Benefits Update
By Dan Exceen & Patti Kunnel, Burnham Benefits
New Secondary Payer Reporting Requirements Take Effect January 1, 2009
The Medicare, Medicaid, and SCHIP Extension Act of 2007 requires health insurers and third party administrators to submit data to the Centers for Medicare and Medicaid Services (CMS) identifying situations where the group health plan is secondary to Medicare. Effective January 1, 2009, certain information must be reported to CMS on a quarterly basis. This information includes Social Security Number (SSN) for eligible employees and their dependents, active/inactive employee statuses, the total number of employees, including full and part-time employees, Employer Identification Number (EIN) or Tax Identification Number (TIN), and the employer's mailing address. Insurers and third party administrators must identify, collect, and submit this data on all Medicare eligible participants. This information will then be stored in the appropriate eligibility system(s) through the insurance provider and reported to CMS.
Group health plans that are currently participating in CMS's voluntary data-sharing program will have little additional compliance responsibility related to the new mandatory reporting; however, the data collection and reporting process may be significant for group health plans not currently participating in CMS's voluntary data sharing program due to the detail of data required to be reported.
For additional information please visit the CMS website at: www.cms.hhs.gov/mandatoryinsrep/.
Source: The Centers for Medicare and Medicaid Services, http://www.cms.hhs.gov/. 2008.
Department of Labor Compliance Updates
The Department of Labor's Wage and Hour Division published a "Final Rule" under the Family and Medical Leave Act (FMLA). The Final Rule becomes effective January 16, 2009, and updates the FMLA regulations to implement new military family leave entitlements enacted under the National Defense Authorization Act which was issued in February 2008.
The Department of Labor's Veterans Employment and Training Service (VETS) also issued a Final Rule revising the regulations requiring federal contractors to report annually on the number of their employees who are veterans. The Final Rule implements the Veteran's Benefit and Health Care Improvement Act of 2000, which extended the protections contained in the Vietnam Era Veterans' Readjustment Assistance Act of 1974 to "recently separated veterans." Recently separated veterans are defined as "veterans who left active military duty within the past three years."
The Final Rule also clarifies that the requirements apply to government contracts entered into before December 1, 2003, and that the requirements apply if a contract entered into before December 1, 2003 is modified on or after that date, and as modified, is worth at least $100,000.
The rule requires that the data be reported on the VETS-100 report and submitted by the employer.
Sources: "Family and Medical Leave Act (FMLA)," GovDelivery, Inc., 25 Nov 2008, www.dol.gov/compliance.
Temporary Relief for Debit Card Use in 2009
The IRS stated that by January 1, 2009, drug stores and pharmacies must be compliant with the Information Identification Approval System (IIAS) in order to accept debit cards for Flexible Spending Account (FSA) or Health Savings Account (HSA) purchases. Recently, however, an exception to this called "the 90% rule" has been issued. The 90% rule states that "if 90% of a store's gross receipts during the prior tax year consisted of FSA eligible items, the store does not need to be IIAS compliant."
Debit cards may be used at these stores but transactions will not be auto-substantiated and participants may need to send in receipts for these purchases. The deadline for merchants to become IIAS compliant or register as meeting the 90% rule has been extended. After June 30, 2009, health FSA and HRA debit cards may not be used at drug stores and pharmacies that are not IIAS compliant or do not meet the 90% rule.
Source: "IRS Gives Temporary Relief for Debit Card Use," eflexgroup. 5 Dec. 2008.
Mental Health and Substance Use Disorder Benefits Parity
President Bush signed the "Emergency Economic Stabilization Act" October 3, 2008 which included provisions to require employer sponsored health plans to provide parity mental health benefits.
Employers that currently have mental health or substance use disorder benefits included in their medical coverage should take note of the new requirements effective beginning in 2010.
Key issues covered by the Act include financial requirements, treatment limits, and network parity.
New financial requirements include that any deductibles, copayments, coinsurance and out-of-pocket costs for mental health and substance abuse disorder benefits should not exceed those of the plan's most common medical/surgical benefits. The prior law that prohibits having plans from having annual/lifetime limits on mental health benefits when there is none on medical/surgical benefits will remain with this provision.
This law also requires that plans not impose limits on the frequency of treatment, the number of maximum visits, the days of coverage, or other comparable limits for mental health or substance use disorder benefits that are more restrictive than other medical / surgical benefits.
Treatment limits under the Act require that plans not impose limits on the frequency of treatment, the number of maximum visits, days of coverage, or other comparable limits that are more restrictive for mental health or substance abuse disorder benefits than other medical/surgical benefits in the plan. Under the network parity requirement, plans must also offer out-of-network mental health or substance abuse disorder benefits if they offer out-of-network medical/ surgical benefits.
Source: "Client Action Bulletin," Milliman 7 Oct 2008.
San Francisco Requires Employers to Provide Public Transportation Benefits
On September 22, 2008, San Francisco signed into law an ordinance that requires employers with at least 20 employees to offer their part-time, full-time, and/or temporary employees one of the three transportation benefit options below:
- a program to make pre-tax contributions under the Internal Revenue Code Section 132(f) to pay for transit passes or vanpool charges,
- transit passes or reimbursements for vanpool charges,
- or a door-to door shuttle service through a vanpooling or similar program at no cost to the employee.
Employers are required to have an appropriate transportation benefit program in place by January 19, 2009.
Source: "San Francisco Will Require Employers to Offer Transportation Benefits," Buck Consultants, LLC 3 Sept. 2008.
Have a comment on this issue? Speak out on our blog. Click here.
