Wednesday, March 4, 2015

King v/s Burwell Update

Update from Greg Stancil, Director of PPACA Compliance:

The oral arguments in the Supreme Court were held this morning. As I previously stated, the two swing votes should be with Justice Kennedy and Chief Justice Roberts.

Based on my review of coverage of the hearings the Chief Justice played his cards fairly close to the vest and didn’t seem to indicate which way he was leaning. He only asked a few questions.

Justice Kennedy asked questions of both sides and made the statement that:

limiting access to the tax credits to 16 states  — to states with PPACA exchanges established by the states, rather than the U.S. Department of Health and Human Services (HHS)  — would create a “serious constitutional problem.”

I’m not sure that necessarily shows which way he will vote, however Wall Street’s reaction seemed to indicate that they felt like the hearing went well for the administration,  as hospital stocks rose more than any other stocks on the S&P as of 12:00pm today.  A ruling against the administration in King v/s Burwell was is in Wall Street’s opinion a big threat to hospital stocks. So in reading the tea leaves (or the ticker) it seems they feel like the administration fared well.

The court is expected to rule in June.

Tuesday, February 24, 2015

Initial "Cadillac Tax" Guidance Released


The Internal Revenue Service released initial guidance on the Affordable Care Act's "Cadillac Tax" which is set to take effect in 2018.  The IRS says that  Notice 2015-16 (http://www.irs.gov/pub/irs-drop/n-15-16.pdf) is intended to “initiate and inform the process of developing regulatory guidance” and addresses several aspects of the Cadillac tax relating to: (1) the definition of applicable coverage; (2) the determination of the cost of applicable coverage; and (3) the application of the annual statutory dollar limit to the cost of applicable coverage.   
 
The IRS anticipates issuing another notice, before the publication of proposed regulations, describing potential approaches to a number of issues not addressed in Notice 2015-16, including procedural issues relating to the calculation and assessment of the excise tax.

Thursday, February 12, 2015

IRS issues final forms for employer shared responsibility and minimum essential coverage reporting requirements

The IRS has issued final forms for the employer shared responsibility and minimum essential coverage reporting requirements.

This reporting is voluntary this year reporting for the calendar year 2014, but is mandatory in 2016 reporting on the calendar year 2015. Copies of the forms and instructions can be found by following the links below.

For more information regarding the reporting requirements please plan to join our webinar on 2/26. You can register by following this link.



Form 1094-B,Transmittal of Health Coverage Information Return:  http://www.irs.gov/pub/irs-pdf/f1094b.pdf 

 
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return: http://www.irs.gov/pub/irs-pdf/f1094c.pdf

 
Form 1095-A, Health Insurance Marketplace Statement: http://www.irs.gov/pub/irs-pdf/f1095a.pdf

 
 
Form 1095-B, Health Coverage: http://www.irs.gov/pub/irs-pdf/f1095b.pdf  

 
Form 1095-C, Employer Provided Health Insurance Offer and Coverage: http://www.irs.gov/pub/irs-pdf/f1095c.pdf

 
Instructions to the Form 1095-B and 1094-B: http://www.irs.gov/pub/irs-pdf/i109495b.pdf 

 
Instructions to Forms 1095-C and 1094-C: http://www.irs.gov/pub/irs-pdf/i109495c.pdf 

Wednesday, January 7, 2015

House bill targets ACA's 30-hour definition for full-time employees

From Business Insurance


Jerry Geisel

House bill targets ACA's 30-hour definition for full-time employees
 
The House of Representatives is expected to vote later this week on newly introduced legislation to ease the health care reform law’s definition of a full-time employee by changing it to those working an average of at least 40 hours per week, shielding more employers from a stiff financial penalty imposed by the law.

Under the Patient Protection and Affordable Care Act, employers with at least 100 employees are required, effective in 2015, to offer qualified coverage to full-time employees — defined as those working an average of 30 hours per week — or be liable for an annual $2,000 penalty per employee. The same requirement applies, effective in 2016, to employers with between 50 and 99 employees.
The measure, H.R. 30, introduced Tuesday by Rep. Todd Young, R-Ind., with 147 co-sponsors, would change the act’s definition of full-time employees to those working an average of 40 hours per week.

