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More ACA FAQs: Mini-Med Plans and Clinical Trials

We are now up to Part XV of the tri-agency FAQs providing guidance on various ACA-related issues.

The most important guidance in these FAQs relates to the treatment of mini-med plans that obtained a waiver from the prohibition on annual limits. But the FAQs also acknowledge, in so many words, that there are some issues on which further guidance simply will not be provided before 2014, so we're going to have to use our best judgment.

Changing the Plan Year on Mini-Med Plans. Employers and insurance carriers offering mini-med plans were required to obtain a waiver from the prohibition on annual limits. Under the waiver program, plans were allowed to continue until the end of the plan year ending in 2014. Creative employers and carriers began exploring whether they could change their plan years now and effectively extend waiver through most of 2014. For example, a plan with a plan year ending June 30 might change to a plan year ending November 30 and rely on the waiver until November 30. 

These FAQs provide, unequivocally, that a change in the plan year will not be effective to extend a plan's waiver. The waiver only applies until the end of the plan year ending in 2014, based on the plan year the plan was using when it applied for the waiver.

In other words, nice try.

Why would this matter? Well, it now appears that mini-med coverage extending into 2014 will be sufficient to allow employers with fiscal year plans to avoid some of the play-or-pay requirements before the end of the plan year ending in 2014. So extending the plan year further into 2014 would provide more months of cheap compliance with play-or-pay. 

Clinical Trials and Other Mandates. The FAQs also say that employers, TPAs, and insurance carriers should not be waiting for guidance on the mandate that requires providing coverage for individuals participating in clinical trials. The government views the statutory language as "self-implementing," so they do not anticipate issuing regulations in the near future. Health plans and insurance carriers will need to implement the requirements "using a good faith, reasonable interpretation of the law."

The FAQs provide similar comments with respect to the mandate that requires plans and insurers not to discriminate against any health care provider who is acting within the scope of the provider's license or certification under state law.


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