Accountable Care Organizations: Good in Theory, Slow to Catch On

Size: px
Start display at page:

Download "Accountable Care Organizations: Good in Theory, Slow to Catch On"

Transcription

1 Accountable Care Organizations: Good in Theory, Slow to Catch On The phrase "accountable care organization" (ACO) was coined in But it didn't really start gaining currency until three years later when the concept was specifically addressed in the Affordable Care Act (ACA). ACOs are integrated health care provider systems that link provider reimbursements to established quality and efficiency goals. The theory is that, if the provider offers high-quality and well-coordinated care, patient outcomes will be good, costs will be controlled and the ACO will prosper. In other words, the incentives of providers, payers and patients (getting good care at an affordable price) are all supposed to align. But the opposite is also true: ACOs that fail to deliver on their quality promises will struggle with costs and patient satisfaction and, ultimately, fail. Like many organizations, yours may be exploring a variety of health care delivery models to both comply with the ACA and provide good benefits to your workforce. Although ACOs aren't without their downsides, they have some potential advantages worth considering. The ACA Connection The ACA promotes ACOs primarily through its Medicare program. For example, the Medicare Shared Savings Program will allow providers who voluntarily agree to work together to coordinate care for patients and, if they meet certain quality standards, to "become eligible to share savings with Medicare when they deliver that care," according to a U.S. Department of Health and Human Services press release. In addition, the ACA's Comprehensive Primary Care Initiative seeks to help primary care practices serving Medicare patients "deliver higher quality, more coordinated and patient-centered care" in several parts of the country. Under the program, some primary care physicians' Medicare income will be supplemented by a monthly fee. Twenty Million Strong Because of its inherent risks, the ACO model has been slow to catch on. But the movement is beginning to gain momentum. Health care consultancy Leavitt Partners has been monitoring some 626 ACOs. Of these: 210 have commercial contracts, 329 have government contracts (that is, Medicare and Medicaid), and 74 have both. The firm estimates that 20 million people now receive health benefits via an ACO.

2 Direct Contracting Model Huge companies such as Boeing and Intel have been testing out the ACO model for years. Because of their size, these large businesses are able to establish their own ACOs by contracting directly with health care systems. For example, Intel launched an ACO for its 5,400 employees near Rio Rancho, New Mexico, last year, partnering with Presbyterian Healthcare Services. Intel projected savings in the $8 million to $10 million range over a five-year period. That Intel plan, called "Connected Care," provides 100 percent coverage for preventive care. Also, medications for hypertension, cholesterol, diabetes and some other conditions are fully covered to incent patient compliance on chronic-condition care. Each patient works with a specific team of specialists to facilitate maximum coordination of care. A number of pioneering smaller employers also are giving ACOs a try. Typically, they're doing so as options in private exchanges under a defined-contribution-based health care plan. Similarities with HMOs ACOs share DNA with health maintenance organizations (HMOs), the delivery model thought to hold great promise when employers first began experimenting with a variety of managed care models back in the 1990s. With a few notable exceptions, such as Kaiser Permanente and Intermountain Healthcare, HMOs failed to take the market by storm. One distinction between today's ACOs and the non-staff-model HMOs (in other words, organizations that don't employ providers) is a greater emphasis on provider quality and coordination of care as a means of improving patient outcomes again, with an intended byproduct being lower costs. But critics are quick to point out that, when cutting costs is the primary purpose of a health care delivery model, the results will likely be disappointing. Nonetheless, advances in electronic medical records systems and data analytics since the 1990s give ACOs a greater shot at success. And, perhaps most significantly, employee resistance to HMOs generally centered on limited provider choice. ACOs operate with similar "narrow network" constraints but, according to advocates, this can be overcome with effective employee education. Employee Buy-In Employees can be hesitant to try new health care options such as ACOs especially if they've had negative experiences with HMOs. Employers and their ACOs will need to build trust with employees to enable participants to find a comfort level and confidence in both the plan itself and the provider network supporting it. Granted, one notable challenge to this process may be convincing employees that a narrower network can meet their needs as effectively as a larger one. To procure employee buy-in for an ACO, an employer and the plan provider will need to emphasize certain aspects of the health care benefits experience. For starters, pre-enrollment communication is paramount. Participants must be well informed on the ins and outs of the model. Once employees have bought into the concept, the orientation process must be methodical and comprehensive. And when the plan is up and running, customer service should be easily accessible, friendly and responsive. Risks and Rewards As with any health care delivery model, a good theory is only the starting point for assessing an ACO's potential for your organization. If you choose to become an early adopter, you'll need to be comfortable with the prospect of a period of trial and error before determining the model's suitability. Key variables will include the depth, quality and competitive landscape of the health care market in your community. You'll also need to weigh your willingness to provide strong plan design incentives to steer employees to the ACO, such as lower coinsurance, copays and deductibles. Work with your financial and benefits advisors to identify the risks and rewards of this model.

