On October 19, 2017, the Centers for Medicare and Medicaid Services approved Oregon's 1332 state innovation waiver proposal. This is the fourth 1332 waiver proposal CMS has approved and the third proposal involving a reinsurance program. Oregon will reinsure 50 percent of claims, in excess of an attachment point to be determined, up to $1 million.
Oregon is financing part of its program through a 0.3 percent tax on major medical premiums but projects that the program will reduce premiums by 7.5 percent in 2018, 7 percent in 2019, and 6.4 percent in 2027 compared to what premiums would have been without the waiver. The waiver approval does not state how much federal money will be passed through to Oregon from reduced federal payments for premium tax credits and cost-sharing reductions to assist in paying for the program.
IRS Will No Long Accept 'Silent Returns'
The Internal Revenue Service has released a guidance informing tax professionals that it will not accept electronically filed tax returns for 2017 unless the taxpayer indicates that he or she had minimum essential coverage as required by the Affordable Care Act's individual responsibility requirement, claims an exemption from the requirement, or pays the individual responsibility penalty. Paper returns that do not address the coverage requirement may be suspended until additional information is received and refunds may be delayed.
The IRS had intended to cease accepting "silent returns" that do not indicate compliance with the individual mandate for the 2016 filing year but delayed doing so in response to President Trump's inauguration day ACA executive order. The new guidance states that after reviewing its process and discussions with the National Taxpayer Advocate, the IRS has determined that requiring taxpayers to provide health coverage information at the time of filing will make it easier for taxpayers to file returns successfully and avoid refund delays.
This guidance should put to rest speculation that the IRS is no longer enforcing the individual mandate and improve compliance. The Treasury Inspector General for Taxpayer Assistance had earlier reported that as of March 31, 2017, a third fewer taxpayers had paid the penalty for 2016 than had for 2015 as of that date http://ift.tt/2p31PRi , possibly reflecting confusion as to whether the requirement was still in effect.
CMS Unpacks New Rule On Payment Of Past Due Premiums
On October 18, 2017, CMS posted at its REGTAP.info website a series of slides explaining the new rule on payment of past due premiums promulgated for 2018 in its market stabilization rule. Under the new rule, insurers may apply an individual's binder payment for new coverage to premiums owed to the insurer (or an insurer in the same control group) for coverage within the prior 12 months or refuse to effectuate the new coverage for failure to pay the initial premium payment. Insurers can only enforce this policy if they gave notice of their policy on nonpayment before the enrollee failed to make pay premiums that became past due and if permitted by state law. The insurer should inform the applicant before the effective date of the new coverage of the amount owed.
Under the new policy, individuals who are receiving advance premium tax credits whose coverage is terminated within the three-month grace period would owe at most the premium for the first month of coverage during the grace period net of advance premium tax credits (APTC) paid to the insurer on their behalf. An individual who stops paying in the last three months of the year, however, and then attempts to enroll in new coverage while in the grace period could, according to CMS, owe the back premium for the full three months, net of ATPC.
If an individual enrolls in coverage but never pays the initial binder payment, coverage is not effectuated and no premium is owed. An individual who attempts to enroll through a special enrollment period but is denied APTC eligibility and subsequently stops paying premiums may have to pay the full amount of premium due to obtain new coverage, but may be able to appeal the APTC denial if an appeal is filed within 90 days of the final eligibility determination. Finally, if an individual obtains employer coverage or some other form of coverage and simply stops paying premiums, insurers may, if permitted by federal and state law, cancel the coverage retroactive to the last day of the period for which premiums were paid if they do so without regard to health status and in accordance with nondiscrimination requirements.
Sens. Graham (R-SC) And Cassidy (R-LA) Are Among Alexander-Murray Cosponsors
Finally, on October 19, 2017, a list of twenty-four cosponsors of the bipartisan short-term premium stabilization proposal was released. The cosponsors include 12 Republicans, 11 Democrats, and one independent. In addition to Senators Alexander and Murray, the chair and ranking member of the Senate HELP committee, the bill is cosponsored by Republican Senators Mike Rounds (SD), Lindsey Graham (SC), John McCain (AZ), Bill Cassidy (LA), Susan Collins (ME), Joni Ernst (IA), Lisa Murkowski (AK), Charles Grassley (IA), Johnny Isakson (GA), Richard Burr (NC), and Bob Corker (TN). Democratic cosponsors include Jeanne Shaheen (NH), Joe Donnelly (IN), Amy Klobuchar (MN), Heidi Heitkamp (ND), Al Franken (MN), Joe Manchin (WV), Tom Carper (DE), Tammy Baldwin (WI), Claire McCaskill (MO), and Maggie Hassan (NH). Angus King of Maine, an independent who caucuses with the Democrats, is also a cosponsor.
It is notable that Senators Graham and Cassidy, the lead sponsors of the ACA repeal bill considered most recently by the Senate, are cosponsors of Alexander-Murray.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2zBMgm7
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