PPACA Activities Remain Active During Congressional Recess

In a twist on Senator Ron Johnson’s (R-WI) court challenge of the Office of Personnel Management (OPM) decision to extend federal employer contributions to Members and employees electing health coverage via the Patient Protection and Affordable Care Act (PPACA)-related health insurance exchanges, House Democrat Representatives Dan Maffei (D-NY), John Barrow (D-GA) and Ron Barber (D-AZ) have offered legislation titled the “Members Play By the Same Rules Act of 2014” that would overturn the OPM decision for Members, but not for their staff. In connection with the criticism that about one million individuals who elected health coverage under PPACA health insurance exchanges did not properly document their eligibility, the Centers for Medicare and Medicaid Services (CMS) announced that about 660,000 of them have since documented their citizenship or legal residency. However, the agency said that more than 300,000 individuals will have only until September 5 to provide the necessary documentation or they will be barred from coverage. CMS also reported that about 7.2 million individuals qualified and were newly enrolled under Medicaid since last October 1st. CMS also clarified the circumstances under which individuals age 65 or older can access health coverage under the PPACA exchanges to meet the law’s individual mandate. The agency released a Frequently Asked Questions (FAQ) which states that seniors who did not pay Medicare taxes while they worked can elect coverage under the exchanges and avoid paying premiums for Medicare Part A and B. However, if they later elect Medicare coverage they will still be subject to the late enrollment penalties. In another action, CMS announced that about $5.3 million remains unspent under the PPACA’s Consumer Assistance Program (CAP) and that about 12 awards will be made to previous grantees. Amid complaints from enrollees and some hospitals and physicians about the narrowing of participating provider networks under health plans offered under the PPACA, the National Association of Insurance Commissioners (NAIC) released new “Managed Care Plan Network Adequacy Model” rules which states can adopt or modify in establishing their standard in measuring the adequacy of provider networks.

Courts Look Favorably on PPACA Challenges

Following an order by the U.S. Supreme Court, the U.S. Court of Appeals for the District of Columbia Circuit issued instructions remanding a case to the U.S. District Court for the District of Columbia which will result in a preliminary injunction putting a temporary halt to any enforcement by the Administration of the PPACA’s contraceptive coverage provisions against the plaintiffs--Fresh Unlimited Inc., Freshway Foods and Freshway Logistics Inc. The closely held companies argued that the rules violated their religious exercise in violation of the Religious Freedom Restoration Act (RFRA). In a similar action, the U.S. District Court for the Western District of Louisiana granted summary judgment for Louisiana College stating that the PPACA’s mandate for the provision of cost-free health insurance coverage for contraceptive drugs, devices and services cannot be enforced against the school. In another case, a judge in the Federal Court for the Southern District of Indiana ruled that the state of Indiana can proceed with its suit against the IRS’s regulations which allow individuals to receive federal premium tax credits even when they obtain coverage under HealthCare.gov rather than under an exchange established by the individual’s state.

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