On February 12, 2024, the IRS released Revenue Procedure 2024-14, which in part provides indexing adjustments for penalties under the ACA employer mandate. As a reminder, the ACA requires applicable large employers (ALEs), those with 50 or more full-time employees (FTEs) and full-time equivalent employees, to offer affordable minimum value (MV) coverage to all FTEs and their dependents or risk a penalty.

On February 9, 2024, the IRS updated its frequently asked questions (FAQs) for the premium tax credit. These FAQs superseded earlier FAQs that were posted on February 24, 2022. Nine existing FAQs were updated, and four new FAQs were added. Among other items, the FAQs explain the basics of the premium tax credit, the eligibility requirements, and how the affordability of employer coverage affects eligibility.

On January 17, 2024, HHS released its Annual Update of the HHS Poverty Guidelines for 2024. The notice provides an annual update on poverty guidelines based on the prior calendar year’s increase in prices as measured by the Consumer Price Index. These guidelines are used, in part, to help determine eligibility for federal programs such as Medicaid and to determine eligibility for subsidies in the individual marketplace.

On January 22, 2024, the DOL, HHS, and IRS (the departments) issued FAQ guidance addressing required coverage of contraceptive drugs under the ACA in response to reports of “unreasonable medical management techniques and other problematic practices” imposing barriers to contraceptive coverage without cost-sharing.

On November 15, 2023, CMS released the proposed Notice of Benefit and Payment Parameters Rule for 2025. This notice is issued annually preceding the applicable benefit year and, once final, adopts certain changes. Additionally, CMS issued Premium Adjustment Percentage and related guidance to inform the payment parameters for the 2025 benefit year. While the proposed rule primarily impacts the individual market and the Exchange, CMS’s Premium Adjustment Percentage and related guidance addresses certain ACA provisions and related topics...

On October 18, 2023, the IRS released Notice 2023-70, which announces that the adjusted applicable dollar amount for PCOR fees for plan and policy years ending on or after October 1, 2023, and before October 1, 2024, is $3.22. This is a $0.22 increase from the $3.00 amount in effect for plan and policy years ending on or after October 1, 2022, but before October 1, 2023.

The IRS recently released both the final forms and instructions for Forms 1094-B/C and 1095-B/C for the 2023 reporting year. Forms 1094-C and 1095-C are filed by applicable large employers (ALEs) to provide information that the IRS needs to administer the employer mandate penalties and eligibility for premium tax credits, as required by the ACA under Section 6056. Form 1094-B and 1095-B are filed by minimum...

On September 29, 2023, the United States District Court for the District of Columbia set aside a 2021 regulation from HHS and CMS (together, “the agencies”) that permitted rather than required plans and insurers to count drug manufacturer assistance toward cost-sharing limits.

On October 3, 2023, the DOL, HHS, and IRS (the departments) issued a request for information (RFI) regarding the application of preventive services requirements under the ACA to over-the-counter (OTC) preventive items and services available without a prescription.