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Proposed 2022 Benefit Payment and Parameters Rule

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule and fact sheet for benefit payment and parameters for 2022. CMS has also released its draft 2022 actuarial value calculator and draft 2022 actuarial value calculator methodology. According to CMS, the proposed ...

Highlights of the Patient-Centered Outcomes (PCORI) / Comparative Effectiveness Fee

The Patient-Centered Outcomes Research Institute (PCORI) fee initially applied from 2012 to 2019. However, in December 2019, the Further Consolidated Appropriations Act, 2020 extended the fee to 2029. The fee is due based on plan/policy years ending on or after October 1, 2012, and before ...

Frequently Asked Questions about the Patient-Centered Outcomes / Comparative Effectiveness Fee

You have a PCORI filing and payment obligation if: You sponsor a major medical self-insured health plan You sponsor a fully-insured health plan and a self-funded health reimbursement arrangement (HRA) You sponsor a health plan that meets minimum essential coverage only (MEC) Employer-sponsored ...

PCORI, TRF and HIP Fee Highlights

The IRS and the Department of Health and Human Services have issued final regulations that provide details on several fees that will be due as part of the Patient Protection and Affordable Care Act (ACA). Self-funded plans will calculate and pay these fees directly. Insurers will calculate and ...

Spending Bill Extends PCORI Fee and Repeals Cadillac Tax, HIP Fee, and Medical Device Excise Tax

On December 20, 2019, President Trump signed the Further Consolidated Appropriations Act, 2020 (Act) to keep the federal government running through September 2020. The Act significantly affects provisions under the Patient Protection and Affordable Care Act (ACA), largely though one fee ...

Scam Alert | Beware of PreTexting

Earlier this afternoon, two Purple Card clients independently reported that a team member of theirs received a fraudulent phone call. The callers represented themselves to be with a company contracted by the health plan for their prescription benefits and made it sound as if they already knew ...

When Boundaries Collide: Holidays & COVID-19

The holidays are often associated with friends, family, and food. It is a great excuse to get folks together whom you may not have seen all year. Calendars resemble a bingo card as celebrations fill dates for weeks, if not months, in advance. Historically, the biggest obstacle you had to work ...

Advocacy in Action | Resolving Denied Claims

Kelly had reached out to The Purple Card with an issue about her MRI. It was denied and she was potentially liable for over $6,500. Her Patient Advocate started working her purple magic! After reaching out to the doctor and the insurance company multiple times, the appeal was approved and the ...

Compliance Recap | October 2020

October was a busy month in the employee benefits world. The Department of Health and Human Services (HHS) renewed the public health emergency due to COVID-19 which took effect on October 23, 2020. The Internal Revenue Service (IRS) issued Notice 2020-76 regarding deadline extensions and ...

Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rules

The Department of Labor (DOL), Department of Health, Department of Health and Human Services (HHS), and the Department of the Treasury (Treasury), collectively “the Departments,” released interim final rules regarding implementation of the Coronavirus Aid, Relief, and Economic Security (CARES) ...