Compliance Corner

September 27, 2022

State and Territory Updates

New Mexico


Podcast Episode 128: Fall Bills: Congress Considers Mental Health Services Proposals

In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health services, such as required behavioral health monitoring for suicide ideations and the need for interventions such as detoxification for substance abuse. Suzanne and Chase walk through proposals from the House on coverage for forensic medical exams relating to sexual assault. Suzanne and Chase close with a discussion of provider network proposals and the Senate’s reauthorization of funding for the Jackie Walorski Maternal and Child Home Visiting Act, which promotes healthy pregnancy practices, language development and early learning at home.

Periodically, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page for the most up-to-date episode.

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October Get Wise Wednesdays – Registration Coming Soon

Check back here soon for the October webinar registration information.

Reminder: It’s MLR Rebate Time Again!

The ACA requires insurers to submit an annual report to HHS accounting for plan costs. If the insurer does not meet the medical loss ratio standards, they must provide rebates to policyholders. Rebates must be distributed to employer plan sponsors between August 1, 2022, and September 30, 2022. Employers should keep in mind that if they receive a rebate, there are strict guidelines as to how the rebate may be used or distributed.

For more information, please see our August 16, 2022, FAQ and contact your advisor for a copy of “Medical Loss Ratio Rebates: A Guide for Employers.”

Reminder: Calendar Year SAR Must Be Distributed by September 30, 2022

Plans that are subject to ERISA and Form 5500 filing must distribute the Summary Annual Report (SAR) to participants within nine months of the end of the plan year; thus, a calendar year plan is generally required to distribute the SAR for the 2021 plan year by September 30, 2022. If the plan applied for an extension to the Form 5500 filing, the SAR is then due within two months following that filing.

The SAR is a summary of the plan’s information reported on Form 5500. If a plan is not subject to Form 5500 filing, then it is exempt from the SAR notice requirement — this would include church plans, governmental plans, and unfunded or insured plans with fewer than 100 participants. Also, large, unfunded self-insured plans are exempt from the SAR requirement even though they are subject to the Form 5500 filing requirement.

Please ask your advisor for a copy of our "Summary Annual Report: A Guide for Employers" white paper for more information.

Reminder: Medicare Part D Notice to Employees Deadline Is October 14, 2022

Employers must notify individuals who are eligible to participate in their medical plan whether the plan’s prescription drug coverage is “creditable” or “non-creditable” as compared to Medicare Part D coverage.

As a reminder, the Medicare Part D notice of creditable coverage should be distributed to employees by October 14, 2022. This notice serves to inform Medicare-eligible individuals of whether or not their employer group coverage is creditable. That information is necessary to help such individuals avoid paying higher premiums (also known as late enrollment penalties) for Medicare Part D coverage.

Employers should consult with their service providers to determine whether their coverage is creditable using either the simplified determination method or actuarial analysis. Also, keep in mind that CMS provides a model notice for employers.

For further information, please ask your advisor for a copy of our "Medicare Part D Disclosures: A Guide for Employers" white paper.