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Reimbursement, H.R. 6199: House Advances Health Savings Account Bills

H.R. 6199, Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018

Floor Situation

On Wednesday, July 25, 2018, the House will begin consideration of H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, under a closed rule.  H.R. 6199 was introduced on June 22, 2018 by Rep. Lynn Jenkins (R-KS) and was referred to the Committee on Ways and Means, which ordered the bill reported on July 11, 2018 by a vote of 24-10. The Rules Committee print includes the text of H.R. 6199, H.R. 6301, H.R. 6305, and H.R. 6312 and H.R. 6317 with modifications, as reported by the Committee on Ways and Means.


Summary              

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H.R. 6199 provides relief from the Affordable Care Act tax on over-the-counter medications and modernizes health savings accounts (HSAs). A section-by-section of the bill is below:

Sec 1. Short Title; Table of Contents

Sec. 2. First Dollar Coverage Flexibility for High Deductible Health Plans Health plans can provide coverage for services before the deductible is met up to $250 a year for an individual and $500 a year for family coverage. This change will allow insurers to provide coverage for and incentivize the use of high-value services that can reduce health care costs more broadly, such as primary care visits and telehealth services.

Sec. 3. Treatment of Direct Primary Care Service Arrangements Under this proposal, a Direct Primary Care (DPC) service arrangement would not be treated as a health plan that would disqualify an individual from contributing to an HSA. For this purpose, a DPC arrangement is an arrangement under which an individual is provided primary care services by primary care practitioners and the sole compensation for such care is a fixed periodic fee that does not exceed an aggregate of $150 a month for an individual and $300 a month for a family. In addition, the fees for the arrangement are treated as qualified medical expenses.

Sec. 4. Certain Employment Related Services Not Treated as Disqualifying Coverage For Purposes of Health Savings Accounts This section allows employers to offer free or discounted services at on-site or retail medical clinics without disqualifying an HDHP enrollee from contributing to an HSA so long as significant medical care benefits are not provided.

Sec. 5. Contributions Permitted If Spouse Has A Health Flexible Spending Account Under current law, Flexible Spending Accounts (FSAs) can be used to reimburse expenses for an individual and their spouses and dependents. This eligibility for FSA benefits disqualifies an otherwise eligible FSA enrollee’s spouse from contributing to an HSA, even when each spouse is covered under a separate health plan. This provision allows an otherwise eligible FSA enrollee’s spouse to maintain an HSA, so long as the aggregate expenses actually reimbursed from the FSA are limited exclusively to what the FSA enrollee would have been entitled to absent the spouse.

Sec. 6. FSA And HRA Terminations or Conversions to Fund HSAs Employees are able, at the employer’s discretion, to convert their FSA and Health Reimbursement Account (HRA) balances into an HSA contribution upon enrolling in a high deductible health plan with an HSA. The conversion amount is capped at $2,650 for an individual and twice that for family coverage. Any conversion taking place during the same year as the FSA or HRA contribution was made will count towards an enrollees’ HSA contribution for that taxable year.

Sec. 7. Inclusion of Certain Over-The-Counter Medical Products as Qualified Medical Expenses Removes Obamacare’s restriction on over-the-counter medicines for all tax-favored health accounts and adds “menstrual care products,” defined as a tampon, pad, liner, cup, sponge, or similar product used by women with respect to menstruation or other genital-tract secretions, as a qualified medical expense for the purposes of these accounts.

Sec. 8. Certain Amounts Paid for Physical Activity, Fitness, And Exercise Treated as Amounts Paid for Medical Care Qualified sports and fitness expenses are treated as qualified medical expenses up to a limit of $500 a year for an individual and $1,000 a year for a joint return. This includes amounts paid for membership at a fitness facility, participation or instruction in a program of physical exercise or physical activity, or safety equipment for use in a program of physical exercise or physical activity.


Background

An individual may establish a health savings account (“HSA”) only if the individual is covered under a plan that meets the requirements for a high deductible health plan. In general, HSAs provide tax-favored treatment for current medical expenses as well as the ability to save on a tax-favored basis for future medical expenses. In general, an HSA is a tax-exempt trust or custodial account created exclusively to pay for the qualified medical expenses of the account holder and his or her spouse and dependents. Within limits, 2 contributions to an HSA made by or on behalf of an eligible individual are deductible by the individual. Contributions to an HSA are excludible from income and employment taxes if made by the employer. Earnings in HSAs are not taxable. Distributions from an HSA for qualified medical expenses are not includible in gross income. Distributions from an HSA that are not used for qualified medical expenses are includible in gross income and are subject to an additional tax of 20 percent. The 20-percent additional tax does not apply if the distribution is made after death, disability, or the individual attains the age of Medicare eligibility (age 65).

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SOURCE: https://policy.house.gov/legislative/bills/hr-6199-restoring-access-medication-and-modernizing-health-savings-accounts-act

WATCH | CMS Panel Discussion on E/M Coding Reform

CMSHHSgov | Published on Jul 20, 2018

Many stakeholders maintain that current CMS evaluation and management documentation guidelines are outdated, complex, ambiguous, and that they fail to distinguish meaningful differences among code levels. CMS has acknowledged that the current guidelines create an administrative burden and increased audit risk for some providers. In response, CMS announced its intention to undertake a multi-year effort—with the input of providers and other stakeholders—to revise the current E/M documentation guidelines. CMS Administrator Seema Verma, – Dr. Rucker, National Coordinator for Health Information Technology, Dr. Kate Goodrich, CMS Chief Medical Officer and Director of CCSQ, Dr. Anand Shah, CMMI Chief Medical Officer, and Dr. Thomas Mason, ONC Chief Medical Officer host an informative live telecast on E/M Coding Reform.

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