Affordable Care Act Review

Affordable Care Act Review

Category Archives: Affordable Care Act

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Questionable Retaliation Theory Gets Traction

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Private Employers
Since our earliest postings, we have warned of a notion, prevalent among employee counsel, that an employer plan sponsor unlawfully retaliates against an employee by reducing her work hours in order to deprive her of ACA “full-time” coverage offer eligibility.  The musings that we have heard and read rarely distinguish claims under ERISA § 510 (29 U.S.C.… Continue Reading

ACA Myths That Just Won’t Die

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
Lawyers, politicians, economists, climate scientists, fad diet peddlers . . . we all know that it’s child’s play to persuade people of what they want to believe. Perhaps that explains the persistence of so many questionable beliefs about ACA compliance. Here are three examples. The Look –[way] back Measurement Method The ACA commands or allows employers… Continue Reading

How (and How Not) to Read This Blog

Posted in Affordable Care Act, Business Organizations, Community Health Needs Assessments, Coverage Mandates, Employee Leasing, Exchanges, Federal Contractors, Government Employers, Grandfathered Status, Independent Contractors, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes, Uncategorized
Nearly three years ago, having spent hundreds of hours immersed in ACA minutiae, we anticipated that clients would not react well to fees for services that consisted principally of telling them that they had asked the wrong question. So we decided, against tradition and much conventional wisdom, to sink lots of unpaid partner time into… Continue Reading

ACA Information Return Deadlines Extended

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Government Employers, Insurers and Brokers, Private Employers, Taxes
On December 28, 2015, the IRS released its Notice 2016-4, granting much needed time for employers and their filing services to catch up to Affordable Care Act Information Return (AIR) Program developments. Here (nearly verbatim) are the extensions: The deadline for furnishing to individuals the 2015 Form 1095-B, Health Coverage, and the 2015 Form 1095-C,… Continue Reading

Updated Tax Credit Eligibility Clarification

Posted in Affordable Care Act
Last week the IRS released the final regulation addressing the effect of various items on an individual’s eligibility for premium tax credits. Generally, premium tax credits are not normally available to individuals who are offered health insurance coverage by their employer. However, an employee may still be eligible for premium tax credits if the employer… Continue Reading

Coming Down Your Chimney: Market Reform Guidance, Information Reporting Penalty Relief and Cadillac Tax Delay

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Federal Contractors, Government Employers, Independent Contractors, Insurers and Brokers, Private Employers, Taxes
It’s the “silly season” on the Hill and a busy season for ACA regulators. This article gives you brief notes about Notice 2015-87, information reporting relief and the § 4980I delay buried in the omnibus spending bill. IRS Notice 2015-87 first answers questions on the periphery of earlier guidance effectively killing stand-alone HRAs. Most notably, an… Continue Reading

HHS 2017 Notice of Benefit and Payment Parameters

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
This is the annual hodge-podge of changes to the risk adjustment, reinsurance, and risk corridors programs, cost sharing parameters, cost-sharing reductions, and Healthcare.gov user fees, usually filling hundreds of Federal Register pages. Stuff gets buried deep, scattered among 45 CFR Parts 144, 146, 147, 153, 154, 155, 156 and 158. Yesterday (101 pages) was no… Continue Reading

DOL Tightens Disability Claim Processing Rules

Posted in Affordable Care Act, Government Employers, Insurers and Brokers, Private Employers
“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources of severe hardship for many individuals, the Department thinks that disability benefit claimants deserve protections equally as… Continue Reading

Five Years Later, Final Rules on Grandfathered Plan Status, Etc.

