Departments Release Guidance on Several Important ACA Provisions

On March 5, 2014, HHS and the IRS separately released four sets of guidance addressing several key provisions in the Affordable Care Act.

The IRS released two sets of final regulations on the Code section 6055 and 6056 information reporting requirements. These regulations require applicable large employers and certain other providers of minimum essential coverage to report information to the IRS and individuals regarding the health coverage they offer. The final regulations allow reporting entities to use a single, combined form for reporting the information required under both section 6055 and 6056. The reporting requirements apply for calendar years beginning after Dec. 31, 2014. However, relief is available in 2015 for reporting entities making good faith efforts to comply.

At the same time, HHS released a separate Insurance Standards Bulletin that extends a transition relief policy for canceled health plans for two additional years. This extended transition relief, which applies for policy years beginning on or before Oct. 1, 2016, gives health insurance issuers the option of renewing policies for current enrollees without adopting all of the ACA’s market reforms for 2014 if permitted by their states. Thus, individuals and small businesses may be able to keep their non-ACA compliant coverage into 2017, depending on the plan or policy year. Issuers that renew coverage under the extended transition relief must, for each policy year, provide a notice to affected individuals and small businesses.

Finally, HHS released its 2015 Notice of Benefit and Payment Parameters Final Rule. The final rule describes payment parameters applicable to the 2015 benefit year and standards relating to the premium stabilization programs, the open enrollment period for 2015 and annual limitations on cost-sharing. Notably, the cost-sharing limits for 2015 are lower than originally proposed: the annual deductible limit will be $2,050 (single) and $4,100 (family), and the out-of-pocket maximum will increase to $6,600 (single) and $13,200 (family). The final rule also implements patient safety standards for QHPs offered in the Exchanges and includes standards related to the employee choice and premium aggregation provisions in federally-facilitated SHOPs.

Among other provisions, the final rule also implements patient safety standards for qualified health plans (QHPs) offered in the Exchanges and includes standards related to the employee choice and premium aggregation provisions in federally-facilitated SHOPs.