A final rule from the US Department of Health and Human Services (HHS) will expand small employers' ability to offer Health Reimbursement Arrangements (HRAs), a change that may make it easier for more Americans to purchase health insurance that they don't receive from their jobs. While it's still too early to tell if the change will significantly impact patients seen by physical therapists (PTs), APTA's advice is to keep an eye open, and be aware of the nuances of HRA payment.

The new rule, set to go into effect January 1, 2020, will allow qualified small employers to offer what's being called an "Individual Coverage HRA" as an alternative to traditional group coverage plans. The idea behind HRAs is that employers provide a monthly tax-free allowance to employees, who can be reimbursed for health care-related expenses up to the allowance limit. The changes set to go into effect next year would permit HRAs to be used to pay for health insurance purchased on the individual market, and allow employers to offer "excepted benefit" HRAs to supplement employer-sponsored insurance—even if the employee isn't enrolled in the group plan.

HHS believes that the change will open up coverage options for more than 11 million employees and family members and increase insurance portability, according to an HHS press release. APTA submitted comments to the proposed rule that largely supported the changes, but recommended that any individual health insurance paid via an HRA must be a policy deemed compliant with the Affordable Care Act. The final rule supports APTA's position.

Those numbers are just estimates, however, and there's no way of knowing just how the use of HRAs will shake out next year, said Kate Gilliard, APTA regulatory affairs senior specialist.

"PTs need to understand that these HRAs will be out there, and that whether the patient can use the HRA for copays depends on how it's set up with the employer," Gilliard said. "Some HRAs are only good for premium payments, so we're advising our members to verify the details of a patient's HRA. If it's found appropriate for use, the HRA can be processed just like a health savings account or flexible spending account."

APTA regulatory affairs staff will monitor rollout of the rule and share new information in PT in Motion News and elsewhere.