“Repealing this provision and restoring the traditional understanding of a 40-hour (workweek) is necessary to protect” the paychecks of employees, Rep. Young said in a statement.
The Obama administration strongly opposes the measure, and a presidential veto is likely if the measure receives final congressional approval.

“The issue is essentially that we would be putting even more workers in a situation where we could see some employers cutting back on their hours to try to avoid the requirement of providing them quality health insurance,” White House Press Secretary Josh Earnest said Tuesday at a briefing.
The House last year approved an identical measure, but the bill died in the Senate, controlled by Democrats at the time, when then-Majority Leader Harry Reid, D-Nev., declined to bring up the bill.
A companion bill is expected to be introduced — perhaps as soon as Wednesday — in the Senate.

Monday, December 1, 2014

New Deadline For Transitional Reinsurance Fee - 12/5/15

From Scott Benefit Services

The Affordable Care Act (ACA) imposes a fee on health insurance issuers and self-funded group health plans in order to fund a transitional reinsurance program for the first three years of Exchange operation (2014-2016). The fees will be used to help stabilize premiums for coverage in the individual market.
Entities that must pay these fees, called “contributing entities,” are generally required to submit their annual enrollment count to the Department of Health and Human Services (HHS) by Nov. 15 of each benefit year. To do this, contributing entities must register on Pay.gov and complete a contribution form for the year.

For the 2014 benefit year, the regulatory deadline for submitting the reinsurance fee contribution form is Nov. 15, 2014. An FAQ initially extended this deadline until Monday, Nov. 17, 2014, since Nov. 15 was a Saturday. However, on Nov. 14, 2014, the Centers for Medicare & Medicaid Services (CMS) further extended the regulatory deadline for contributing entities to submit their 2014 enrollment counts until 11:59 p.m. on Dec. 5, 2014. The payment deadlines (Jan. 15, 2015, and Nov. 15, 2015) remain the same.
The contribution form that will be used to submit annual enrollment counts became available Oct. 24, 2014. HHS also provided an Annual Enrollment and Contributions Submission Form Manual and a Supporting Documentation Job Aid Manual.

Contributing Entities

A contributing entity is defined as a health insurance issuer or a third-party administrator (TPA) on behalf of a self-insured group health plan. However, certain types of coverage are excluded from paying reinsurance fees.

·      Fully-insured Group Health Plans—For insured health plans, the issuer of the health insurance policy is required to pay reinsurance fees. However, issuers will likely shift the cost of the fees to sponsors through premium increases.

·      Self-insured Group Health Plans—For self-insured group health plans, the plan sponsor is liable for paying reinsurance fees, although a TPA or an administrative-services-only (ASO) contractor may pay the fee at the plan’s direction. For a plan maintained by a single employer, the employer is the plan sponsor.

Wednesday, November 5, 2014

Thoughts on the Election

After the election results last night many people will wonder  how the shift in power in the senate will impact the ACA legislation. It will certainly be interesting to see how aggressive the GOP is out of the gate in attacking the ACA. One thing is certain, and that is that it won’t be repealed. Even though the GOP has the majority they don’t have a veto-proof majority and the President will certainly veto any attempts to repeal the law and in on record stating as much.  The thought is that the GOP will attempt to defund aspects of the ACA as opposed to attempting to repeal it.

The challenge for the GOP is that the proverbial “toothpaste” is already out of the tube. 8 million people received subsidies this year so to take that away poses a pretty significant political challenge. I imagine the GOP will attempt to rewrite certain aspects of the law that fit its agenda but again, the veto pen looms if it isn’t something that the President can agree with.

All in all we can expect a bit of chaos once again relative to the ACA legislation, which means now more than ever it will be important to stay on top of the latest developments with ACA to stay compliant and in the know. At Scott we are positioned well and ready for the challenge will continue to be a leader in our market relative to ACA compliance and information.
 
Greg Stancil
Director of Healthcare Reform

Saturday, November 1, 2014

HPID Requirement Delayed Until Further Notice

Statement of Enforcement Discretion regarding 45 CFR 162 Subpart E - Standard Unique Health Identifier for Health Plans

Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F). This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.

On September 23, 2014, the National Committee on Vital and Health Statistics (NCVHS), an advisory body to HHS, recommended that HHS rectify in rulemaking that all covered entities (health plans, healthcare providers and clearinghouses, and their business associates) not use the HPID in the HIPAA transactions. This enforcement discretion will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps.