FTE Tracking and Health Coverage Reporting Thursday, September 25, - PowerPoint PPT Presentation

FTE Tracking and Health Coverage Reporting Thursday, September 25, 2014 2:00 pm – 3:00 pm EST

Today’s Speakers Joe DiBella  Executive Vice President of the Health & Welfare Practice  Conner Strong & Buckelew Phyllis Saraceni  Senior Vice President, Compliance & Audit Practice Leader  Conner Strong & Buckelew 2

Welcome and Agenda Conner Strong & Buckelew’s next installment in ongoing series of webinars on key national healthcare reform issues  2015 healthcare reform planning issues  HIPAA health plan identifier (obtained by November 5)  Transitional Reinsurance Fee (start process by November 15)  Full-time employee measurement / 2015 enrollment process  New health coverage reporting forms  Strategies to track, obtain, organize, and submit required health coverage reporting information 3

Political and Social Landscape Patient Protection and Affordable Care Act (“PPACA” or “ACA” or HCR”)  Repeal remains unlikely  President standing firm on continued roll-out (w/ executive delays)  Vulnerable members of Congress concerned with re-election  Highly partisan House and Senate under pressure to find consensus and address problems  Bipartisan legislative fix opportunities unlikely to succeed - President will veto (e.g., House bills to delay mandates and modify definition of FTE from 30 hours/week to 40)  Growing concerns about more political fallout, particularly because of law's convoluted connections with tax system  IRS using website, social media, and webcasts to inform public  Insurer connection issues between their computer systems and government's systems 4

Taxes, Fees, and Penalties

Participant Question Can you list all taxes and changes that a 50+ group incurs? See next slide for inventory. 6

Inventory of Major HCR Requirements 1) Pay or Play/Employer Mandate 25) Elimination of the RDS 2) Coverage Information Reporting 26) Early Retiree Reinsurance Program 3) Track Full Time Employees 27) Over the Counter Drug Changes 4) Decide whether to Pay or Play 28) Cadillac Tax 5) Worker Classification and Time Tracking 29) Plan Amendment/Terminations 6) Non-Calendar Year Section 125 Plans 30) Automatic Enrollment 7) Prepare for Interaction with the Marketplaces 31) First Dollar Coverage for Preventive Care 8) Pre-Existing Condition Exclusion 32) Revised Appeal Process 9) PCOR Fee 33) Patient Protections 10) Transitional Re-Insurance Fee 34) Insured Non-Discrimination Rules 11) Health Insurer Fee 35) Clinical Trial Coverage 12) Prepare and Distribute Marketplace Notice 36) Transparency Reporting 13) Summary of Benefits and Coverage (SBC) 14) Prepare and Distribute SPDs and SMM 15) Wellness Program Incentive 16) 90 Day Waiting Period 17) Lifetime Limit on Essential Health Benefits 18) Out of Pocket Limits 19) Coverage for Adult Children 20) W2 Reporting for Value of Benefits 21) Recessions 22) Health FSA Contribution Limit 23) Health FSA Carry Over 24) Medical Loss Ratio Rebates 7

Employers – Excise Tax Penalties  PPACA excise tax penalties - applies to multitude of HCR requirements  $100/day/affected individual for certain violations: - Potentially more significant than pay or play penalties - Example: Total potential ANNUAL excise tax per person for continuous violation of single requirement could be $36,500  Applies for each day failure occurs and ends on date failure corrected  Limited correction window available - makes identifying and promptly correcting potential errors of utmost importance  Employers required to self-report and pay excise tax for violations using Form 8928 8

Fees and Taxes/Employers and Insurers Comparative Effectiveness Research Fee – Funds Patient-Centered Outcomes Research Institute (PCORI) which conducts research on effectiveness of treatments Annual fee of $1 per member, increasing to $2, then indexed • Health Insurance Industry Fee –Helps fund PPACA implementation Insured plan only • 2% – 2.5% of premium in 2014 • 3% – 4% of premium in future years • Transitional Reinsurance Program (TRP) Fee – Annual fee intended to lessen impact of adverse selection in individual market $63 per member per year (PMPY) in 2014 • $44 PMPY in 2015 • $25 – $30 PMPY in 2016 • 9