3 IRS Proposes Changes to Play-or-Pay Measurement Periods Under the ACA, large employers (as defined under the act) risk a penalty if they don't offer affordable, "minimum essential" health care coverage to their full-time employees. This is the concept popularly known as "play or pay." In September, the IRS released Notice to propose approaches for identifying those full-time employees in situations where the measurement period applicable to an employee changes. Available Methods Under the final play-or-pay regulations, applicable large employers may identify full-time employees using either of two methods: 1. The look-back method. Here, hours are tracked during a measurement period of up to 12 months starting on a date selected by the employer. The hours are counted during an optional administrative period immediately after the measurement period, and they're used to "lock in" full-time or part-time status during a "stability period" of up to 12 calendar months. 2. The monthly method. Under this approach, employers identify full-time employees each calendar month by counting hours only during that month. The employer can choose different measurement periods and different methods for specified categories of employees (such as salaried and hourly). Notice looks at changes in the duration or start date of measurement periods under the look-back method, and it addresses an employer's election to change from the look-back method to the monthly method (or vice versa). The Notice also provides examples to illustrate the rules. Measurement period changes: The proposed rules apply when the measurement period changes because an individual employee transfers positions within the same applicable large employer. Also, employer-initiated changes to the measurement period for a category of employees will be treated as if those employees had transferred to new positions as of the effective date of the change. Notice categorizes employee transfers under two circumstances: 1. The employee is in a stability period. Employees in a stability period at the time of transfer will retain their full-time or parttime status for the remainder of that stability period. At the end of that period, the employees' status will be based on hours during the measurement period for their second position and will be locked in for the associated stability period. To the extent the measurement period for the second position overlaps the measurement period for the first position, the employer would count all hours during the second position's measurement period including those overlapping hours that were credited during the first position's measurement period. If an employee's status in the second position cannot be determined under the measurement period applicable to that position (as could happen for a new variable-hour employee not yet employed for a full initial measurement period applicable to the second position), the rules for an employee who isn't in a stability period apply. 2. The employee isn't in a stability period. At the time of transfer, if an employee isn't in a stability period for the first position, the employee's status will be determined solely under the second position's measurement period. The employer will take into account all hours credited during the second position's measurement period, including hours that overlap with the first position's measurement period. The Notice emphasizes this special rule doesn't override general principles under the look-back method. For instance, still applicable is the requirement that new employees who are reasonably expected, as of their start dates, to work full-time hours generally will have full-time status determined under the monthly method until they complete one full standard measurement period. Notice explains the application of the rules when new full-timers transfer to positions for which they've completed a standard measurement period. Generally, the ACA's rules for method changes, which are included in the final regulations, require a transition period intended to protect employees who have earned full-time status. But the final regulations don't address whether, or under what conditions, an employer can initiate a switch between the look-back and monthly methods.

4 Notice states that employers may switch between methods provided that they adhere to the same transition rules that apply when individual employees have a method change due to a change in employment status. Comments requested: Until further guidance is issued, and at least through December 31, 2016, employers can rely on Notice The IRS has, however, requested comments on the proposed approaches particularly as they might apply to mergers and acquisitions where the parties to the transaction use different measurement periods or methods. Until then, employers involved in a corporate transaction may rely on the approaches described in the Notice. Comments can be submitted until December 29, With the first stability periods under the look-back method slated to start Jan. 1, 2015, Notice fills some important gaps in the existing guidance. Correctly identifying full-time employees is of utmost importance because, as mentioned, a full-time employee's receipt of subsidized coverage on a Health Insurance Marketplace may trigger an employer penalty. Furthermore, large employers will soon become subject to an ACA-mandated reporting requirement regarding information about the coverage offered to full-time employees Offer a Cafeteria Plan? New Election Changes Now Allowed If your organization offers a cafeteria plan, take note: The IRS has expanded the permitted election change rules. Now allowed are midyear election changes for two additional situations in which employees may want to drop their employer-sponsored health care coverage. Beginning September 18, 2014, cafeteria plans may allow employees in these two situations to prospectively revoke an election for coverage under a group health plan that: Isn't a health care Flexible Spending Account, and Provides minimum essential coverage when specific conditions are met. These changes were announced in IRS Notice Reduction of Hours The first situation involves an employee whose hours of service have been reduced to less than 30 hours per week without a corresponding loss of eligibility for the employer's group health plan for example, because the plan's eligibility provisions have been drafted to avoid penalties under the ACA's "play or pay" provisions. Such an employee may drop group health plan coverage midyear, but the change must correspond to the employee's intended enrollment (and the intended enrollment of any related individuals whose coverage is being dropped) in other minimum essential coverage. The new coverage must be effective no later than the first day of the second month following the month in which the original coverage is dropped. Cafeteria plans may rely on an employee's reasonable representation about the intended enrollment. This particular election change would accommodate an employee who wishes, for example, to enroll in the plan of a spouse's employer after the reduction of hours. Note: Election changes under this provision aren't limited to situations involving the playor-pay rules. Marketplace Coverage The second situation involves an employee who'd like to change from the employer's group health plan to Health Insurance Marketplace coverage without a period of duplicate coverage or no coverage. Such an employee may drop group health plan coverage midyear but only if the change corresponds to the employee's intended enrollment (and the intended enrollment of

