Under the Affordable Care Act, group health plans and health insurance issuers are required to provide certain notices in a culturally and linguistically appropriate manner. The rules require certain accommodations to be made for notices sent to an address in a county in which 10% or more of the population is literate only in the same non-English language. The determination of which counties meet the 10% threshold will be determined annually and is based on American Community Survey (ACS) data published by the United States Census Bureau. The list of counties meeting the 10% threshold that is applicable for 2013 was recently released by HHS and is available at
The Obama administration Tuesday announced a one-year delay in the Affordable Care Act’s requirement that businesses with 50 or more employees offer coverage to their workers or pay a penalty.
Administration officials said the delay was in response to employers’ concerns about the law’s reporting requirements. Delaying the law’s "employer responsibility" provision would give employers more time to comply and give the government more time to consider ways to "simplify the new reporting requirements consistent with the law," according to a blog post from Mark J. Mazur, the assistant secretary for tax policy at the Department of Treasury.
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Blaming low compensation and the hassles of healthcare reform, 34% of general practice physicians say they plan to leave the practice of medicine over the next decade, according to a new national survey. The survey of 2,218 physicians by recruiting firm Jackson Healthcare also found that 16% of the respondents said they will, or are strongly considering, retiring, leaving medicine, or going part-time in 2012.
Of those physicians who said they plan to retire or leave medicine this year, 56% cited economic factors and 51% cited health reform as among the major factors. Of those physicians who said they are strongly considering leaving medicine in 2012, 55% were under age 55.
"That's what we were most surprised about; that the majority of the folks that were considering leaving medicine or planning to leave medicine this year were under 55 years old. The key takeaway is that they're not retiring; they're quitting," say the researchers. The survey also found that specialists were more inclined to leave medicine in the next decade, including:
• Oncologists and hematologists - 57% said they would retire by 2022
• Otolaryngologists - 49% said they would retire in the next decade
• General Surgeons - 49% said they would retire by 2022
• Cardiologists - 45% said they would retire in the next decade
• Urologists - 42% said they would retire by 2022
On May 8, the DOL issued eagerly anticipated guidance regarding the notice of health insurance exchanges that employers must distribute to employees during 2013, including model notices that employers may use to satisfy the notice obligation.
The first model notice applies to employers who offer a health plan to some or all employees. The second model notice applies to employers who do not offer a health plan. Employers are permitted to modify the model notices as long as they still meet the content requirements specified in the health care reform law.
Employers must provide the notice to all current employees by October 1, 2013, though the notice may be provided sooner. Also starting October 1, 2013, new employees must receive the notice at the time of their hire. For 2014, the DOL will consider a notice to be timely provided at hire if it is provided within 14 days of the employee’s start date. The notice must be provided in writing and can be provided electronically if the DOL’s electronic disclosure safe-harbor requirements are met; otherwise, the notice may be provided by first-class mail.
Also in connection with the new exchange notice, the DOL released a revised COBRA Model Election Notice that includes information about the health insurance exchanges. The DOL included a redline document showing the changes made by the revised COBRA notice.
Just over three years ago, Congress enacted legislation that overhauls the U.S. health care system and affects nearly all taxpayers, many employers, and many elements of the health care industry. The legislation contains a host of tax changes, many of which are both complex and novel. Some already have gone into effect, some go into effect this year, and still others will be in place in 2014 and 2018.
Thomson Reuters is offering a complimentary publication that helps you get a fix on the rules newly effective this year, as well as those looming on the horizon, by presenting a timeline of 2013-2018 tax changes in the health care legislation, and a concise summary of each new tax provision.
Law360, New York (May 03, 2013, 12:01 PM ET) -- The Internal Revenue Service on Friday plugged a loophole that could have let companies skirt the health reform mandate that large employers provide affordable medical benefits, saying businesses that force employees to enroll in excessively expensive plans would be fined as if they hadn't offered coverage at all.
In a notice of proposed rulemaking, the IRS took aim a potential vulnerability in the Affordable Care Act, which penalizes corporations that don’t offer reasonably priced health insurance, but only if at least one staff member declines coverage and subsequently gets a government subsidy to shop on a health insurance exchange.
If all employees enrolled in pricey health plans — even against their will — they would theoretically be disqualified from receiving subsidies, and the company would be off the hook for offering shoddy coverage. To avoid that scenario, the IRS said that mandatory enrollment in too-costly plans would be viewed the same as not supplying any benefits, and the businesses would face fines for such conduct.
James R. Napoli, senior counsel on the health reform task force at Proskauer Rose LLP, told Law360 the IRS’ move addressed a course of action many employers were contemplating in order to save cash.
“That was strategy that was actively being discussed by a number of employers, and obviously the federal government ... viewed that as a potential loophole that they’re trying to shut down through that guidance,” Napoli said.
In addition to breaching the employer mandate, such conduct could also be seen by the IRS as interference with employee access to subsidies, the notice said.
Napoli said that this suggested the IRS was taking an expansive view of the ACA’s whistleblower protections, which bar retaliation against workers who receive tax credits to subsidize their purchases on exchanges.
“The key here is that this is indicating, at least from the federal government’s perspective, that the employee doesn’t need to actually receive the credit in order for the [ACA] whistleblower protection to apply,” Napoli said.
Under the ACA and associated regulations, if a corporation with at least 50 full-time employees doesn’t provide health benefits to at least 95 percent of full-time workers, and one or more full-time employees receives a subsidy to buy coverage on a health insurance exchange, the company will be forced to make a “shared responsibility payment.” That payment will amount to $2,000 per year for every full-time employee, not counting the first 30 employees.
Resistance to the employer mandate has given rise to a number of creative attempts — viewed by some as underhanded — to avoid having to comply. Some businesses, for example, have trimmed employees' hours so that their full-time workforce falls below the ACA threshold. Other corporations have studied breaking up their businesses into smaller units, but rules are in place to connect the dots and prevent that tactic from being effective.
In other instances, there have been reports of companies planning to drop insurance altogether and just pay the penalty, although it’s believed that such drastic measures will be relatively rare.
Proposed Regulations on Minimum Value
The IRS has issued proposed regulations explaining how to determine if an employer-sponsored group health plan provides minimum value. The term minimum value, which was introduced by the Affordable Care Act, has significance for both individuals and employers. Individuals who are not offered coverage under an employer-sponsored plan that provides minimum value may be able to receive a premium assistance credit to help them purchase health coverage through a health insurance marketplace. Employers that do not offer minimum value coverage may face penalties if a full-time employee purchases health insurance through a marketplace and receives a premium assistance credit.
Application for Health Insurance
The Centers for Medicare & Medicaid Services (CMS) has simplified and shortened the application for health coverage that individuals will complete in order to purchase health coverage through a health insurance marketplace. The applications, which can be submitted starting on October 1, can be found at http://cciio.cms.gov/resources/other/index.html#hie (scroll down to “Forms” under the Affordable Insurance Exchanges heading and look for April 30, 2013 Marketplace Consumer Application).
Proposed regulations (REG-122706-12) were issued to implement the 90-day waiting period limitation and to make technical amendments to health care coverage requirements under the Affordable Care Act provisions that are already in effect as well as those that will become effective beginning 2014. The proposed regulations provide that a group health plan or a health insurance issuer offering group health insurance coverage is not to apply any waiting period that exceeds 90 days.