Thursday, July 21, 2016

The ACA Makes My Head Hurt!

by Norma Shirk, Esq.

Imagine the following scenario:

Stephanie is the HR Director for her company and she's spent years trying to figure out how to comply with the Affordable Care Act (ACA) requirements for large employers. She works for a company that provides janitorial services to businesses.

The company has issued as many as 700 W-2's in one year but it has a core group of 300 employees who work varying schedules. Turnover is high because few people like working low-paying janitorial jobs. Janitorial jobs are also risky, as when employees slip on newly mopped floors or wrench their backs emptying trashcans. Stephanie fortifies herself with extra coffee to get through the weekly safety meetings reporting injuries.

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Monday, May 23, 2016

Billions Spent Illegally on Affordable Care Act Benefits

by Jillian Jagling, Esq.

The Affordable Care Act ("ACA") created both tax credits to make health insurance premiums more affordable and cost-sharing reductions intended to reduce deductibles, coinsurance, and co-pays. According to the ACA, insurers are required to reduce the cost-sharing of eligible individuals enrolled in their plans; and the insurers are supposed to get their money back from the federal government. As of June 2015, about 5.6 million people received cost-sharing reductions. (Source: June 30, 2015 Effectuated Enrollment Snapshot)

However, while Congress clearly appropriated funds in the ACA to pay for the premium tax credits, in a recent lawsuit, the U.S. House of Representatives ("House") argued that the billions of dollars spent since January 2014 on cost-sharing reductions were not appropriated by Congress and therefore violate the Constitution.

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Tuesday, January 26, 2016

More Delays for the ACA: New Filing Deadlines and "Cadillac" Tax Date

by R. Brent Gambill, Esq.

IRS Extends the ACA's Form 1094 and Form 1095 Filing Deadlines

The IRS has unexpectedly extended the deadlines by which insurers and self-funded employers must provide health plan enrollment and coverage information to employees and the IRS under the Affordable Care Act (ACA). This is the information required to be reported on Forms 1094 and 1095. Notice 2016-4 issued December 28, 2015 extends the due dates:

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Wednesday, October 21, 2015

Conflict and Confusion Continue over Employee Wellness Programs

by Timothy Puin, Esq.

For every dollar a company spends on an employee wellness program—whether by offering free flu shots, a discounted salad bar, or T-shirts for tracking steps on a Fitbit device—the company may save as much as $4 in lost productivity and related costs. However, employers who get a little too enthusiastic in this regard about may find themselves on the wrong side of the laws protecting employee rights.

Employee wellness programs have come under renewed scrutiny by the U.S. Equal Employment Opportunity Commission (EEOC) since the Affordable Care Act (ACA) created new incentives for employers to maintain wellness programs as a way of controlling health care spending related to diabetes, hypertension, obesity, and tobacco use, in particular.

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Monday, March 30, 2015

Controlling End-Of-Life Decisions: The Difference Between DNR and Living Will

by Chris Calamita, Esq.

There is often confusion between a living will and a do not resuscitate order (DNR). Recent online articles have added to this confusion. In Kentucky, a DNR applies to resuscitation attempts by health care providers before you get to the hospital (for example, attempts by paramedics and nursing home staff). The living will informs doctors of your end-of-life care decisions should you not be able to speak for yourself.

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Monday, March 16, 2015

Ignorance Isn't Bliss: Not Knowing the Medicaid Rules Can Cost You

by Misty Clark Vantrease, Esq.

The meeting began like so many before, but I soon realized that this one would be one that would stick with me. Judy had made the heartbreaking decision two years ago to place her husband in a nursing home. He had advancing dementia and she had cared for him as long as she could at home. She put him in a nice, clean place close to her so that she could see him as often as possible.

Although she didn't drive (she'd never learned), kind friends and church members would take her to see her ailing husband almost every day. They had married over 60 years before, and her tender words about him showed she was still head over heels for him.

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Monday, March 9, 2015

Affordable Care Act Preparation for a (New) Large Employer

by Norma Shirk, Esq.

Eleanor owns a business that has grown rapidly over the past few years. She's overcome many challenges along the way, such as watching a talented employee have a meltdown in a meeting with an important client. Then there's the time the office Christmas party degenerated into a drunken reenactment of Salome and the Seven Veils.

With all that action, she ignored the fuss around the Affordable Care Act (ACA) because she simply lacked the time to deal with it. Now the ACA has her attention because Eleanor knows that in about a year she will pass the magical 50-employee mark. So Eleanor does a little ACA research to see how deep a hole of liability she may face as a "large" employer. What she's learned so far fills her with equal parts joy and dismay.

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Wednesday, March 4, 2015

Self-Insured Employers Face Additional ACA Reporting Requirements

by Jaclyn M. McLean, Esq.

I was recently asked to help a very large, self-insured employer start the arduous process of Affordable Care Act ("ACA") compliance. This included the typical analysis of determining whether the employer was an "Applicable Large Employer" ("ALE")[1] under the Act (it is), and whether the employer provided "Minimum Essential Coverage" (it does).

However, as I became more familiar with the statute and its regulations, I quickly realized I was in the unfortunate position of explaining to my client that it would have one of the ACA's biggest reporting burdens as a self-insured employer.

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Monday, August 18, 2014

What a California Employer Needs To Know About "Hobby Lobby"

by Gordon E. Bosserman, Esq.

Image courtesy of Nicholas Eckhart on Flickr

Everyone seems to be talking about "Hobby Lobby." This term refers to the decision of the United States Supreme Court in the case entitled Burwell v. Hobby Lobby Stores, Inc. Relying on the Religious Freedom Reformation Act of 1993 ("RFRA"), the Supreme Court held that this Act trumped certain provisions of the Affordable Care Act ("Obamacare"). The provision of Obamacare in question required an employer to provide certain types of contraception as part of the health care insurance the employer offered to its employees.

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Monday, June 9, 2014

"Play or Pay:" The Devil is in the Details

by Dean A. Spina, Esq.

A client of mine often notes that in writing contracts the "Devil is in the details." Identifying the nuances that are critical to a successful contract makes contract law challenging and rewarding.

Identifying the nuances makes compliance with the Play or Pay obligations imposed by the Affordable Care Act ("ACA") challenging because the "Devil is in the Details."

The ACA, approved in 2010, is a lengthy Act. Title X of ACA amended Titles 1-IX. The ACA was amended by another Act just a week later. Provisions have been amended in the subsequent years. Fixed deadlines have been challenging for the agencies to implement and the resulting delays have stretched out the implementation for some provisions for three or more years.

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