PCOR Fee Adjusted The IRS released the adjusted applicable dollar amount for determining the Patient-Centered Outcomes Research (PCOR) fee. The new fee amount is $2.39. It applies to plan years ending on or after October 1, 2017 and ending before October 1, 2018. Each year the PCOR fee amount is updated using the projected amount of HHS National Health Expenditures. The fee is intended to fund research about patient outcomes and to improve the quality of health care in the U.S. It is due each year by July 31.
Under a Health Reimbursement Arrangement (HRA), (or, less commonly, a Health Care Flexible Spending Account [FSA] that does not meet the excepted benefit criteria;) the PCOR fee is calculated based on the number of covered lives.
Federal Agencies Relax Contraceptive Coverage Mandate Effective as of October 6, 2017, two companion interim final rules issued by the U.S. Departments of Health and Human Services, Treasury, and Labor expand exemptions related to the Affordable Care Act requirement that non-grandfathered group health plans provide coverage without cost-sharing for contraceptive services (referred to as the "contraceptive mandate"). Previously, the contraceptive mandate was subject to exemptions for religious employers and accommodations for certain other non-profit religious organizations and closely held for-profit entities with sincerely held religious beliefs against certain contraceptives. Expanded Exemptions The new rules exempt entities that object to establishing, maintaining, providing, offering, or arranging (as applicable) coverage, payments, or a plan that provides coverage or payments for some or all contraceptive services based on their sincerely held religious beliefs or moral convictions. For this purpose, the term "contraceptive services" includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling.
Religious Exemption. This exemption applies to non-governmental plan sponsors--including non-profit organizations and for-profit entities (whether or not they are closely held or publicly traded)—that object based on sincerely held religious beliefs.
Moral Exemption. This exemption includes the plans of plan sponsors that are non-profit entities, as well as for-profit entities that have no publicly traded ownership interests (as defined under the law).
Disclosure Requirements Exempt entities will not be required to comply with a self-certification process. However, where an exemption applies and all or a subset of contraceptive services are omitted from a plan's coverage, otherwise applicable ERISA disclosures must reflect the omission of coverage in ERISA plans. For more information on the interim final rules, please click here.
New Executive Order Calls for Expanding Access to Association Health Plans
President Trump has signed an executive order calling upon the U.S. Department of Labor (DOL) to consider, among other things, expanding access to Association Health Plans, which could potentially allow employers to form groups across state lines. Until further guidance is issued or legislation is signed, however, all current ACA requirements remain in effect, including penalties for noncompliance. Key Highlights The following are key highlights of the order:
Association Health Plans (AHPs): The executive order directs the DOL to consider adopting a broader interpretation of the Employee Retirement Income Security Act (ERISA), which could potentially allow employers in the same line of business anywhere in the country to join together to offer health insurance coverage to their employees.
Short-Term, Limited Duration Insurance (STLDI): The executive order directs federal agencies to consider ways of expanding coverage through low-cost STLDI, which is not subject to certain ACA rules.
Health Reimbursement Arrangements (HRAs): The executive order directs federal agencies to consider changes to the rules regulating HRAs so that employers can make better use of these arrangements for their employees.
For more information on this executive order, click here.
Note: In general, executive orders must be implemented in a manner consistent with applicable law, including the Administrative Procedure Act, which requires extended review of and public comment on any federal rules which may be proposed as a result of an executive order. Going forward, we will promptly report changes made to any ACA requirements. For more information on the ACA, check out our Health Care Reform section.