below for additional information.
The news release is available here.
A White House Fact Sheet is available here.
The proposed rules on STLDI are available here.
A Fact Sheet on the proposed STLDI rules is available here.
The report to Congress on the No Surprises Act (Evaluation of the Impact of the No Surprises Act on Health Care Market Outcomes: Baseline Trends and Framework for Analysis - Report One) is available here.
Departments Publish FAQs About ACA and No Surprises Act, Part 60
On July 7, 2023, the Departments of Labor, HHS, and the Treasury (Departments) published Frequently Asked Questions (FAQs) regarding implementation of certain provisions of the Affordable Care Act (ACA) and Title I (the No Surprises Act) of Division BB of the Consolidated Appropriations Act, 2021. The questions address the following:
- Limitations on Cost-Sharing Under the ACA
Q1: Is cost-sharing for services furnished by a nonparticipating provider, facility, or provider of air ambulance services (as defined for purposes of the No Surprises Act) considered cost-sharing for benefits provided outside of a plan's network for purposes of the maximum out-of-pocket (MOOP) limit?
Q2: The Departments are aware that some plans and issuers have contractual relationships with providers, facilities, or providers of air ambulance services that the plans and issuers do not consider to be part of their network. May a plan or issuer treat a provider, facility, or provider of air ambulance services with which it has a contractual relationship as out-of-network for purposes of the MOOP limit under Public Health Service Act Section 2707 and ACA Section 1302(c), while also treating them as participating for purposes of the No Surprises Act?
- The No Surprises Act and Transparency in Coverage With Regard to Facility Fees
Q3: Are facility fees included in the definition of items and services for purposes of the Transparency in Coverage final rules and the good faith estimate requirements of the No Surprises Act?
The FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 60, are available here.
IRS Releases Draft 2023 Forms 1094-C and 1095-C
On July 7, 2023, the Internal Revenue Service (IRS) released text of Draft 2023 IRS Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns and Draft 2023 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage. This information is in draft form and is not meant to be used for filing purposes. Please refer to the IRS documents for additional information.
The Draft 2023 IRS Form 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns is available here.
The Draft 2023 IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage is available here.
CMS Releases Revised Guidance for Medicare Drug Price Negotiation Program
On June 30, 2023, HHS’ Centers for Medicare and Medicaid Services (CMS) released revised guidance as part of the implementation of the Inflation Reduction Act. The revised guidance details the requirements and parameters of the new Medicare Drug Price Negotiation Program for the first round of negotiations, which will occur during 2023 and 2024 and result in prices that will be effective beginning in 2026. For specific details, please refer to the guidance, Fact Sheet, and other available resources provided in the links below.
The news release is available here.
A Fact Sheet on the Medicare Drug Price Negotiation Program Revised Guidance is available here.
The Medicare Drug Price Negotiation Program Revised Guidance is available here.
Additional information on the Medicare Drug Price Negotiation Program is available here.
Retirement
PBGC Publishes Final Rule on Benefit Payments and Allocation of Assets
On July 10, 2023, the Pension Benefit Guaranty Corporation (PBGC) released a final rule that makes changes to the PBGC’s regulations on benefits payable in terminated single-employer plans and allocation of assets in single-employer plans. The changes make clarifications and codify policies involving payment of lump sums, changes to benefit form, and valuation of plan assets. The final rule becomes effective on August 10, 2023.
The final rule is available here.