By Phil Larson

Have you analyzed whether or not your retiree coverage may need minimum essential coverage reporting for 2015?  While many parts of the Affordable Care Act (ACA) specifically excludes retiree only coverage, the new requirements to report minimum essential coverage under the Internal Revenue Code §6055 does not include such an exception.  

As a reminder, the §6055 reporting applies to issuers (e.g. HMO) and employers and other entities that sponsor self-insured medical programs that qualify as minimum essential coverage.  This reporting will important as it will be used by the IRS to verify the individual mandate, premium subsidy eligibility for exchange coverage, and the employer responsibility rules under Internal Revenue Code §4980H (also called the employer pay or play rules).    

The minimum essential coverage reporting rules clearly state that retiree coverage is included in the reporting (as minimum essential coverage).  However, the preamble to the final regulations, the actual regulations, and the recently released questions and answers on this topic say that say that minimum essential coverage that supplements a primary plan of the same plan sponsor OR that supplements government-sponsored coverage (like Medicare) will be “supplemental” coverage and not subject to this reporting.   

This seems to imply that most retiree coverage is excluded (if it supplements Medicare) but early retiree coverage or HRA only plans (which may not supplement Medicare) may still need to be included in this reporting if the program qualifies as minimum essential coverage.

It will be important for entities that need to perform this reporting to determine which plans apply.  If you need assistance with understanding these requirements or other ACA requirements, please contact Kinney & Larson.   

By Phil Larson

A sometimes surprising fact is that just a name of a person can be protected health information under the Health Insurance Portability and Accountability Act (HIPAA).  

This is because protected health information can be just the fact that someone received services at a medical provider or health plan.  For example, I have an appointment on Monday with my Dentist.  HIPAA does not require that the information include the type of services I need or the medical condition I have in order to be protected.   In fact, the data may be protected even without the name.  For example, an address list of people who received services would also fall under protected health information just as would a list of name(s).   

Customer lists for providers are essentially a list of individuals who use medical services at their facility and should be protected information.  Protections include all of the privacy requirements and if the data is held electronically, all of the physical, administrative, and technical requirements for the data as well. 

Entities should be mindful of this fact and especially when they send out mass mailings as postcard reminders.  A subcontractor for the Maryland's Developmental Disability Administration (DDA) recently learned this lesson.  In early 2014, the subcontractor mailed postcards to approximately 2200 individuals to remind them to fill out the satisfaction survey for the DDA.  The postcard was not enclosed in an envelope and therefore the name of the person receiving DDA services was publicly viewable.  The DDA was made aware of this and contacted the vendor promptly who is in process of notifying the affected individuals and updating their policies for this deficiency.

HIPAA can be complex, and sometimes the data is still covered even without a name or other medical information.  If you need assistance understanding HIPAA or have questions with where it applies, please contact Kinney & Larson LLP.