Second Chance Open Enrollment Through April 30 For ObamaCare: How Will Employers React If a Second Chance Enroller Triggers an Employer Mandate Penalty?

February 23, 2015 at 9:04 am | Posted in Affordable Care Act, Health Care | Leave a comment
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The Hill reported today that the Obama administration (through CMS) will hold a second enrollment period for ObamaCare this year to give people a chance to avoid a new tax penalty for going without insurance. The enrollment period will run from March 15 to April 30, at the height of tax filing season, officials said. The announcement does not address the issue of whether any form of transitional relief would be available to a large employer who, until now, may have avoided a penalty under the employer mandate because of the failure of an employee to sign up for ACA coverage and possibly receive a premium subsidy. Arguably, such an employer would now be exposed again since employees lacking coverage will have another bite at the ACA health coverage subsidy apple.

Congressional Democrats and advocacy groups had been pushing for the new enrollment period, arguing that millions of people are still unaware of the penalty and should be able to sign up for ObamaCare once they learn of it. “Our intention in doing this is not to increase numbers for numbers sake, it’s to make sure that if there were people who were unaware of the fee that they aren’t disadvantaged by that,” Andy Slavitt, the Centers for Medicare and Medicaid Services’ deputy administrator, said on a call with reporters. The administration estimates that up to 6 million people will likely be forced to pay the fine for not having insurance during this year’s tax season, marking the first time that the penalty will be in effect. Officials said that they do not have an estimate for how many people will take advantage of the new enrollment period.
People signing up now will still have to pay a penalty for lacking insurance in 2014. Anyone who was uninsured last year will be hit with penalties of either $95 or 1 percent of their income — whichever is higher. That fine will spike this year to $325 or 2 percent of their income. Officials said that the new period is a one-year-only occurrence. “Our intention is that this is one year only for people who have not been in the communication loop around the tax penalty,” Slavitt said.
Separately, the administration announced that there had been an error on a tax return form for people with coverage under ObamaCare, causing some tax credits to be calculated either too high or too low. Officials said the problem affects around 50,000 people who have already filed their taxes, and that they are being contacted to correct the problem.
A link to the announcement can be found here: CMS Announces Special Enrollment Period for Tax Season

Supreme Court to Hear Legal Challenge Federal Subsidies and Obamacare in March

December 23, 2014 at 10:53 am | Posted in Affordable Care Act, Health Care, Regulations | Leave a comment
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Supreme Court to Hear Legal Challenge Federal Subsidies and Obamacare in March

The  Supreme Court announced that on  March 4th it will hear arguments in King v. Burwell.  The case addresses the concept of statutory construction and the issue of whether  the federal government can legally hand out healthcare subsidies in 34 states that have federal exchanges since they opted out of creating their own state based exchanges. The plaintiffs  filed their opening brief on Monday which advance the argument that the literal text of the ACA does not allow for subsidies at federal exchanges. If the subsidy arrangement is struck down, the ACA will essentially have two different sets of requirements and risks for employers and employees across the country that will turn on their state of residence. In November the Supreme Court announced that it would take up the case, surprising many court-watchers and healthcare experts, since the matter had yet to be heard on reconsideration by a full en banc panel of judges in the D.C. Circuit Court of Appeals. An earlier 3 judge panel had found the subsidies to be unauthorized under the ACA..

A copy of the plaintiff’s129 page  brief can be found here:  129-page document

Massachusetts: New $254 Million Health Exchange Website is working

November 18, 2014 at 2:30 pm | Posted in Affordable Care Act, Health and Human Services, Health Care, Health Insurance Marketplace, HHS, Medical, Wellness | Leave a comment
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by Steve LeBlanc, Associated Press

BOSTON (AP) — Massachusetts officials are reporting a successful weekend launch of the state’s revamped health insurance website, but cautioned of possible “hiccups” in the system with expected heavier traffic during the week.

Officials said Monday that in the first two days of the new federal open enrollment period, nearly 5,000 eligible people were immediately registered for state Medicaid coverage.

Nearly 7,000 others were able to complete the process of determining eligibility for plans that comply with the federal Affordable Care Act. They still need to review those insurance plans, choose one, and make their first month’s premium payment.