5 any related individuals whose coverage is being dropped) in the Health Insurance Marketplace coverage that's effective no later than the day after the last day of the original coverage. Cafeteria plans may rely on an employee's reasonable representation about the intended enrollment. This additional election was intended, at least in part, to allow employees participating in non-calendar-year plans to elect Health Insurance Marketplace coverage during a Marketplace's open enrollment period and drop their employer-provided coverage when the Marketplace's coverage takes effect. Additional Information The IRS intends to amend the permitted election change regulations under Internal Revenue Code Section 125 to reflect the new guidance. But taxpayers can rely on the guidance immediately. Also, allowing the additional election changes is optional and will require a plan amendment. The amendment generally must be adopted on or before the last day of the plan year in which the additional changes are allowed. The changes can be effective retroactively to the first day of that plan year, provided that the plan operates in accordance with the guidance and that participants are informed of the amendment. Under a special rule, employers that begin allowing the changes during the 2014 plan year have until the last day of the 2015 plan year to adopt an amendment. Although plan amendments may be adopted retroactively, election changes to revoke coverage retroactively aren't permitted. Increased Flexibility The additional permitted election changes provide increased flexibility and resolve questions about the interaction between the ACA and the permitted election change rules, which were drafted long before the act was signed into law. If your organization intends to allow the additional changes, you'll likely appreciate having some extra time to amend your plan. Should you need time to think about it, however, remember to keep the deadline in mind. Also don't forget that, if you'll be allowing the additional changes, you must communicate such plan revisions to employees while properly coordinating them with third-party administrators or other service providers.

Additional Permitted Election Changes for Health Coverage under 125 Cafeteria Plans

Additional Permitted Election Changes for Health Coverage under 125 Cafeteria Plans Additional Permitted Election Changes for Health Coverage under 125 Cafeteria Plans Notice 2014-55 PURPOSE This notice expands the application of the permitted change rules for health coverage under a

More information

COBRA and the Affordable Care Act

COBRA and the Affordable Care Act BAGNALL 1345 East Chandler Boulevard Building 1, Suite 103 Phoenix, Arizona 85048 (480) 893-6510 http://www.bagnall.us COBRA and the Affordable Care Act The Consolidated Omnibus Budget Reconciliation Act

More information

PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA)

PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA) PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA) What employers need to know to make informed decisions about ACA compliance. Employer Shared Responsibility Under the employer

More information

New HHS Rules for 2016 Tighten "Minimum Value" Standard

New HHS Rules for 2016 Tighten Minimum Value Standard New HHS Rules for 2016 Tighten "Minimum Value" Standard An apparently unintended loophole in the Affordable Care Act (ACA) has been closed. Under previous rules, large employers (as defined under the act)

More information

Section 125 Qualifying Events. Revised June 2013

Section 125 Qualifying Events. Revised June 2013 Section 125 Qualifying Events Revised June 2013 Section 125: Qualifying Events Page 2 of 6 A Section 125 Cafeteria Plan must provide that participant elections are irrevocable and cannot be changed during

More information

Heffernan Benefit Advisors Presents Health Care Reform: What Non-Profits Need to Know. The session will begin shortly

Heffernan Benefit Advisors Presents Health Care Reform: What Non-Profits Need to Know. The session will begin shortly Heffernan Benefit Advisors Presents Health Care Reform: What Non-Profits Need to Know The session will begin shortly Sound should come through your speakers when the session begins Verify that the volume

More information

Health Insurance After Age 65

Health Insurance After Age 65 1 GUIDE TO MEDICARE PLANNING Health Insurance After Age 65 Whether you are retired or still working, Medicare will likely become part of your life after you turn 65. In the United States today, most health

More information

Affordable Care Act 101: What The Health Care Law Means for Small Businesses

Affordable Care Act 101: What The Health Care Law Means for Small Businesses Affordable Care Act 101: What The Health Care Law Means for Small Businesses December 2013 These materials are provided for informational purposes only and are not intended as legal or tax advice. Readers

More information

H I V. and Insurance YOUR LEGAL RIGHTS HIV AND INSURANCE 1

H I V. and Insurance YOUR LEGAL RIGHTS HIV AND INSURANCE 1 HIV AND INSURANCE 1 H I V and Insurance YOUR LEGAL RIGHTS UPDATED MARCH 2014 published by: AIDS Legal Council of Chicago 180 North Michigan Avenue, Suite 2110 Chicago, Illinois 60601 (312) 427.8990 2 AIDS

More information

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS

THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Community THE AFFORDABLE CARE ACT ( ACT ), NEW EMPLOYER MANDATES, AND IMPACTS ON EMPLOYER- SPONSORED HEALTH INSURANCE PLANS Prepared for the 2014 Massachusetts Municipal Association Annual Meeting On March

More information

The Affordable Care Act: An Employers

The Affordable Care Act: An Employers The Affordable Care Act: An Employers Guide to the Maze Payroll Network, Inc. - HQ/DC Metro 2092 Gaither Road Rockville, MD 20850 301.339.6000 Payroll Network, Inc. - Baltimore Metro 400 East Pratt Street,

More information

Reporting Requirements for Employers and Health Plans

Reporting Requirements for Employers and Health Plans Brought to you by Cross Employee Benefits Reporting Requirements for Employers and Health Plans The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health

More information

The health insurance marketplaces, or exchanges, created

The health insurance marketplaces, or exchanges, created Employee Benefits Report 2121 N Glenville Drive Richardson, TX 75082 866.881.2255 www.mgmbenefits.com Health Insurance November 2013 Volume 11 Number 11 Private Exchanges: An Option Worth Exploring An

More information

Does the Affordable Care Act Require Health Insurance Coverage for Substitutes?

