Regulatory Activity

Final Rule Clarifies Eligibility for Wraparound Benefits

On Wednesday, March 18, the Internal Revenue Service (IRS), the Employee Benefits Security Administration, and the Centers for Medicare and Medicaid Services (CMS) issued a final rule that amends the regulations regarding excepted benefits. Excepted benefits include those benefits that are more limited or tangential to medical care, such as limited scope vision or dental benefits, coverage for a specified disease or illness, or Medicare supplement policies.

This final regulation amends the definition of “limited excepted benefits” in the group market to provide employers with two options for offering limited wraparound coverage. Under the first option, an employer could offer limited wraparound benefits to part-time and retired employees, as well as their dependents, who are enrolled in eligible individual health insurance. This regulation clarifies that the Basic Health Program, a state-based coverage program for low-income residents who are otherwise ineligible for marketplace coverage, qualifies as eligible individual health insurance. Alternatively, under the second option, an employer could offer wraparound coverage for employees enrolled individually in Multi-State Plans, provided that the wraparound coverage meets the requirements outlined in the regulation and is approved by the Office of Personnel Management.

Under the final rule, wraparound coverage could first be offered as excepted benefits between January 1, 2016 and December 31, 2018. The wraparound coverage pilot program sunsets on the later of either three years after the wraparound coverage was first offered or upon expiration of the last collective bargaining agreement relating to the plan.

Stakeholders Push Back on MU Stage 3 Reporting Period

On Friday, March 20, CMS released a proposed rule which would specify the Stage 3 MU criteria for providers and hospitals to qualify for Medicare and Medicaid EHR incentive payments and to avoid downward payment adjustments under the Medicare EHR Incentive Program. Stage 3 is expected to be the final stage of MU, and its requirements focus on the advanced use of certified EHR technology (CEHRT) in an effort to bolster information sharing and deliver high-quality, efficient, and coordinated care for patients.

Beginning in CY 2017, the proposed rule would change the EHR reporting period from 90 days to a full calendar year for all providers except for Medicaid providers in their first year of MU. Additionally, the proposed rule would support efforts to align the EHR Incentive Programs with other EHR quality reporting programs, including the Hospital Inpatient Quality Reporting (IQR) and Physician Quality Reporting (PQRS) programs.

Hospitals and provider groups immediately criticized CMS for requiring year-long reporting periods in future years, without first keeping its promise to shorten the reporting period for 2015. In January, the agency had stated that it will change the 2015 reporting period to 90-days, but has yet to release its flexibility rules for 2015.

The comment period for the proposed rule ends on May 29, 2015.

ONC Proposes Changes to the Health IT Certification Program

On Friday, March 20, the Office of the National Coordinator for Health Information Technology (ONC) released a proposed rule relating to the Health IT Certification Program. The Health IT Certification Program was established by the Health Information Technology for Economic and Clinical Health (HITECH) Act to oversee national health IT programs. This proposed rule identifies ways to boost interoperability and proposes modifications to make the Health IT Certification Program more “open and accessible” to different types of health IT besides EHRs.

ONC National Coordinator Karen DeSalvo stated that this proposal, which was released in tandem with CMS’s MU rule, will support Stage 3’s effort to build a coordinated, interoperable health IT system.

The comment period ends on May 29, 2015.

Legislative Activity

For more information on Lawmakers Continue Negotiations on Doc Fix Package, Working Framework Announced, click here.

Pari Mody also contributed to this article.