The successful rollout was in sharp contrast to a year ago, when a failed health exchange forced the state to place hundreds of thousands of residents into temporary Medicaid coverage and led to a costly overhaul of the website. The website woes were also an embarrassment for the state that provided a blueprint for the federal health care law.

Maydad Cohen, a special assistant to Gov. Deval Patrick, said Monday that the new website has proven stable and reliable — handling more than 57,000 visitors over the first two days of open enrollment.

“During the weekend we saw excellent performance of the website,” Cohen told reporters Monday. “We had a very successful, very exciting weekend.”

Of the nearly 7,000 people deemed eligible to obtain insurance through the state’s health insurance exchange during the weekend, about 3,600 individuals and families already have selected a plan and 137 already have paid their first month’s premium, state Health Connector officials said.

Those numbers will continue to climb as more people sign up for insurance.
Hundreds of call representatives also are assisting those looking to sign up for coverage, having trouble with the website or are unsure how to use it.

Cohen said one of the main reasons for high call wait times is that many of those seeking one-on-one help want to go through the entire application on the phone, something that can take 45 minutes or more per application.

Cohen urged those seeking to sign up for coverage to try the website first.

As a result of the previous website troubles, the state ended up putting more than 400,000 individuals into temporary subsidized insurance programs, including MassHealth, the state’s Medicaid program.

Secretary of Health and Human Services, John Polanowicz said between 175,000 and 225,000 of those were expected to enroll in new coverage, including through MassHealth.

Polanowizc said the number is lower than the 400,000 because of what he called the natural “churn” of subsidized care, with individuals losing their eligibility because they’ve found a job that offers insurance, or have obtained health care through a spouse, or have moved out of state.

Dec. 23 is the deadline to ensure coverage that starts on Jan. 1. Fixing the website hasn’t been cheap. The original cost of Massachusetts’ website was estimated at $174 million. That has jumped to $254 million.

HHS Claims that Quality Improvements and the Affordable Care Act Saved 15,000 Lives and $4 Billion in Health Spending During 2011 and 2012

May 7, 2014 at 10:43 am | Posted in Affordable Care Act, Health and Human Services, Health Care, Medical, PPACA, Regulations | Leave a comment
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HHS announced today that new preliminary data show an overall 9% decrease in hospital acquired conditions nationally during 2011 and 2012. National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

HHS claims that the Affordable Care Act is also helping reduce hospital readmissions. After holding constant at 19% from 2007 to 2011 and decreasing to 18.5% in 2012, the Medicare all-cause 30-day readmission rate has further decreased to approximately 17.5% in 2013. This translates into an 8% reduction in the rate and an estimated 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013.

A complete copy of the HHS announcement can be found here: http://www.hhs.gov/news/press/2014pres/05/20140507a.html

HHS Announces New Round of 2014 HIPAA Compliance Audits: Are You Ready?

March 25, 2014 at 9:18 am | Posted in Compliance, Federal Laws, Health and Human Services, Health Care, HIPAA, Medical, Regulations | Leave a comment
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Last month, the HHS Office of Civil Rights (OCR) announced that there will be a more vigorous HIPAA audit effort in 2014 of HIPAA covered entities, including health plans, and their business associates. Speaking at a February 24th health care technology conference, Susan McAndrew, OCR deputy director for health information privacy said: “Hopefully in coming months you’ll see actual activity that will start up on the audit process.” OCR soon will launch a survey of 1,200 organizations as a first step toward selecting those to be audited. McAndrew also stated that the organizations to be surveyed were selected from “a large database,” and the survey seeks to verify if the entity is a suitable candidate for a HIPAA audit.

In a February 24th notice published in the Federal Register, OCR announced that it will survey “up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program.” According to the notice, the survey “will gather information about respondents to enable OCR to assess the size, complexity and fitness of a respondent for an audit.” An OCR spokesperson says the survey will target approximately 800 covered entities and 400 business associates.

If you have not done so already, at a minimum, a plan sponsor should start to self assess: (1) whether it is a HIPAA covered entity; (2) whether it receives protected health information (PHI); and (3) assuming it receives PHI, has it taken timely and reasonable steps to secure the PHI in a manner consistent with HIPAA’s regulations?

ACA Exchange Enrollment Hits 4 Million

February 26, 2014 at 2:09 pm | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA, Regulations | Leave a comment
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HHS announced Tuesday that approximately 4 million Americans have enrolled through the end of January for coverage through the Affordable Care Act Exchanges. A full enrollment report for February will be released in mid-March.

