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In-Patient Hospitalization Requirements Finalized for Minimum Value Plans

On November 21, 2014, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released proposed regulations in the form of the 2016 Notice of Benefit and Payment Parameters. The proposed regulations address a number of issues, including in-patient hospitalization requirements for minimum value plans.

The proposed regulations formalize guidance provided in IRS Notice 2014-69 (released on November 4) addressing the glitch in the HHS minimum value (MV) calculator that generated a fair amount of media attention earlier this year. The calculator is intended to be used to determine whether an employer-sponsored plan provides 60 percent minimum value. According to HHS and Treasury, the online MV calculator was improperly qualifying certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services.

  

The proposed regulations would require that, in order to satisfy minimum value, an employer-sponsored plan must provide substantial coverage of both in-patient hospital services and physician services. The proposed regulations would apply to employer-sponsored plans, including plans that are in the middle of a plan year, immediately on the effective date of the final regulations. However, the proposed regulations provide that the final regulations will not apply before the end of the plan year for plans that, before November 4, 2014, entered into a binding written commitment to adopt, or began enrolling employees into, the plan, so long as that plan year begins no later than March 1, 2015.

Posted by Cristie Travis at 6:52 AM

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