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Final HHS rules set PPACA reinsurance fee amounts, payment schedule

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Final HHS rules set PPACA reinsurance fee amounts, payment schedule

Employers will be allowed to pay a controversial health care reform law fee in two installments and have certainty on the amount of the fee during the second year of the three-year program under final rules issued Wednesday by the U.S. Department of Health and Human Services.

Authorized by the Patient Protection and Affordable Care Act, the fees are intended to generate $25 billion in revenues to be used to partially reimburse commercial insurers writing policies in public exchanges for individuals with high health care costs.

Earlier, HHS had set the first-year fee at $63 per plan participant and had proposed a $44 fee for the second year. The final rules affirm the $44 fee for the second year.

HHS has not proposed the amount of the fee for the third and last year of the program.

HHS also finalized that the fee will be paid in two installments. For example, of the first year's $63 fee, employers would make a payment of $52.50 per participant by Jan. 15, 2015, and an additional payment of $10.50 during the fourth quarter of 2015.

“We recognize that the reinsurance collections provided for in the Affordable Care Act will result in substantial upfront payments from contributing entities for the reinsurance program. Therefore, in consideration of the comments received, we are finalizing our proposal to collect contributions via two payments,” the final rules said.

Like the earlier proposed rules, the final rules will exempt — for 2015 and 2016 only — self-insured and self-administered plans from the fees. HHS said its reading of the law is that such plans “should not be a contributing entity,” adding that few plans will qualify for the exemption.

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“Very few plans are self-administered,” said Amy Bergner, managing director of human resources solutions at Pricewaterhouse-Coopers L.L.P. in Washington.

Still, that exemption means that other plan sponsors will have to pay more than they otherwise would in order to raise the mandated $25 billion, said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

The fee has drawn fire from some members of Congress who have introduced bills to repeal it. Rep. Pat Tiberi, R-Ohio, who has introduced a repeal bill, earlier said “it is simply outrageous that employers will be forced to pay the tax while they will get nothing in return.”

But the likelihood of a repeal winning approval is low, observers say. A repeal “would mean that a significant amount of money would have to be raised elsewhere,” said Gretchen Young, senior vice president of health policy with the ERISA Industry Committee in Washington.