If you live in Vermont and are DPC oriented, you likely breathed a sign of relief when the state abandoned law it had passed to establish a single payor system as of 2017 (which would have made DPC in the state all but impossible). Look out, because they are at it again! One of these options is an all-payer model. Act 54 of 2015 directs the Agency of Administration and the Green Mountain Care Board to “jointly explore an all-payer model, which may be achieved through a waiver from the Centers for Medicare and Medicaid Services” (CMS). Details can be found in this Vermont Legal Aid Guide and this Vermont Biz article by Erin Mansfield also offers some helpful info.

The Consolidated Appropriations Act of 2016 was signed last week by President Obama. Highlights include:
- The absence of any language making DPC membership fees a deductible HSA expense
- Delay the "Cadillac Tax" by two years (it now starts Jan 1, 2020) and for those that choose to pay it, the tax is now considered a deductible business expense
- Eliminates the medical device tax for 2016 and 2017
- Reduces federal revenue by $34 Billion

Health Reimbursement Accounts - I am routinely asked whether employer DPC offerings fall within this space. Fellow physicians want a black and white answer, but unfortunately this clear cut answer does not exist. I'm attempting to find the time to author a comprehensive piece discussing these issues, but in the likely event that does not happen, the simplest way I can refer to this situation is as follows: The HRA "issue" is mainly a hurdle for business owners that are both subject to the ACA requirement (i.e. have 50 or more employees) and want to pay for all or a portion of their employees DPC periodic fee WITHOUT offering those same employees any type of qualifying coverage. Recent IRS notices do offer some guidance:
- IRS Notice 2015-87
- IRS Notice 2013-54
- IRS Notice 2015-17

Highlighting Excellent Blogs - I plan to do this more often. For those out there looking for a greater understanding of the ACA's impact on employers - more specifically the health insurance mandate and how that might weigh on their decision to purchase DPC for their employees, please consider the following posts from the Employment Matters Blog, which did a 24 part series : I would recommend DPC oriented readers start with the following entries:
- Part 1
- Part 3 (The Basics)
- Part 5 (Reporting of Health Reimbursement Arrangements under Code § 6055)
- Part 6 (Reporting Group Health Plan Opt-Out Arrangements under Code § 6055)
- Part 8 ( Reporting Offers of Coverage “On Behalf of Another Entity”)
- Part 16 (Reporting for, and Clearing Up Confusion Over, Post-65 Retiree Health Reimbursement Arrangements)
- Part 20 (Reporting Affordability on Form 1095-C, Part II, Line 16 Using 2-Series Codes 2F, 2G, and 2H)

That's all for now. Merry Christmas to all! (Click the title of the post if you wish to comment, ask a question, or propose a future blog topic.)

Phil Eskew