Does the Affordable Care Act Require Health Insurance Coverage for Substitutes? Does the Affordable Care Act Require Health Insurance Coverage for Substitutes? On January 2, 2013, the IRS issued proposed rules addressing key issues for employers under the Affordable Care Act (ACA).

More information

Using the Look-Back Measurement Method to Determine Full Time Status Lisa Klinger, J.D. & Susan Grassli, J.D. www.healthreformupdates.

Using the Look-Back Measurement Method to Determine Full Time Status Lisa Klinger, J.D. & Susan Grassli, J.D. www.healthreformupdates. , Using the Look-Back Measurement Method to Determine Full Time Status Lisa Klinger, J.D. & Susan Grassli, J.D. www.healthreformupdates.com 8-4-2014 Background Under the Employer Shared Responsibility

More information

Shared Responsibility: What It Means for Your Business

Shared Responsibility: What It Means for Your Business Shared Responsibility: What It Means for Your Business The provisions of the Affordable Care Act (ACA) apply to nearly all companies in the United States. The ways they apply, however, can be different

More information

Employer Reporting of Health Coverage Code Sections 6055 & 6056

Employer Reporting of Health Coverage Code Sections 6055 & 6056 Brought to you by Hickok & Boardman HR Intelligence Employer Reporting of Health Coverage Code Sections 6055 & 6056 The Affordable Care Act (ACA) created new reporting requirements under Internal Revenue

More information

FAQs: Variable Hour Employees Working on Campus and the Affordable Care Act (ACA)

FAQs: Variable Hour Employees Working on Campus and the Affordable Care Act (ACA) FAQs: Variable Hour Employees Working on Campus and the Affordable Care Act (ACA) As you may know, Health Care Reform (the Affordable Care Act or ACA) is underway and new aspects of the regulations become

More information

Affordable Care Act (ACA) Dashboard

Affordable Care Act (ACA) Dashboard Affordable Care Act (ACA) Dashboard WORKTERRA s proprietary software tools have been designed to deliver a strategic snapshot of Health Care Reform s impact on your business. Our Affordable Care Act (ACA)

More information

FAQ. Affordable Care Act s Employer Mandate: Deciding Whether Your Organization Should Pay or Play FAQ

FAQ. Affordable Care Act s Employer Mandate: Deciding Whether Your Organization Should Pay or Play FAQ FAQ Affordable Care Act s Employer Mandate: Deciding Whether Your Organization Should Pay or Play Editor s Note: On April 17, 2013, WorldatWork hosted the second webinar of a three-part town-hall series

More information

2016 Annual Enrollment Guide

2016 Annual Enrollment Guide 2016 Annual Enrollment Guide FOR NEW MEXICO EMPLOYEES Choose benefits to power your best life. Annual Enrollment is October 26 to November 13, 2015 Changes effective January 1, 2016 JUMP TO COMPARISON

More information

Important Effective Dates for Employers and Health Plans

Important Effective Dates for Employers and Health Plans Brought to you by Krempa Associates, Inc. Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into

More information

Important Effective Dates for Employers and Health Plans

Important Effective Dates for Employers and Health Plans Brought to you by Sullivan Benefits Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into law.

More information

Important Effective Dates for Employers and Health Plans

Important Effective Dates for Employers and Health Plans Brought to you by Hipskind Seyfarth Risk Solutions Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act

More information

Your Questions Answered

Your Questions Answered Your Questions Answered 1. GENERAL 1.1 What is happening to my retiree medical and prescription drug benefits for Medicare-eligible participants as of January 1, 2015? Effective December 31, 2014, CIGNA

More information

Documenting Method for Identifying Full-time Employees

Documenting Method for Identifying Full-time Employees Brought to you by Higginbotham Documenting Method for Identifying Full-time Employees Beginning in 2015, the Affordable Care Act (ACA) imposes a penalty on applicable large employers (ALEs) that do not

More information

PERSONNEL POLICIES AND PROCEDURES Personnel Policy Adopted by Res.: 1323 (2014)

PERSONNEL POLICIES AND PROCEDURES Personnel Policy Adopted by Res.: 1323 (2014) BENEFITS 6.1 Health Insurance PERSONNEL POLICIES AND PROCEDURES Personnel Policy Adopted by Res.: 1323 (2014) Personnel Procedures Approved: 11-5 -2014 1. PURPOSE: To establish the policy and procedures

More information

Updates to Affordable Care Act: Law, Regulatory Explanation and Analysis, 2014

Updates to Affordable Care Act: Law, Regulatory Explanation and Analysis, 2014 Updates to Affordable Care Act: Law, Regulatory Explanation and Analysis, 2014 Chapter 2. Individuals 205. Individual Health Insurance Mandate In December 2013, the Administration announced that individuals

More information

Does the Affordable Care Act Require Health Insurance Coverage for Substitutes?

Does the Affordable Care Act Require Health Insurance Coverage for Substitutes? Does the Affordable Care Act Require Health Insurance Coverage for Substitutes? On January 2, 2013, the IRS issued proposed rules addressing key issues for employers under the Affordable Care Act (ACA).

More information

Insure Tennessee. What is Insure Tennessee?

