USA: Alliant’s Employee Benefits Compliance & Fast Facts – February 17, 2017

February 23, 2017:

The following information on compliance in the United States was provided to us by Asinta Partner, Alliant:

Republican Leaders in the House Release Repeal and Replace Policy Document

Republican leaders in the House of Representatives released a policy document on repealing and replacing the Affordable Care Act (ACA) titled “Obamacare Repeal and Replace Policy Brief and Resources.” The 19-page document includes a repudiation of the ACA and 6 pages of proposed changes. Note this is not legislation and does not indicate a specific timeline for repeal and replace legislation. Proposals include:

• Health Care Tax Credits: The document proposes an “advanceable and refundable” tax credit to help Americans who do not receive insurance through their employer or a government program. The document states that the ACA’s existing advanced payment of a premium tax credit did not work because subsidies could only be used to purchase “expensive, one-size fits all coverage . . . . [and] . . . could only be used on the government exchanges.” Unlike the ACA’s existing tax credit, the proposed credit is also not based on income and increases with age.

• Health Savings Accounts: The document adopts many of the ideas from the Ryan Better Way proposal on increasing the utility of HSAs. It endorses increasing HSA contribution limits, increasing flexibility with respect to reimbursing expenses incurred before an HSA was established, and allowing both spouses to make catch up contributions to the same account.

• Modernizing and Strengthening Medicaid: The document states that the Medicaid expansion “for able-bodied adults” would be repealed subject to a limited transition period where federal funding of the expansion would continue. The proposal suggests states could then choose between block grants or financing based on a per capita allotment.

Notably, the document expressly states that House Republicans would repeal both the individual and employer mandates under the ACA. There is strong support for the repeal of the individual mandate and recent actions stabilizing the individual market seem to be geared towards supporting a market without an individual mandate (requiring continuous coverage and proposed late enrollment penalties). The administration has otherwise been silent on repealing the employer “Pay or Play” mandate. The document does not specify how the plan will be paid for but comments from members of Congress suggest it will ultimately include a cap on the tax favored status of employer provided coverage. We will watch for legislative text and continue to provide updates as this plan or other proposals evolve.

Pay or Play Refresher

As clients flood your inbox with 1095 coding questions, it is a good time to remember that all good and compliant answers to reporting questions begin with a solid understanding of the basic Pay or Play mechanics. For example: How do you code an individual who was covered on the plan all year except for an unpaid leave of absence for 4 months at the end of the year during which they dropped coverage. Proper coding here depends on whether the employer uses the look back or monthly method to determine full-time employee status; in other words, the answer to the question depends on whether the employee was in a stability period as a full-time employee or whether their full-time status was determined monthly. The answer will determine whether the employer can use Code 2B (not a full-time employee for the month) on Line 16 to avoid potential penalties. Recall that employers have two options to determine full-time employee status: Look back or monthly. These methods will usually apply across all classes of employees. Not only does an understanding of these rules impact 1095-C coding, but it also determines how an employer manages changes in employee status and offers of coverage throughout the plan year. As it looks more and more like the employer mandate will continue for at least a couple of years, it is crucial to understand how the Pay or Play mandate works and how to minimize penalty risk for the employer. We have a host of Alliant Insights (white papers) that provide plain language, in depth explanations of the Pay or Play fundamentals available here. Take a look and share with clients as you continue to deal with the administrative challenges of Pay or Play.

ACA Repeal and Replace Compliance Slides

The compliance team has created slides available on the portal around the current state of the ACA. The slides are available here and should be used for client meetings and presentations so that we can present a consistent, national message. The slides will be kept up-to-date with changes and updates around the ACA and our industry.

Save the Date for our next Compliance Webinar!

The next compliance webinar will be on Tuesday, April 11 at 10 AM PST. A calendar appointment will go out to staff next week with and an invitation to clients and prospects will go out in the upcoming weeks. The webinar will be an in-depth look at the current state of the ACA and discuss any proposed or possible changes.

HIPAA Reminder – Toolkit Available on the Portal!

As a reminder, clients with self-funded health and welfare plans need HIPAA Policies and Procedures in place to comply with HIPAA’s Privacy and Security Rules. This does not need to be the top priority for clients that limit self-funding to a Health Reimbursement Arrangement or Health Flexible Spending Account. However, it should be a priority for clients that self-fund major medical plans even if a Third Party Administrator manages the day to day operations of the plan. Alliant has a ready-made solution on the Portal that is appropriate for most clients – the HIPAA Toolkit. The HIPAA toolkit is a collection of documents accompanied by a WebEx with voiceover explaining how to customize them. Our teams customize these documents using the WebEx instructions and with feedback from clients on things like what individual (or position) should be designated as the privacy/security official. Once the documents are complete the client should review them and flag any questions or concerns. Our Compliance Department can help teams address any issues raised by clients. Once the documents are in final form they should be formally adopted and the client should proceed with training its workforce. We have a train the workforce WebEx with voiceover on the portal that clients can use. If this process does not work for a specific team or client contact Compliance for a vendor recommendation and outsourced solution.

 

Special thanks to Alliant for providing us with this content. If you have any questions regarding compliance in the United States, please get in contact with Alliant via their contact page here.