CMS

Posted August 7th, 2018 in Producers, Individuals

Last week, the Trump administration issued final rules which extend the maximum duration of short-term medical plans (STM plans). STM plans can now have an initial coverage period just shy of one year (364 days). Taking into account renewals, STM plans can have a maximum duration of up to 36 months.

Posted February 20th, 2018 in Producers, Employers, Individuals
Congress keeps finding ways to include certain healthcare provisions into federal spending bills. A temporary spending bill passed in January included a suspension or delay of the Cadillac Tax, health insurer tax and medical device tax.
Posted February 13th, 2018 in Producers, Employers, Individuals

Happy Fat Tuesday! Much like the paczki, we will soon be without a "donut hole"- for Medicare Part D. The donut hole, also known as the gap in Medicare prescription drug coverage, will close a year earlier than expected as a result of a budget deal signed by President Donald Trump this past Friday. The donut hole will now close in 2019 instead of 2020.

Posted January 16th, 2018 in Producers, Employers, Individuals
In a letter sent to state Medicaid Directors on Thursday, the Trump Administration announced that it would allow states to impose work requirements to qualify for Medicaid. States will have the flexibility to design their work requirement eligibility structure, but they must submit details to the Centers for Medicare and Medicaid Services (CMS) for approval. 
 
Posted December 12th, 2017 in Producers, Employers, Individuals
We haven’t even gotten through the 2018 open enrollment season yet, but the Centers for Medicare and Medicaid Services (CMS) has already proposed rules that would impact health insurance markets for 2019. Each year, CMS issues a Notice of Benefit and Payment Parameters which explains various rules, inflation adjustments and other changes that will occur with the implementation of the Affordable Care Act (ACA).
Posted October 3rd, 2017 in Producers, Employers, Individuals
Each year employers must provide a written notice to Medicare-eligible employees who are covered under their group health plan. The notice must include information about the creditable coverage status of the prescription drug benefit. In other words, the notice tells employees if the prescription drug benefit on the group health plan is at least as good as the standard Medicare Part D plan. 
 
Posted April 18th, 2017 in Producers, Employers, Individuals
On April 13th, the Centers for Medicare and Medicaid Services (CMS) finalized rules which aim to stabilize Exchanges and the individual marketplace. There are five key takeaways from the new rules:
 
Posted December 20th, 2016 in Producers, Employers, Individuals
The health insurance industry saw quite the year in 2016. Here are some of the highlights:
 
  1. ACA reporting had to be submitted for the first time which was an administrative struggle for several employers, but most were able to find a way to get it completed.
     
  2. Several Co-Ops, including Land of Lincoln Health, were forced to shut down due to solvency problems. 
     
  3. Most insurers reduced or eliminated commissions on the sale of individual health insurance plans as a result of profit losses.
     
Posted July 22nd, 2016 in Producers, Employers
The Internal Revenue Service (IRS), Social Security Administration (SSA), and the Centers for Medicare & Medicaid Services (CMS) are required to share information that each agency has about whether Medicare beneficiaries or their spouses are working. This sharing of information is referred to as the IRS-SSA-CMS Data Match, and the purpose of the Data Match is to identify situations where another group health plan may be primary to Medicare. In general, a group health will be primary to Medicare when:
 
Posted May 23rd, 2016 in Producers, Employers
As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.
 
Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value. 
 

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