Insure Tennessee. What is Insure Tennessee? Coverage for Tennessee s uninsured that is market-based, promotes personal responsibility, addresses cost, and is a big step towards real healthcare reform in Tennessee. What is Insure Tennessee? 2 What

More information

Health Care Reform: Ready or Not, Here it Comes! Presented by:

Health Care Reform: Ready or Not, Here it Comes! Presented by: Broader Perspective. Business Solutions. Health Care Reform: Ready or Not, Here it Comes! Presented by: Ryan Fridborg, MAOD, SPHR Executive Vice President, Employee Benefits rfridborg@boltonco.com Marilyn

More information

How Health Reform Will Affect Health Care Quality and the Delivery of Services

How Health Reform Will Affect Health Care Quality and the Delivery of Services Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care

More information

Date: Re: Important Notice from [Insert Name of Your Organization] about Health Insurance Marketplace Coverage and Our Medical Plan(s)

Date: Re: Important Notice from [Insert Name of Your Organization] about Health Insurance Marketplace Coverage and Our Medical Plan(s) Date: Re: Important Notice from [Insert Name of Your Organization] about Health Insurance Marketplace Coverage and Our Medical Plan(s) THIS NOTICE IS FOR ALL EMPLOYEES Please read this cover letter and

More information

ACA Employer Mandate: The Ultimate Guide

ACA Employer Mandate: The Ultimate Guide ACA Employer Mandate: The Ultimate Guide Table of Contents Are you ready? WHO needs to comply? WHAT forms do you need to file to comply? WHEN do you need to file the forms? WHERE do you get the forms?

More information

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery

LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery LTC Division Webinar Accountable Care Organizations and LTC Pharmacy - The New Era in Health Care Delivery 1 The Pioneer ACO Model James Vasquenza Jr. Vice President, Preferred Provider Network, Innovatix

More information

Patient Protection and Affordable Care Act Compliance Checklist for Employers

Patient Protection and Affordable Care Act Compliance Checklist for Employers October, 2014 Patient Protection and Affordable Care Act Compliance Checklist for Employers Under the Employer Mandate in the Affordable Care Act, effective January 1, 2015, employers with 50 or more full-time

More information

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years

Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Health Care Reform Management Alert Series Roadmap of Plan Changes Needed For Upcoming Plan Years Seyfarth Shaw has generously given permission to Lawyers Alliance for New York to circulate this chart

More information

IRS Health Coverage Reporting Instructions Leave Many Questions Unanswered

IRS Health Coverage Reporting Instructions Leave Many Questions Unanswered September 23, 2014 If you have questions, please contact your regular Groom attorney or one of the attorneys listed below: Katie Bjornstad Amin kamin@groom.com (202) 861-2604 Christine L. Keller ckeller@groom.com

More information

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012

Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM. David Johnson jdjohnson@rcmd.com November 15, 2012 Getting Ready for 2014: The Big Year for Healthcare Reform Anne Arundel County SHRM David Johnson jdjohnson@rcmd.com November 15, 2012 0 Topics for Discussion 1. Recap of Supreme Court Decision on Affordable

More information

Health Care Reform Update: What's Coming in 2014 for HRAs and Cafeteria Plans. WEBCAST Q&As. Thursday, October 24, 2013

Health Care Reform Update: What's Coming in 2014 for HRAs and Cafeteria Plans. WEBCAST Q&As. Thursday, October 24, 2013 Health Care Reform Update: What's Coming in 2014 for HRAs and Cafeteria Plans WEBCAST Q&As Thursday, October 24, 2013 HRAs Q: Is a medical expense reimbursement plan (employer contribution only) under

More information

Employer s guide to health care reform requirements

Employer s guide to health care reform requirements Employer s guide to health care reform requirements June 2015 edition As the Affordable Care Act (ACA) continues to be implemented, you ll need to remain aware of the policies and provisions that affect

More information

Health Care Reform: What to Expect in 2013 2014. Employee Benefits Series. Health Care Reform 2015 COMPLIANCE CHECKLIST

Health Care Reform: What to Expect in 2013 2014. Employee Benefits Series. Health Care Reform 2015 COMPLIANCE CHECKLIST Health Care Reform: What to Expect in 2013 2014 Employee Benefits Series Health Care Reform 2015 COMPLIANCE CHECKLIST This checklist is designed to help employers who sponsor group health plans review

More information

Employer's guide to health care reform

Employer's guide to health care reform Employer's guide to health care reform Employer's guide to health care reform: the complete small business resource With the Affordable Care Act (ACA) in full swing, it s important you understand what

More information

AFFORDABLE CARE ACT REPORTING

AFFORDABLE CARE ACT REPORTING AFFORDABLE CARE ACT REPORTING Introduction The Affordable Care Act (ACA) requires the State of Missouri to offer health insurance to full time equivalent employees. The ACA also generally requires individual

More information

CHANGES TO PLAN B EFFECTIVE SEPTEMBER 1, 2014

CHANGES TO PLAN B EFFECTIVE SEPTEMBER 1, 2014 Trustees AGMA Retirement Plan Executive Director Debra Bernard AGMA Health Fund Derek J. Davis John Coleman Alan S. Gordon, Esq. 1430 Broadway, Suite 1203 New York, NY 10018 Candace Itow Telephone (212)

