November 30, 2018



 

In This Issue
Fast Facts
State Spotlight: CMS Releases Four Concepts for Waivers, Including Reinsurance Programs
CMS Introduces Enhanced Direct Enrollment for Federal Marketplace
IRS Extends ACA Reporting Deadline and Transitional Relief in 2020
NAHU Seeks Balance-Billing Stories to Shape Forthcoming Legislation
Healthcare Happy Hour: How States Can Take Advantage of ACA Waivers
HHS Adjusts Civil Monetary Penalties
Register Now for Next Week’s Webinar on Transitioning to a Fee-Based Business
December’s Compliance Corner Webinar Features a Deep Dive on AHPs
Scholarships Available for Capitol Conference
HUPAC Roundup
What We’re Reading
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HHS Adjusts Civil Monetary Penalties

by Compliance Committee Chair Joan Fusco
Chief Compliance Officer,Savoy Associates

Head over to the Compliance Cornered blog to check out our latest post: HHS Adjusts Civil Monetary Penalties. HHS has announced annual adjustments of civil monetary penalties. The latest adjustments are based on a cost-of-living increase of 2.04%. Here are the highlights:

HIPAA Administrative Simplification. HIPAA administrative simplification encompasses standards for privacy, security, breach notification and electronic healthcare transactions. The HITECH Act of 2009 created liability for Business Associates and substantially increased the penalty amounts creating four categories of violations. The penalty amounts for each violation are:oLack of knowledge: The minimum penalty is $114 (up from $112), the maximum penalty is $57,051 (up from $55,910) and the calendar-year cap is $1,711,533 (up from $1,677,299).

  • Reasonable cause and not willful neglect: The minimum penalty is $1,141 (up from $1,118), the maximum penalty is $57,051 (up from $55,910) and the calendar-year cap is $1,711,533 (up from $1,677,299).
  • Willful neglect, corrected within 30 days: The minimum penalty is $11,410 (up from $11,182), the maximum penalty is $57,051 (up from $55,910) and the calendar-year cap is $1,711,533 (up from $1,677,299).
  • Willful neglect, not corrected within 30 days: The minimum penalty is $57,051, the maximum penalty is $1,711,533 (up from $1,677,299) and the calendar-year cap is $1,711,533 (up from $1,677,299).

Medicare Secondary Payer. The Medicare Secondary Payer statute prohibits a group health plan from “taking into account” the Medicare entitlement of a current employee or a current employee’s spouse or family member and imposes penalties for violations. The indexed amounts for violations applicable to employer-sponsored health plans are:oThe penalty for an employer that offers incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary is $9,239 (up from $9,054).

  • The penalty for willful or repeated failure to provide requested information regarding group health plan coverage is $1,504 (up from $1,474).
  • The penalty for responsible reporting entities that fail to provide information identifying situations where group health plan is primary is $1,181 (up from $1,157).

Summary of Benefits and Coverage. An SBC generally must be provided to participants and beneficiaries before enrollment or re-enrollment in a group health plan. The penalty for a health insurer’s or non-federal governmental health plan’s willful failure to provide an SBC is $1,128 (up from $1,105) for each failure.

These adjustments are effective for penalties assessed on or after October 11, 2018, for violations occurring on or after November 2, 2015.

And in case you missed it, last week the Compliance Cornered blog featured the adjustments to the IRS 2019 Tax Limits.

The IRS has provided tax inflation adjustments for tax year 2019:
  • The dollar limit on employee salary reduction contributions to health FSAs will be $2,700 (up from $2,650 in 2018).
  • The maximum amount of payments and reimbursements under a QSEHRA will be $5,150 for self-only coverage and $10,450 for family coverage (up from $5,050 and $10,250 for 2018).
  • HSA-compatible high-deductible health plans:
  • The annual deductible for self-only coverage must not be less than $1,350 for self only and $2,700 for family (no changes from 2018).
  • The out-of-pocket maximum is $6,750 for self-only and $13,500 for family.
  • The annual contribution limit is $3,500 for self-only and $7,000 for family.

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