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status
Today, the ACA enforcement agencies (DOL, HHS, IRS) jointly published final rules, effective January 1, 2017, on grandfathered plan status, pre-existing condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals and patient protections. Interim rules and sub-regulatory guidance issued since June 2010 are merged and finalized. On first reading (104 pages), we see no… Continue Reading

The 29th FAQ

Posted in Affordable Care Act
On October 23, 2015, the Departments of Labor, Health and Human Services and Treasury (the “Agencies”) jointly released FAQs about Affordable Care Act (ACA) Implementation (Part XXIX) and Mental Health Parity Implementation. These FAQs clarify several items. Clarify that ancillary services to certain preventive services must be covered with no cost-sharing. We will discuss in… Continue Reading

RIP, Automatic Enrollment

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers, Taxes
Sixty-seven months ago, Congress ordered employers of 200 or more full-time employees to switch from opt-in to opt-out enrollment. See 29 U.S.C. § 218a. But the enforcement agencies could not write a rule that did more good than harm, so they gave up. A lame duck Senator killed a bipartisan repeal bill in his committee last… Continue Reading

Request for Information about ALE Reporting Status

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Government Employers, Private Employers, Taxes
We work closely with employers (mostly ALEs) and an array of service providers – payroll processors, benefit plan consultants and administrators, software developers and transmitters, employee leasing firms, insurance brokers and insurers. We’re hearing from them and from others pretty consistent impressions of the state of employer readiness to furnish (by February 1, 2016) and to file… Continue Reading

“Make It a Triple”: EEOC Supersizes Wellness Program Rules, Again

Posted in Affordable Care Act, Government Employers, Private Employers
In June 2013, DOL, HHS and IRS explained that they view employer-sponsored wellness programs as narrow exceptions to the ACA’s health status discrimination prohibition. Early this year, the EEOC slathered-on its own rules, derived from the Americans with Disabilities Act (ADA). On October 30, the EEOC proposed a third set of restrictions, related to the Genetic… Continue Reading

What Parts of the ACA Will Congress Repeal by Budget Reconciliation?

Posted in Affordable Care Act, Coverage Mandates, Taxes
“None,” is our best guess, practically speaking. Congress passed much of what became the consolidated Affordable Case Act under “budget reconciliation” rules, which preclude a filibuster and enable a bill to pass the Senate with a simple majority vote. Tax and spending legislation may be passed and repealed that way. H.R. 3762, now on the… Continue Reading

Do Seasonal Workers “Count” for Forms 1094-C and 1095-C?

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Private Employers, Taxes
We were asked that recently, proving that there is such a thing as a wrong question. Let’s break it down. The same person may be both a “seasonal worker” and a “seasonal employee,” but those terms are used to discuss separate ACA subjects. This has caused great confusion. Here’s how the Employer Shared Responsibility Cost… Continue Reading

House Passes Significant ACA Amendment by Voice Vote

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers
With little apparent Democrat opposition, the U.S. House of Representatives on September 28 routinely passed a bill to allow employers of 50 to 100 employees to avoid the ACA’s especially heavy regulation of small group health plans beginnning in 2016, subject to state rules to the contrary. The lack of controversy suggests that this bill… Continue Reading

Healthcare.gov: No 2015 Employer Subsidy Notices

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Private Employers, Taxes
On Friday afternoon, September 18, the Centers for Medicare and Medicaid Services (CMS) published a set of “Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program.” The update is welcome for what it tells us about the subsidy certification appeal process beginning in 2016, summarized below. It’s troubling, however, for its confession… Continue Reading

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers
On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions: 2015 Instructions for Forms 1094-C and 1095-C; 2015 Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns; 2015 Form 1095-C Employer-Provided Health Insurance Offer and Coverage; 2015 Instructions for Forms 1094-B and 1095-B; 2015 Form 1094-B Transmittal of… Continue Reading

ACA Menu Labeling Requirements: Draft FDA Guidance

Posted in Affordable Care Act, Business Organizations, Uncategorized
The FDA’s 105-page final rule on chain restaurant nutrition labeling of menu items now has an associated, 53-page, draft guidance document, supplementing the FDA’s 132-page Food Labeling Guide, we learned from the September 16 Federal Register. And you thought the ACA was only for hospitals, doctors and insurers. Silly you. Need a drink? Here are… Continue Reading