IRS Issues ESR Reporting Instructions OOP Rule Delay Sought

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IRS Issues ESR Reporting Instructions OOP Rule Delay Sought
Calendar21 August 2015

The IRS recently released draft instructions for 2015 employer shared-responsibility (ESR) forms. These instructions provide several, mostly helpful, clarifications for completing the individual statements and IRS transmittal (due in early 2016), including a relaxed standard for use of the “98% offer” method and some relief for employers with reporting duties for multiemployer plan populations. Draft 2015 instructions were also released for the form which insurers and certain others will use to report on enrollees’ minimum essential coverage (MEC).

Following up from a July House Committee hearing, key GOP House lawmakers are taking aim at controversial Affordable Care Act (ACA) guidance requiring self-insured and large-group insured nongrandfathered health plans to "embed" individual in-network out-of-pocket (OOP) limits in family coverage limits by the 2016 plan year. In a recent letter to Health and Human Services (HHS) Secretary Sylvia Burwell, the Republican chairmen of the three committees with jurisdiction over the ACA objected to the new requirement. House Education and the Workforce Chairman John Kline, R-MN, has asked for a one-year enforcement delay, but it’s unclear at this time whether changes will be made to the May guidance from HHS, IRS, and the Labor Department.

Regulators assured employers and insurers in the private marketplace they will not face transparency reporting under the ACA until they have an opportunity to comment on proposed rules. Qualified health plans on public exchanges using the HealthCare.gov IT platform will begin transparency reporting first, followed by other state-based exchanges, according to a CMS proposal. A triagency FAQ confirms that transparency reporting requirements for employers and insurers for other plans may differ from the requirements in the CMS proposal.

A new tool from the Robert Wood Johnson Foundation compares what essential health benefits (EHBs) state benchmark plans offer beyond the 10 required by ACA, current as of March. ACA requires nongrandfathered health plans in the individual and small-group markets to cover health services and items in10 general EHB categories but states have some discretion in choosing an EHB benchmark plan, so benefits beyond the ACA-required ones may vary from state to state. Additional information on EHBs and benchmark plans can be found in a Cigna analysis, updated in May, and an overview by the National Health Law Program released in August. States had until June 1 to select a new benchmark plan for the 2017 plan year. HHS is expected to publish a list of state benchmark plans for public comment before final federal approval is granted.

Congress continues its August recess. Both chambers are scheduled to return to legislative session on September 8.

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