Hamilton Headlines
August 17, 2016

OIG Favorable Advisory Opinion

OIG Approves Hospice payments to nursing facilities for dual eligible patients under Medicaid demonstration project

On July 20, 2016, the Office of Inspector General (OIG) issued a favorable Advisory Opinion regarding payments between a hospice and a nursing facility.  "  It was determined that a hospice provider would not activate administrative sanctions by making supplemental payments to nursing facilities for room and board expenses of residents  who are dually eligible for Medicare and Medicaid. 

For dually eligible hospice patients residing in nursing facilities, Medicare pays for the hospice care while the state Medicaid program pays for the nursing facility room and board
 expenses. The state's payment must be at least 95% of the daily rate for patients who have not elected to receive hospice care.

In general, the state's Medicaid program pays the hospice for the dually eligible patient's room and board. The hospice then reimburses the nursing facilities at a negotiated rate.

Under the proposed arrangement, the hospice provider would make supplemental payments to the nursing facilities for dually eligible hospice patients that, combined with the payment from the MCO, would equal the amount the facilities would have received had the patients not elected hospice.

"We believe the Proposed Arrangement would help to ensure that the nursing facility has no incentive to provide a lower level of room and board services" to the hospice's dually eligible patients "or to discourage patients from electing hospice," the opinion said.

Proposed Form 5500 Annual Return/Report Modernization

The Department of Labor's Employee Benefits Security Administration issued a proposed revision to the Form 5500 Annual Return/Report.  Additionally, EBSA published a notice of proposed changes to its annual reporting regulations under Title I of ERISA.

Under Employee Retirement Income Security Act (ERISA) pension and other employee benefit plans are generally required to file the Form 5500 concerning the financial condition and operations of the plan.

The proposed revisions are intended to:
  • Modernize the financial statements and investment information filed about employee benefit plans.
  • Update the reporting requirements for service provider fee and expense information.
  • Enhance accessibility and usability of data filed on the forms.
  • Require reporting by all group health plans covered by Title I of ERISA.
  • Improve compliance under ERISA and the Internal Revenue Code through new questions regarding plan operations, service provider relationships, and financial management of the plan.       

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IRS Issues Draft Instructions for Forms 1094-B and 1095-B for 2016

Last week, the IRS released drafted instructions for Forms 1094-B and 1095-B for 2016.  The IRS generally do not release drafts, so changes may arise.

Highlights of the changes are:

  • Health insurers encouraged (but not required) to report coverage in catastrophic health plans enrolled in through the Marketplace for months of 2016.
  • On Form 1095-B, language "Do not attach to your tax return.  Keep for your records." has been added.
  • Also added on Form 1095-B in Part I, lines 2 and 3, and Part IV, columns (b) and (c) were updated to reflect the rule that a taxpayer identification number (TIN) may be entered.
  • The heading to Part II on 1095-B was revised to read "Information about Certain Employer-Sponsored Coverage" to clarify that Part II will be blank for some individuals with employer-sponsored coverage.


OCR Reminds Covered Entities and Business Associates to Check Their Spam Email

Phase II of the HIPAA audits are underway for Covered Entities and Business Associates.  OCR reminds CE's and BA's to search their spam and/or junk folders for messages from OSOCRAudit@hhs.gov as selected covered entities would have received notification letters on and around Monday, July 11, 2016.  

Business Associate audits will commence in the fall.  Communication from OCR is set through email and may be classified as spam or junk mail.

The letter received through email will be asking for verification of primary contact within the organization.  Click to view the Verification Letter.

CMS Promise of Better Care for Older Adults

CMS Promises Better Care for Older Adults

Acting Administrator for CMS (Centers for Medicare & Medicaid Services) Andy Slavitt has spoken about moving to the next chapter in implementing the Affordable Care Act frequently since becoming administrator.  

On August 11, 2016, CMS proposed the first major update to the PACE (Programs of All-inclusive Care for the Elderly) program in a decade. 

Per his blog announcement, Mr. Slavitt states "The goal of this proposal is to strengthen beneficiary protections and provide PACE organizations with more administrative and operational flexibilities so they can do what they do best - caring for our nation's most vulnerable individuals. While PACE serves a relatively small number of people today, our proposal is intended to encourage states to further expand these programs."

2016 EEO-1 Survey
The Employer Information Report EEO-1 is required to be filed with the U.S. Equal Employment Opportunity Commission's EEO-1 Joint Reporting Committee.  The deadline for submitting and certifying is September 30, 2016.

To check if you should be filing or further instructions, go to EEO-1
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Please note that Hamilton Insurance does not provide legal advice, and this does not constitute advice of any kind for any 
particular situation. Instead, this is intended as non-comprehensive general information serving as a starting point for further 
discussion. Please contact your tax and/or legal advisors for information about how these issues affect you.  
About Us
H amilton Insurance , a top ranked independent broker in the Washington DC/Metropolitan Area and the nation, has over 35 years of experience in providing insurance brokerage, risk management and employee benefit solutions. It represents a full suite of commercial, health & welfare, and personal insurance solutions, supported by risk compliance and group benefit administrative services. 

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