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

THE AFFORDABLE CARE ACT: DECISIONS THAT NEED TO BE MADE NOW. April 2014

THE AFFORDABLE CARE ACT: DECISIONS THAT NEED TO BE MADE NOW. April 2014 THE AFFORDABLE CARE ACT: DECISIONS THAT NEED TO BE MADE NOW April 2014 Introduction Speakers Anne Pachciarek Partner Employee Benefits and Executive Compensation DLA Piper Mark Boxer Partner Employee Benefits

More information

Guidance issued on employer shared responsibility requirements

Guidance issued on employer shared responsibility requirements Guidance issued on employer shared responsibility requirements The shared responsibility requirements are one of the most significant provisions that employers need to address under the Affordable Care

More information

Notice 2015-87 I. PURPOSE AND OVERVIEW

Notice 2015-87 I. PURPOSE AND OVERVIEW Further Guidance on the Application of the Group Health Plan Market Reform Provisions of the Affordable Care Act to Employer-Provided Health Coverage and on Certain Other Affordable Care Act Provisions

More information

Health Care Reform: Health Plans Overview. Presented by: Brian Lenzo, Preferred Benefits Services

Health Care Reform: Health Plans Overview. Presented by: Brian Lenzo, Preferred Benefits Services Health Care Reform: Health Plans Overview Presented by: Brian Lenzo, Preferred Benefits Services Agenda What is the legal status of the law? Which plans must comply? Grandfathered plans Reforms currently

More information

Affordable Care Act FAQ

Affordable Care Act FAQ Affordable Care Act FAQ Based on regulatory guidance issued as of March 2014 and subject to change. Contents General ACA Questions... 1 ACA Marketplace... 1 ACA Employer Shared Responsibility... 2 ACA

More information

IRS Provides Guidance on HRAs, FSAs, Pay-or-Play and Other Issues

IRS Provides Guidance on HRAs, FSAs, Pay-or-Play and Other Issues January 20, 2016 LEGAL ALERT INFORM on REFORM IRS Provides Guidance on HRAs, FSAs, Pay-or-Play and Other Issues On December 16, 2015, the IRS released Notice 2015-87, which contains guidance on a broad

More information

EMPLOYER MANDATE FACT SHEET

EMPLOYER MANDATE FACT SHEET EMPLOYER MNDTE FCT SHEET INFORMED ON REFORM Overview Employers must offer health insurance that is affordable and provides minimum value to their full-time employees and their children up to age 26 or

More information

The Affordable Care Act: What Public Employers Need to be Doing Now

The Affordable Care Act: What Public Employers Need to be Doing Now The Affordable Care Act: What Public Employers Need to be Doing Now April 30, 2014 J. Richard Johnson IPMA-HR Webinar Copyright 2014 by The Segal Group, Inc. All rights reserved. 1 ACA Update Discussion

More information

benefits Mayo Pre-Tax Health Savings Account Plan Document and Summary Plan Description January 2015

benefits Mayo Pre-Tax Health Savings Account Plan Document and Summary Plan Description January 2015 Plan Document and Summary Plan Description A Component of the Mayo Flexible Spending Account Plan January 2015 benefits TO BUILD ON TABLE OF CONTENTS Table of Contents INTRODUCTION... 3 Pre-Tax HSA Is

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future.

Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. If you have any questions, please contact: Health Reform: A Guide

More information

Nevada Employer s Guide to the Affordable Care Act. Nevada Division of Insurance

Nevada Employer s Guide to the Affordable Care Act. Nevada Division of Insurance Nevada Employer s Guide to the Affordable Care Act Nevada Division of Insurance Nevada Employer s Guide to the Affordable Care Act State of Nevada Department of Business and Industry Division of Insurance

More information

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100

Health Care Reform. Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 Health Care Reform Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 *Tobacco-related disease *Poor diet *Lack of exercise *Excessive use of alcohol *American

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation

More information

Frequently Asked Questions as of 01/07/2015 Healthcare FSA Administration with Carryover Provision

Frequently Asked Questions as of 01/07/2015 Healthcare FSA Administration with Carryover Provision Frequently Asked Questions as of 01/07/2015 Healthcare FSA Administration with Carryover Provision On October 31, 2013, the U.S. Treasury Department and the IRS issued Notice 2013-71, which gives employers

More information

Working With a Staffing Company. What clients need to know about compliance

Working With a Staffing Company. What clients need to know about compliance Working With a Staffing Company Under the Affordable Care Act What clients need to know about compliance The Staffing Industry s Position on the ACA Members of the American Staffing Association, the industry

More information

Employer Tax Penalties Linked to Employees Receiving Tax Credits. Calculation of Non-deductible Excise Taxes Under IRC 4380H

Employer Tax Penalties Linked to Employees Receiving Tax Credits. Calculation of Non-deductible Excise Taxes Under IRC 4380H Washington Council Employer Tax Penalties Linked to Employees Receiving Tax Credits Employers will face taxes under IRC 4980H if they do not offer minimum essential coverage or if the coverage they offer

More information

Frequently Asked Questions By Topic

Frequently Asked Questions By Topic Small Business FAQ s Frequently Asked Questions By Topic Small Business Health Insurance Why should I provide group health insurance to my employees? How much of the employees' premium is the employer

More information

The Affordable Care Act: What s next for employers?