“With individuals and families enrolling in coverage every day, we continue to see strong demand nationwide from consumers who want access to quality, affordable coverage,” Centers for Medicare & Medicaid Services administrator Marilyn Tavenner wrote in a blog post Tuesday. “Our outreach efforts are in full force with community partners and local officials participating in hundreds of events each week and enrollment assistors are helping more and more people enroll in coverage,” she continued.

Only five weeks remain in the open enrollment period.

Affordable Care Act Update: Final Regulations for 90-Day Waiting Period Released

February 21, 2014 at 11:19 am | Posted in Affordable Care Act, Compliance, Creditable Coverage, Department of Labor, Employment Law, Federal Taxes, Health and Human Services, Health Care, PPACA, Regulations | Leave a comment
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On February 20th, The U.S. Departments of Labor, Treasury, and Health and Human Services published final regulations (85 pages) implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals.

To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period.

Additionally, requiring employees to complete a certain number of hours before becoming eligible for coverage is generally allowed as long as the requirement is capped at 1,200 hours. The rules also address situations in which it cannot be determined that a new employee will be working full-time.

The departments are issuing a companion proposed rule that would limit the maximum duration of an otherwise permissible orientation period to one month. This proposal will be open for public comment.

A link to the final rule is here: http://www.dol.gov/opa/media/press/ebsa/20140220-redfeg1.pdf.

HHS Announces 53% Increase in Federal Exchange/Marketplace Enrollment

February 14, 2014 at 9:21 am | Posted in Affordable Care Act, Compliance, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Medical, PPACA | Leave a comment
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HHS Secretary Kathleen Sebelius announced on February 12 that enrollment in the Health Insurance Marketplace continued to rise in January, with a 53 percent increase in overall enrollment over the prior three-month reporting period, with young adult enrollment outpacing all other age groups combined.

Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by February 1, 2014 (the end of the fourth reporting period for open enrollment), with January alone accounting for 1.1 million plan selections in state and federal marketplaces. In January, 27 percent of those who selected plans in the Federally-facilitated Marketplace are between the ages of 18 and 34, a three percentage point increase over the figure reported for the previous three-month period. Young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of February 1, while all other age groups combined grew by 55 percent.

A copy of the HHS press release is here: http://www.hhs.gov/news/press/2014pres/02/20140212a.html

 

Massachusetts Application Process for 2014 Wellness Tax Credit Is Delayed

January 31, 2014 at 11:59 am | Posted in Compliance, Department of Public Health, DPH, Health Care, State Laws | Leave a comment
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The Massachusetts Department of Public Health has announced that (a) the application a wellness tax credit for tax year 2013 is closed; and (b) the deadline for the wellness tax credit in 2014 will be December 31, 2014.  The state’s application system, however, is currently under revision and will be online again in the Spring.

2014 Federal Poverty Guidelines Released… Will be Used to Determine Health Insurance Subsidy Eligibility at State and Federal Exchanges

January 24, 2014 at 9:44 am | Posted in Compliance, Employment Law, Health and Human Services, Health Care, Health Insurance Exchanges, Health Insurance Marketplace, Regulations | Leave a comment
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HHS has released 2014 federal poverty guidelines which, among other things, will establish income thresholds for health insurance subsidy eligibility on state and federal exchanges. The threshold (in the 48 contiguous states and DC) for one person will be $11,670, a $180 increase over the 2013 level. The 2014 guidelines reflect a 1.5 percent price increase between calendar years 2012 and 2013. If an employee qualifies for an exchange subsidy in 2015, the receipt of that subsidy might trigger a “large” employer (50 FTEs) shared responsibility penalty under internal revenue code section 4980H.

2014 Poverty Guidelines for the 48 Contiguous States and the District of Columbia

Persons in Family/Household

Poverty Guideline

1

$11,670

2

$15,730

3

$19,790

4

$23,850

5

$27,910

6

$31,970

7

$36,030

8

$40,090

For families/households with more than 8 persons, add $4,060 for each additional person.

A copy of the release as it appears in the Federal register is here:
http://www.gpo.gov/fdsys/pkg/FR-2014-01-22/pdf/2014-01303.pdf

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