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“Medium-Sized” Employers Given a Temporary Break in PPACA Pay or Play Penalties

On February 12, 2014, the IRS published Final Regulations pertaining to the shared responsibility provisions of the Patient Protection and Affordable Care Act of 2010 (“PPACA”), delaying implementation of certain “pay or play” requirements.

Large employers are defined in PPACA as those with fifty or more full time equivalent employees. Under Code Section 4980H, generally, large employers could be subject to a penalty if they fail to offer full-time employees “affordable” coverage that provides “minimum value,” as those terms are defined by law.

The Final Regulations offer a new piece of transitional guidance for some large employers—that is, those with less than one hundred full time equivalent employees. Such employers will not be subject to a penalty under Code Section 4980H for the 2015 plan year if the employer:

  • has less than one hundred full time employees in 2014;
  • has not reduced its work force size or overall hours of service between 2/9/14 and 12/31/14;
  • maintained the health coverage that was in effect on 2/9/14 without material change; and
  • certified that the employer met such requirements on a prescribed IRS form (which will be released with upcoming Code Section 6056 regulations).

If these conditions are met, the employer will not become subject to PPACA pay or play penalties until the 2016 plan year.

The Final Regulations also offer additional guidance on a number of other PPACA related areas such as:

  • health coverage for an employee’s dependents is delayed to the 2016 plan year if the employer did not previously offer dependent coverage;
  • employers are relieved of providing coverage to 95% of their work force until 2016 if they do in fact cover 70% of their applicable work force during the 2015 plan year;
  • seasonal employees whose customary annual employment is six months or less generally will not be considered full time employees;
  • hours contributed by bona fide volunteers for a government or tax exempt entity (such as volunteer fire fighters) will not create full time employee status;
  • teachers and educational employees will not be treated as part time employees simply because their school is closed or operating on a limited schedule during the summer;
  • a safe harbor for calculating hours of service for adjunct faculty; and
  • certain previously issued PPACA transitional guidance applicable to the 2014 plan year has been extended to the 2015 plan year.

For more information or questions related to PPACA, please contact Barbara Sanchez-Salazar.

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News Briefs:

FDA Considers Major Changes to Over-the-Counter Drug Regulations
The U.S. Food and Drug Administration is considering sweeping changes to how it regulates over-the-counter drugs from aspirin to allergy medications to make it easier to react to new information on a product's safety or recommended use. The agency's current rules for nonprescription medicines are more than 40 years old, and do not require manufacturers to get approval as long as the main ingredient had previously been deemed safe and effective for that entire category of medications.
(Source: Reuters, 2014-02-21) Read the full article
U.S. Concerned Over Safety Issues of Medicines Coming from India
India, the second-largest exporter of over-the-counter and prescription drugs to the United States, is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines. Dr. Margaret A. Hamburg, the commissioner of the United States Food and Drug Administration, arrived in India to express her growing unease with the safety of Indian medicines because of "recent lapses in quality at a handful of pharmaceutical firms."
(Source: The New York Times, 2014-02-14) Read the full article
Drug Firms Plan to Fight Proposed FDA Generic Drug Regulations
The United States Food and Drug Administration's proposed regulations for generic drugs will mandate drug-manufacturing companies to inform consumers of every single known health risk involved with every drug product that they sell. The drug companies are planning on fighting these newly proposed rules stating that they "would be nothing short of catastrophic" and would only "create dangerous confusion."
(Source: Counsel & Heal, 2014-02-18) Read the full article
Evidence Shows Few Benefits to Hospital Mergers
Hospitals are busily merging with other hospitals and buying up groups of doctors, but what's the evidence that bigger hospitals offer better value? Not a lot.
(Source: Bloomberg, 2014-02-18) Read the full article
Feds Boosting Crackdown on Health Care Fraud
Healthcare fraud is estimated to cost the country $80 billion a year, and it's growing, according to the FBI and Health and Human Services Office of Inspector General. And healthcare fraud prosecutions are on the rise nationwide, according to a recent report from the Transactional Records Access Clearinghouse at Syracuse University, which tallied prosecutions brought under a specific Healthcare Fraud statute and found 366 cases last year, a three percent increase over the previous year.
(Source: Tampa Tribune, 2014-02-23) Read the full article
Many Health Practices Finding ACA Tough to Maneuver
In the past, offices have been able to make sure patients are insured quickly, by using an online verification system, but for exchange patients practices also have to call the insurer to make sure the patient has paid his premium. If he hasn't, the insurance company can refuse to pay the doctor for the visit, or come back later and recoup a payment it made.
(Source: Kaiser Health News, 2014-02-25) Read the full article
Health Care Organizations Face Increasing Number of Cyberattacks
Add this to the list of things to freak you out: Healthcare organizations of all kinds are being routinely attacked and compromised by increasingly sophisticated cyberattacks. A new study found that networks and Internet-connected devices in places such as hospitals, insurance companies and pharmaceutical companies are under siege and in many cases have been infiltrated without their knowledge.
(Source: Los Angeles Times, 2014-02-18) Read the full article
Eleven States Taking Steps to Make Health Care Prices Public
Colorado is one of eleven states that are starting to make a lot of health care prices public. “None of us have had much information about how much health care services actually cost, and how much we're getting for our money. And an all payer claims database gives you that information, so you can become an empowered consumer,” says Edie Sonn, from a nonprofit called CIVHC.
(Source: Kaiser Health News, 2014-02-19) Read the full article
Health Insurance Determining Who's Transferred to Trauma Centers
When private hospitals transfer patients who don't have insurance to public hospitals, it's called "patient dumping." But a study from Stanford University suggests a twist: Hospitals, it seems, are less likely to transfer critically injured patients to trauma centers if the patients have health insurance.
(Source: NPR, 2014-02-19) Read the full article
More Insurers Establishing Palliative Care Programs
Insurers are establishing programs that give the sickest patients the chance to receive extra care for their pain, suffering and emotional needs, in a move that turns out to cut spending substantially. Such palliative-care programs aim to provide assistance to patients with chronic or terminal illnesses, and go beyond the drug prescriptions and surgeries such patients typically receive.
(Source: The Wall Street Journal, 2014-02-23) Read the full article
 
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