NSIDE HIS SSUE - NIHB

1 ISSUE 12 -07. FEBRUARY 21, 2012. Although the lack of financing for the payroll tax INSIDE THIS ISSUE holiday and the methods of paying for other provisions were somewhat contentious topics Congress Passes Payroll Tax Extension, among both parties, the bill passed both UI and SGR Fix chambers easily and on a bi-partisan basis. In the House, it was approved 293-132 and in the HRSA Distributes Pre-decisional Tribal Senate, it passed 60-36. It now will go to the Consultation Policy President's desk for signature. HHS FY 2013 National Budget ADMINISTRATION UPDATES. Consultation Update HRSA Distributes Pre-decisional Tribal Consultation Policy HILL UPDATES.

2 The Health Resources and Services Congress Passes Payroll Tax Extension, UI Administration (HRSA) has distributed a pre- and SGR Fix decisional, draft Tribal Consultation Policy for comment. HRSA will be accepting comments On February 17th, after several weeks of through March 16, 2012 at deliberation by a conference committee and well The policy and a Dear ahead of its end-of-the-month deadline, Congress Tribal Leader letter are attached for your review voted to approve 3630, a bill to extend the and comment. payroll tax holiday through the end of the year. The bill also extends unemployment insurance IRS Extends Comment Period for Comment (UI) and avoids a planned 27% cut to Medicare on General Welfare Exclusion for Tribal provider payments due to the Sustainable Growth Benefit Programs Rate (SGR), the formula tying reimbursement rates to economic growth.

3 The IRS is extending the time limit for commenting on guidance the agency issued At a cost of $100 billion, the payroll tax holiday regarding the application of the general welfare extension is unpaid-for. However, the UI exclusion to Indian tribal government programs. extension and SGR patch are financed by Comments may now be submitted through March increasing retirement contributions by federal 14, 2012. workers, $5 billion from the Affordable Care Act's (ACA) Prevention and Public Health fund, The Internal Revenue Service (IRS) and Treasury and reduced payments to hospitals, Medicaid, and Department are requesting Tribal comment clinical labs.

4 Regarding the application of the general welfare exclusion to Tribal government programs that provide benefits to Tribal members. According to NIHB 926 PENNSYLVANIA AVE, SE, WASHINGTON, DC 20003 (202) 507-4070 Page 2 of 5. the Internal Revenue Code, an individual's gross income includes income from all sources Insurance Customers see Better Value Under (including non-monetary) and can therefore be ACA. taxed. However, The Internal Revenue Service has held that under a limited general welfare Health and Human Services Secretary Kathleen exclusion, that payments under governmental Sebelius announced last week that consumers will social benefit programs for the promotion of the soon begin receiving unprecedented information general welfare are not includible in a recipient's on the value of their health insurance coverage , gross income.

5 And some will receive rebates from insurance companies that spend less than 80 percent of their On Nov. 15, 2011, the IRS issued Notice 2011- premium dollars on health care. 94, which requested that comments be provided by February 13. The guidance solicits comments The Affordable Care Act requires that insurance regarding the application of the exclusion to companies this year begin notifying customers Indian tribal government programs such as: how much of their premiums they have spent on medical care and quality improvement. Beginning Housing (for example, programs in 2011, insurers were required to spend at least providing housing on and off the 80 percent of total premium dollars they collect reservation, with income limits different on medical care and quality improvement.)

6 From those of the United States Insurance companies that do not meet the 80/20. Department of Housing and Urban standard (also known as the Medical Loss Ratio). Development); are required to pay rebates to their customers this Cultural (for example, programs involving year. tours of sites that are historically significant to a tribe; language The proposed consumer notices about whether preservation programs; community their insurance company has met the new recreational programs; cultural and social standard have been posted on , events); and HHS is seeking public comment to help Education (for example, programs ensure the notices are useful transparency tools providing tutors or supplies to primary for consumers.

7 And secondary school students; job retraining programs for adults); and In the individual market, the Affordable Care Act Elder programs (for example, programs allows the Secretary to adjust the medical loss providing heating assistance or meals). ratio standard for a state if it is determined that meeting that standard may destabilize the state's Comments now may be submitted in writing on individual insurance market. HHS has concluded or before March 14, 2012. Comments should be its review of 18 state requests for adjustments to submitted to Internal Revenue Service, the medical loss ratio rule. As a result of HHS'. CC:PA:LPD:PR (Notice 2011-94), Room 5203, decision to deny insurance companies the ability Box 7604, Ben Franklin Station, to spend more premium dollars on administrative Washington, DC 20044, or electronically to overhead costs rather than on medical claims, Please consumers will receive up to $323 million in include Notice 2011-94 in the subject line of rebates this year compared to what would have any electronic communications.

8 Alternatively, been owed if all state adjustment requests were comments may be hand delivered between the fully granted, according to data from state hours of 8:00 and 4:00 Monday to regulators and issuer reports. Friday to CC:PA:LPD:PR (Notice 2011-94), Courier's Desk, Internal Revenue Service, 1111 These adjustment request determinations were Constitution Avenue NW, Washington, made as a result of a transparent and data-driven process, and the documentation related to each state's request has been publicly posted. In total, NIHB 926 PENNSYLVANIA AVE, SE, WASHINGTON, DC 20003 (202) 507-4070 Page 3 of 5. HHS determined that no adjustment was For the National HHS Tribal Budget and Policy necessary in ten states, approved an altered Consultation, HHS will use the presentation adjustment in six states, and approved the request protocol as set forth in the HHS Tribal sought by one state.

9 This includes a denied Consultation Policy on page 13 of 22, which adjustment for Wisconsin, and an altered reads: adjustment for North Carolina, both announced 9. Presentation protocol will ensure that the highest ranking today. official from each respective Tribe is given the opportunity to address the session first, followed by other elected officials, The announcement is part of the Obama those designated by their elected official to represent their Administration's effort to increase transparency in respective Indian Tribes and representatives of Indian/Tribal the health insurance marketplace. The Organizations. notification will let consumers know if their i.

10 Official letter from the Indian Tribe designating a insurer did not meet the 80/20 standard -- and representative must be presented to IGA before the session that they or their employer will receive a begins. rebate. HHS is also considering requiring insurers Order of Tribal Leadership Presentation: In the notify consumers if their insurer did meet the open sessions, HHS will offer the highest-ranking 80/20 standard. For the text of these proposed official from each respective Tribe the first notifications, please visit: opportunity to address the session followed by other elected officials and those designated to speak #mlr for a Tribe or Tribal Organizations.