Tuesday, August 20, 2019

Tweaked Rules, Court Ruling Cast More Doubt on Impact of PPACA

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The federal government continued to rework regulations stemming from the Patient Protection and Affordable Care Act (PPACA) in June amid a key court ruling and a wave of studies that tried to forecast how employers will cope with the long-term effects of the law.

The Department of Health and Human Services (HHS) tweaked a regulation concerning internal claims appeals and external review for health care claims in group and individual plans, trimming the time beneficiaries will have to prepare an appeal, from 120 to 60 days, according to a report in Kaiser Health News.

HHS also reduced the types of denials that can be challenged and the amount of information that insurance companies must provide when a claim is denied.

However, the agency left a few key features of the regulation stand, including the requirement that self-insured employer plans must use at least two independent review organizations when handling appeals to health care claims.

HHS also announced an end of waivers for limited, or "mini-med" health care plans after Sept. 22, according to Business Insurance.  Many of the plans do not meet the requirements of minimum dollar coverage amounts created by PPACA. Companies that have already received waivers can still file for extensions, provided they apply by Sept. 22. The waivers will last through the end of 2013, as long as plan sponsors meet certain requirements and keep the government and their employees informed about the plan.

Meanwhile, the Department of Labor (DOL) made its own change to a PPACA regulation, reversing the requirement that health care plans must notify urgent-care patients of coverage decisions within 24 hours. The DOL decided to keep that requirement at the current 72 hours after it reconsidered the "cost and benefits" of the 24-hour deadline.

While agencies were busy retooling these PPACA rules, a federal appellate court in Ohio handed the Obama administration a key victory by ruling that the health care reform law's requirement that all Americans purchase health insurance is not unconstitutional, according to a report in the Los Angeles Times.

While most experts think the Supreme Court will be the ultimate decider of PPACA's fate, the decision by the 6th Circuit Court of Appeals signaled a significant victory for the Obama administration because one of the judges who upheld the constitutionality of the law was a conservative and a former law clerk for Supreme Court Justice Antonin Scalia.

In the court of public opinion -- at least among employers -- the full fallout from PPACA remains a mystery, and several conflicting studies released in June do little to clear the air.

Research published in the McKinsey Quarterly indicated that 30 percent of employers say they are sure or likely to end their employer-sponsored health plans after the main provisions of PPACA take effect after 2014, according to a FoxNews.com report.  That figure jumps to 50 percent among employers who are "very aware" of the law.

Reform supporters questioned the results, citing previous studies that showed a much smaller number of employers who expect to dump health care insurance. Also, a recent study by the Urban Institute suggested that PPACA might actually increase the number of small employers that offer coverage. The institute projects the law will generate a 10 percent increase in the number of employers with 100 or fewer employees that offer health care insurance because of tax incentives and stabilization of the health care market. 

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