Benefit Buzz - November 2023

Zywave, Inc • December 1, 2023

Benefit tips brought to you by MFC Benefits, LLC

Learn more about the Final Forms and Instructions for 2023 ACA reporting and the deadline for submitting Gag Clause Attestation.

FINAL FORMS AND INSTRUCTIONS FOR 2023 ACA REPORTING RELEASED

The IRS has released final 2023 forms and instructions for reporting under Internal Revenue Code Sections 6055 and 6056:
• 2023 Forms 1094-B and 1095-B (and instructions) will be used by providers of minimum essential coverage, including self-insured plan sponsors that are not applicable large employers (ALEs), to report under Section 6055.
• 2023 Forms 1094-C and 1095-C (and instructions) will be used by ALEs to report under Section 6056, as well as for combined Section 6055 and 6056 reporting by ALEs who sponsor self-insured plans.

No major substantive changes were made to the final forms and instructions for 2023 reporting. However, the 2023 instructions include information on the new electronic filing threshold for information returns required to be filed on or after Jan. 1, 2024, which has been decreased to 10 or more returns (originally, the threshold was 250 or more returns).

Employers should become familiar with these forms and instructions for 2023 calendar year reporting and begin to explore options for filing these returns electronically (e.g., they may be able to work with a third-party vendor to complete the electronic filing). Reporting entities that may be in a position to perform their own electronic reporting can review the IRS’ ACA Information Returns (AIR) Program webpage.

Electronic IRS returns for 2023 must be filed by March 31, 2024. However, since this is a Sunday, electronic returns must be filed by the next business day, which is April 1, 2024 .

DEADLINE FOR SUBMITTING GAG CLAUSE ATTESTATION IS DECEMBER 31, 2023

A federal transparency law prohibits health plans and health insurance issuers from entering into contracts with health care providers, third-party administrators (TPAs) or other service providers that contain gag clauses (i.e., clauses restricting the plan or issuer from providing, accessing or sharing certain information about provider price and quality and de-identified claims).

Plans and issuers must annually submit an attestation of compliance with the gag clause prohibition to the federal government. The first gag clause attestation is due by Dec. 31, 2023 . Employers should review what action they may need to take to comply with the attestation requirement.

If the issuer for a fully insured health plan provides the attestation, an employer does not also need to provide an attestation for the plan. Self-insured employers can enter into written agreements with their TPAs to provide the attestation, but the legal responsibility remains with the health plan. Also, some TPAs may be unwilling to submit attestations for their self-insured groups.

Employers who need to submit their own attestations should review the instructions and user manual for submitting attestations electronically through the Centers for Medicare & Medicaid Services.

Provided to you by MFC Benefits, LLC

© 2023 Zywave, Inc. All rights reserved

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Benefit Buzz - May 2024

By MFC Benefits, LLC • May 15, 2024

Learn more about the Prescription Drug Report due date and the Court Ruling on Free Preventive Care. PRESCRIPTION DRUG REPORT IS DUE BY JUNE 1, 2024 Group health plans must annually submit detailed information on prescription drug and health care spending to the federal government. This reporting is referred to as the "prescription drug data collection," or the "RxDC report." The next RxDC report is due by Saturday, June 1, 2024, covering data for 2023. Employers should confirm they are taking steps to comply with this reporting deadline, such as providing information to third-party vendors on a timely basis. The RxDC report is comprised of several files, including those that require specific plan-level information, such as plan year beginning and end dates and enrollment and premium data. It also includes files that require detailed information about medical and pharmacy benefits. RxDC reports must be submitted through an online portal maintained by the Centers for Medicare and Medicaid Services (CMS). CMS'RxDC website includes updated reporting instructions and other reporting resources. Employers commonly use third parties, such as issuers, third-party administrators (TPAs) and pharmacy benefit managers (PBMs), to submit RxDC reports on behalf of their health plans. Employers using third parties to submit RxDC reports must ensure that this reporting responsibility is reflected in a written agreement with the third party. Employers may work with multiple third parties to complete the RxDC report for their health plans. For example, a self-insured employer may use both its TPA and PBM to submit different portions of the RxDC report. A health plan's submission is considered complete if CMS receives all required files, regardless of who submits them. COURT RULING EXPECTED SOON ON FREE PREVENTIVE CARE The 5th U.S. Circuit Court of Appeals is expected to issue a decision within the next few months regarding the constitutionality of the Affordable Care Act's (ACA) preventive care mandate. The ACA requires non-grandfathered health plans and health insurance issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles. In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA's preventive care mandate. More specifically, the court ruled that the preventive care coverage requirements based on an A or B rating y the U.S. Preventive Services Task Force on or after March 23, 2010, violate the U.S. Constitution. The Biden administration appealed the District Court's decision to the 5th Circuit. A ruling by the 5th Circuit is expected soon, likely followed by an appeal to the U.S. Supreme Court. It is uncertain whether the 5th Circuit will reverse or uphold the District Court's ruling. However, for now, non-grandfathered health plans and issuers must continue to cover, without cost sharing, the full range of preventive car services required by the ACA. If the 5th Circuit rules that a key component of the ACA's preventive care mandate is unconstitutional, employers will want to consult with their issuers or TPAs to assess the impact on their health coverage. Provided to you by MFC Benefits, LLC © 2024 Zywave, Inc. All rights reserved Download the PDF copy here. Link: http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://content.zywave.com/file/b6f7a224-b3a3-4409-a8f2-953f0994d66a/Benefits%20Buzz%20Newsletter%20January%202024.docx Link: http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://content.zywave.com/file/b6f7a224-b3a3-4409-a8f2-953f0994d66a/Benefits%20Buzz%20Newsletter%20January%202024.docx