Not-for-Profit Board Governance & Compliance Update

As a key player in the nonprofit community, New York recently took big steps to combat bad habits and under-supported initiatives and regulations. In a recent report drafted by the Leadership Committee for Nonprofit Revitalization (“Committee”) and released by New York Attorney General Eric T. Schneiderman (“Attorney General”), among all issues addressed, strengthening board governance and accountability seemed to be the elephant in the room.

Adam Reiss, CPA and Citrin Cooperman’s  Practice Leader of the firms Not-for-Profit Organizations and Employee Benefit Plans Practices has addressed the two initiatives designed around improvement of board governance and developed an “Annual Board Governance and Compliance Checklist”.  To review this article and check list click here.

Retail Sales Will Be Vital for Insurers as 125 Million Switch Health Coverage | AIS Health

IRS Issues Rule Change on Using Debit Cards for OTC Drugs

Effective January 1, 2011, the Affordable Care Act requires that individuals obtain a prescription for over-the-counter (OTC) medicines and drugs (other than insulin) in order to receive reimbursement for the cost of the medicine from a health plan. The Internal Revenue Service (IRS) issued Notice 2010-59 in November 2010, which prohibited plans from allowing a health Flexible Spending Arrangement (FSA) or Health Reimbursement Arrangement (HRA) debit card to pay for OTC medicines and drugs, even if the individual has obtained a prescription for the drug. The IRS allowed for a two-week transition period (from January 1-15, 2011) during which debit cards could be used to purchase OTC drugs, in order to allow debit-card systems to be re-programmed.

On December 23, 2010, the IRS issued Notice 2011-5 and accompanying answers to frequently asked questions (FAQs), which reversed its position on the use of debit cards to purchase OTC medicines and drugs for which the individual has a prescription. Effective  January 16, 2011, under certain conditions, health FSA and HRA debit cards may continue to be used to purchase OTC medicines or drugs at the following businesses: pharmacies, drug stores and grocery stores if those stores have pharmacies, and mail-order and Web-based vendors that sell prescription drugs.

Conditions for Using Debit Cards to Purchase OTC Medicines or Drugs

  • The prescription must be presented to the pharmacist at or before the time of purchase,
  • The OTC medicine or drug must be dispensed by a pharmacist under applicable law;
  • A prescription number must be assigned;
  • The pharmacy or other entity must retain records of the prescription number, purchaser, amount, and date of sale;
  • The pharmacy or other entity must make these records available to the employer on request;
  • The debit card system must be designed so that it will not accept a charge for OTC medicines or drugs unless a prescription number is assigned; and
  • Other existing rules for the use of debit cards are satisfied.

When the OTC medicine or drug order is sold by a vendor that uses health-related Merchant Codes, all of the following conditions must be satisfied:

  • The vendor must retain records of the purchaser, amount, and date of sale;
  • The vendor must make these records available to the employer on request; and
  • Other existing rules for the use of debit cards are satisfied.

When the OTC medicine or drug order is sold by a “90% pharmacy,” the following condition must be satisfied:

  • Substantiation (including a copy of the prescription or other documentation that a prescription has been issued) must be properly submitted in accordance with the terms of the plan with other information from an independent third party that satisfies the requirements of the proposed cafeteria plan regulations.

Note: A pharmacy is a “90% pharmacy” if (i) it maintains no inventory information approval system, and (ii) 90% of the store’s gross receipts in its prior taxable year met the definition of medical care expenses under section 213(d) of the Internal Revenue Code.

When the OTC medicine or drug order is filled by a vendor that is not described above:

  • The vendor may not accept FSA and HRA debit cards to pay for OTC medicines and drugs after January 15, 2011.

amednews: Health plans wonder about their role in ACOs :: Nov. 29, 2010 … American Medical News

How can employers make the best decision on grandfathering their health plan?

The interim regulations on grandfathered plans under the Patient Protection and Affordable Care Act (PPACA) are designed to allow employers to keep their current plans and at the same time ensure that employees are protected from significant loss of benefits or increased costs. Federal guidance, effective Sept. 23, 2010, attempts to lay down the rules for employers who want to retain grandfathered status.

These restrictions pose a serious challenge to employers who wish to keep their plans under the grandfathering clause. With calendar-year plan renewal season in full swing, many employers are anxious to make decisions. However, various factors — especially a company’s location — make a one-size-fits-all solution for employers unrealistic and impracticable.

This white paper addresses advantages and disadvantages of grandfathered status as a variety of experts share insight about key employer concerns, financial options and seeking guidance. As a UBA Member Firm we are please to offer you this white paper on, How Employers Can Make the Best Decision on Grandfathering Their Health Plans.ee theTheir Health Plans

How Could Mid-Term Elections Impact Health Care Reform

A new AP poll finds that Americans who think the Health Care Reform law should have done more outnumber those who think the government should stay out of health care by 2-to-1. 

The poll found that about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral. On the other side, about one in five say they oppose the law because they think the federal government should not be involved in health care at all.

The AP poll was conducted by Stanford University with the Robert Wood Johnson Foundation. Overall, 30 percent favored the legislation, while 40 percent opposed it, and another 30 percent remained neutral.

With several of the reforms new provisions going into effect last week, House Republicans unveiled its 21-page “Pledge to America”  a blueprint for what the party would do should it retake one or both houses of Congress, the GOP lays out its own ideas for improving health care. The document proposes to do away with health care mandates on small businesses, allow the purchase of health care across state lines and enact “real medical liability reform.”

 

It would seem unlikely that the GOP would accomplish appealing the reform in its entirety even if they gained control of the House and Senate.  But we can expect significant changes to the reform for the changes expected to take place in 2014.

HHS Launches New Consumer Focused Health Care Website

The U.S. Department of Health and Human Services today unveiled an innovative new on-line tool that will help consumers take control of their health care by connecting them to new information and resources that will help them access quality, affordable health care coverage.  Called for by the Affordable Care Act, HealthCare.gov is the first website to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool. 

HealthCare.gov  is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans.  Consumers can receive information about options specific to their life situation and local community.

In addition, the website will be a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources.  The website will connect consumers to quality rankings for local health care providers as well as preventive services.

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