Individual Mandate and the Exchange Americans must pay penalty or have minimum essential coverage (MEC) • beginning 1/1/14 (unless exemption applies) Can buy insurance on or off exchanges - some get federal premium • (subsidy) assistance on exchange Exchange and tax complications await consumers •  Second open enrollment season runs Nov 15 to Feb 15  Shorter than last year (3 months instead of 6) and overlaps with Holiday season  Carrier pricing and subsidy amounts changing for 2015 coverage  New forms and line items added to 2014 tax returns (filed in Spring 2015) – all must prove they have MEC and got correct subsidy amount (too much and tax refunds will be reduced) 10

Employer Mandate Employers with 50+ full-time employees (FTEs) or FT equivalents must offer affordable, minimum value medical coverage to FTEs and their children up to age 26 or face penalty. Employer Size 2015 Plan Year 2016 Plan Year and Beyond 1-49 FTEs Does not apply Does not apply 50-99 FTEs (For 2015, must certify they Employer must offer coverage are not reducing size of Does not apply to 95% of FTEs and workforce to stay below dependents to age 26 100 FTEs) Employer must offer coverage Employer must offer coverage 100 or more FTEs to 70% of FTEs and to 95% of FTEs and dependents to age 26 dependents to age 26 11

Participant Question Please describe the amounts due to federal government in November for employee coverage, per person payment. See next slide for information on TRP fee due in November. 12

TRP Fee Contributions required for 2014, 2015 and 2016 benefit years • HHS collects contributions and sets national contribution rate • Can have TPA submit on plans’ behalf (many will not assist) • If do not have pay.gov account, need to create account to complete TRP • contribution submission filing Submit enrollment count by 11/15/14 using special Form (not yet available) - • Form will automatically calculate TRP contribution amount Have option - • • payment of $63/covered life by 1/15/15, or • 2 payments/year: $52.50/covered life due 1/15/15 and $10.50/covered life due 11/15/15 13

Key TRP Deadlines for 2014 Benefit Year Date Activity Contribution Amount No later than Submit Annual Enrollment November 15, 2014 Count and Schedule Contribution Payment Date No later than Remit first Contribution $52.50 per covered life January 15, 2015 Amount No later than Remit Second Contribution $10.50 per covered life November 15, 2015 Amount Total $63.00 per covered life 14

TRP Contribution Submission Process Overview A Reporting Entity completes all of the following steps: 1 2 3 4 Collect Data, Calculate Annual Enrollment Complete Upload Enter Payment Register on Count and Contribution Supporting Information Pay.gov Prepare Form Text Supporting Documentation On Pay.gov 15

Scheduling the TRP Payment • HHS recommends scheduling payment at least 30+ days after Form submission but before 1/15/15 deadline − This will allow for validation and correction if necessary • Here is an example for a combined collection: 16

What Can You Do to Prepare for TRP  Self-insured employers register on Pay.gov (carriers handle TRP fee for insured plans)  Collect information needed to compete Form and Supporting Documentation  Contact bank to have ALC+2 value added to allow for automatic debits (if applicable)  Monitor TRP guidance, including the CMS.gov “Reinsurance Contributions” specific CCIIO webpage  Sign up and receive notifications for training sessions on www.REGTAP.info  Attend special TRP webinars for more information (register at www.REGTAP.info)  Complete TRP contribution submission process on Pay.gov beginning later this Fall 17

Participant Question Please address Auto Enrollment for 200+ employees. Will this happen? Governmental guidance confirms employers not required to comply with provision until guidance is provided. To date no guidance provided, so employers currently not required to comply. Rules and regulations must be issued before implementation can happen, and time will be provided prior to implementation. 18

HIPAA Health Plan Identifier

HIPAA HPID Requirement HIPAA requires “covered entities” conducting covered transactions electronically to use standardized formats and codes  Applies to covered transactions involving eligibility/enrollment and payment of health care claims  A “controlling health plan” (CHP) is required to obtain health plan identifier (HPID) to be used on all standard transactions conducted by plan and business associates (e.g., the claims administrator)  Insurer is covered entity and will be completing HPID application process  Broad definition of CHP appears to encompass self-funded health plans sponsored by employers 20