Aug 16, 2024
Compliance News Week Ending August 16, 2024
In this Article:
- HHS Announces Penalties for HIPAA, Medicare Secondary Payer (MSP), and Summary of Benefits and Coverage (SBCs) Violations
- When is Creditable Coverage Determined for 2025 Medicare Part D Changes?
- When Should Creditable (or Non-Creditable) Notices be Distributed?
- ACA Health Insurance Subsidies Could Expire at the End of 2025
HHS Announces Penalties for HIPAA, MSP, and SBC Violations Effective August 8, 2024
HHS announced adjustments of civil monetary penalties for statutes within its jurisdiction. HHS published confirmation in the Federal Register stating the latest amounts are based on a cost of living increase of 1.03241%. The adjustments are effective for penalties assessed on or after August 8, 2024, if the violation occurred on or after November 2, 2015.
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When is Creditable Coverage Determined for 2025 Medicare Part D Changes?
For employer-sponsored prescription drug coverage, creditable status determinations must be made upon plan renewal. For example, for an August – July plan year, creditable status based on the 2025 Medicare Part D changes must be determined for the plan year that goes into effect in August 2025. Creditable status for the August 2024 – July 2025 plan year is tied to the 2024 Medicare Part D plan design.
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When Should Medicare Part D Creditable (or Non-Creditable) Notices Be Distributed?
CMS guidance indicates the creditable coverage notices should be distributed to eligible individuals upon initial eligibility, annually, and upon a change in creditable status.
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ACA Health Insurance Subsidies Could Expire at the End of 2025
The effect of the subsidies expiring would be enrollees in the HealthCare.gov states could see annual payments at least double on average.
Without the enhanced subsidies in the Inflation Reduction Act (IRA), Affordable Care Act (ACA) Marketplace enrollees in the states that use HealthCare.gov would see their annual premium payments at least double on average, according to a new KFF Analysis.
Enrollees in three states would see the steepest annual increases and premiums would rise by an average of 93% or $624 overall in HealthCare.gov states.
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