The Affordable Care Act: What s next for employers? The Affordable Care Act: What s next for employers? Prepared by: Jill Harris, Director, Washington National Tax, McGladrey LLP 507.226.0482, jill.harris@mcgladrey.com Bill O Malley, Director, Washington

More information

How ACA is Changing Employer Health Benefits and the Marketplace Presented by:

How ACA is Changing Employer Health Benefits and the Marketplace Presented by: North Carolina State Health Plan How ACA is Changing Employer Health Benefits and the Marketplace Presented by: J. Richard Johnson Senior Vice President, Public Sector Health Practice Leader rjohnson@segalco.com

More information

U.S. ATTITUDES TOWARD HEALTH INSURANCE AND HEALTHCARE REFORM. A report by Valence Health August 2015

U.S. ATTITUDES TOWARD HEALTH INSURANCE AND HEALTHCARE REFORM. A report by Valence Health August 2015 U.S. ATTITUDES TOWARD HEALTH INSURANCE AND HEALTHCARE REFORM A report by Valence Health August 2015 U.S. ATTITUDES TOWARD HEALTH INSURANCE AND HEALTHCARE REFORM Executive Summary With the Affordable Care

More information

School District Obligations Under the New Federal Health Care Law: Is Your District Going to Play or Pay the Penalty?

School District Obligations Under the New Federal Health Care Law: Is Your District Going to Play or Pay the Penalty? TM MISSOURI SCHOOL BOARDS ASSOCIATION HELPING SCHOOL BOARDS SUCCEED School District Obligations Under the New Federal Health Care Law: Is Your District Going to Play or Pay the Penalty? Click to jump to

More information

SUMMARY: This document contains final regulations relating to section 125 cafeteria

SUMMARY: This document contains final regulations relating to section 125 cafeteria [4830-01-u] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 8921] RIN 1545-AY23 Tax Treatment of Cafeteria Plans AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations.

More information

Health Reform in a Nutshell: What Small Businesses Need to Know Now.

Health Reform in a Nutshell: What Small Businesses Need to Know Now. Health Reform in a Nutshell: What Small Businesses Need to Know Now. With the passage of the most significant reform of America s modern-day health care system, many small business owners and human resources

More information

toolkit New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law Fact Sheet pages 2-3

toolkit New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law Fact Sheet pages 2-3 EXPANDING THE POSSIBILITIES toolkit New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law 1 2 3 4 Calling 5 6 Sample Fact Sheet pages 2-3 Types of Coverage

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

Overview of Reporting Requirements. ACA Reporting. Overview. Overview of Reporting Requirements. ACA Reporting Examples

Overview of Reporting Requirements. ACA Reporting. Overview. Overview of Reporting Requirements. ACA Reporting Examples ACA Reporting August 18, 2015 Norbert F. Kugele April A. Goff 2015 Warner Norcross & Judd LLP. All rights reserved. WNJ.com Overview Overview of Reporting Requirements Why have reporting Status of forms

More information

Chapter 8: Just in Case Additional Material

Chapter 8: Just in Case Additional Material Chapter 8: Just in Case Additional Material Here I go into detail about Medicare, Medicare Advantage (MA) plans, and Medigap plans. What about Medicare? Medicare is a federal health insurance program for

More information

CLICK HERE TO ADD TITLE

CLICK HERE TO ADD TITLE CLICK HERE TO ADD TITLE HEALTH CARE REFORM & ITS EFFECTS ON YOUR BUSINESS Presented by Jenny Arthur, SPHR AGENDA Background/History The Past: Previously Implemented HCR Provisions The Present: Current/Pending

More information

SUMMARY: This document contains final regulations relating to section 125 cafeteria

SUMMARY: This document contains final regulations relating to section 125 cafeteria [4830-01-u] DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 8878 ] RIN 1545-AU61 Tax Treatment of Cafeteria Plans AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations.

More information

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: November 2014

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: November 2014 AFFORDABLE CARE ACT Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform changes apply regardless

More information

Wells Insurance. 2015 ACA Compliance Update

Wells Insurance. 2015 ACA Compliance Update Wells Insurance 2015 ACA Compliance Update Wells Insurance Today s Agenda Cost-Saving Strategies Deadlines & Implications for you Plan Design Changes Reinsurance Fees Employer Penalty Rules Reporting of

More information

Health Care Reform: A Guide for Self-Funded Plans. Key steps to prepare for 2014 Preparing for the future Snapshot of reform (2010-2019)

Health Care Reform: A Guide for Self-Funded Plans. Key steps to prepare for 2014 Preparing for the future Snapshot of reform (2010-2019) Health Care Reform: A Guide for Self-Funded Plans Key steps to prepare for 2014 Preparing for the future Snapshot of reform (2010-2019) Table of Contents Health Care Reform is Here: Are you ready? 3 Key

More information

Oak Ridge National Laboratory. New Coverage New Choices

Oak Ridge National Laboratory. New Coverage New Choices Oak Ridge National Laboratory New Coverage New Choices What we ll cover today What is changing and why? How this affects you Introducing Extend Health Medicare marketplace Going forward Questions & answers

More information

ACA Strategy. Why ACOs? 4/16/2014 ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT

ACA Strategy. Why ACOs? 4/16/2014 ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT ACCOUNTABLE CARE ORGANIZATIONS UNDER THE AFFORDABLE CARE ACT Stephen P. Williams, JD 864 350 5276 1984carrera@gmail.com ACA Strategy One of the main ways the Affordable Care Act seeks to reduce health

More information

IBM Selects Extend Health to offer Medicare-Eligible Retirees a New Way to Receive Health Care Coverage

IBM Selects Extend Health to offer Medicare-Eligible Retirees a New Way to Receive Health Care Coverage IBM Selects Extend Health to offer Medicare-Eligible Retirees a New Way to Receive Health Care Coverage As of January 1, 2014, IBM will offer Medicareeligible retirees* and their Medicare-eligible dependents**

More information

Your Retiree Medical Transition Guide

Your Retiree Medical Transition Guide Your Retiree Medical Transition Guide What you need to know. Prepare for your enrollment. Partner with your own dedicated Benefits Advisor. Get help paying for your coverage. A New Way to Find the Right

More information

Employer-Shared Responsibility

Employer-Shared Responsibility Affordable Care Act Planning to Deal with the Pay-or-Play Penalties Effective January 1, 2015 Anne Hydorn Hanson Bridgett LLP Telephone: (415) 995-5893 Email: ahydorn@hansonbridgett.com Judy Boyette Hanson

More information

Employer s guide to health care reform

Employer s guide to health care reform Employer s guide to health care reform Employer s guide to health care reform Benefits strategies and resources for small businesses Small businesses are the innovators, modernizers and visionaries that

More information

August 2015. AmeriCorps VISTA Healthcare FAQs

August 2015. AmeriCorps VISTA Healthcare FAQs August 2015 AmeriCorps VISTA Healthcare FAQs AmeriCorps VISTA Healthcare FAQs The Affordable Health Care Act (ACA) reformed healthcare and ensures that essential healthcare benefits are made available

More information

Submitted electronically via: Notice.comments@irscounsel.treas.gov

Submitted electronically via: Notice.comments@irscounsel.treas.gov 20 F Street, NW, Suite 200 Washington, D.C. 20001 202.558.3000 Fax 202.628.9244 www.businessgrouphealth.org Creative Health Benefits Solutions for Today, Strong Policy for Tomorrow October 1, 2015 Submitted

More information

Hospitals and the Affordable Care Act (ACA)

Hospitals and the Affordable Care Act (ACA) Hospitals and the Affordable Care Act (ACA) General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Corporate Account Customer Support at: 1-888-259-8414

More information

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal)

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) Group Health Insurance Q & A HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) 1. Will small employers continue to have 12 month rates as they exist today? a. Yes. Employer groups

More information

Your guide to health care reform provisions

Your guide to health care reform provisions Your guide to health care reform provisions February 2014 edition Since the Patient Protection and Affordable Care Act (PPACA) was enacted in March 2010, businesses have been impacted by federal health

More information

Considerations for implementing an in-house health clinic

Considerations for implementing an in-house health clinic White paper: Healthcare Considerations for implementing an in-house health clinic By Theresa G. Edwards, National Healthcare Industry Segment Leader June 2015 Although employer-sponsored nurses have been

More information

HEALTH CARE REFORM: Grandfathered Health Plans

HEALTH CARE REFORM: Grandfathered Health Plans HEALTH CARE REFORM: Grandfathered Health Plans Guidance concerning grandfathered health plan status was issued on June 17, 2010, by the Departments of Labor, Treasury and Health and Human Services with

More information

How To Get A Pension From The Boeing Company

How To Get A Pension From The Boeing Company Employee Benefits Retiree Medical Plan Retiree Medical Plan Boeing Medicare Supplement Plan Summary Plan Description/2006 Retired Union Employees Formerly Represented by SPEEA (Professional and Technical

More information

Medicare Open Enrollment for 2014 Friday, 25 October 2013 17:58. A summary of what you need to know.

Medicare Open Enrollment for 2014 Friday, 25 October 2013 17:58. A summary of what you need to know. A summary of what you need to know. Medicare Open Enrollment has arrived. The open enrollment period for 2014 runs from October 15-December 7, 2013. This is not only a period where you may enroll for the

More information

Tracking Employment-Based Health Benefits in Changing Times

Tracking Employment-Based Health Benefits in Changing Times Tracking Employment-Based Health Benefits in Changing Times by Brian Mauersberger Bureau of Labor Statistics Originally Posted: January 27, 2012 Most Americans obtain their health care coverage through

More information

Medicare has four components, Part A, Part B Part C and Part D:

Medicare has four components, Part A, Part B Part C and Part D: Medicare What is Medicare? Medicare is a National Health Insurance Program for people 65 years of age and older Certain persons with disabilities under the age of 65 People with end stage renal disease

More information

Guidance on the Application of Code 4980D to Certain Types of Health Coverage Reimbursement Arrangements

Guidance on the Application of Code 4980D to Certain Types of Health Coverage Reimbursement Arrangements Guidance on the Application of Code 4980D to Certain Types of Health Coverage Reimbursement Arrangements Notice 2015-17 I. PURPOSE AND OVERVIEW This notice reiterates the conclusion in previous guidance

More information