48 posts categorized "Healthcare Reform"

September 11, 2013

More Health Care Reform Developments

Proposed Section 6055 Regulations

The IRS has issued proposed regulations providing guidance to providers of minimum essential health coverage that are subject to the information reporting requirements of IRC Sec. 6055. Beginning in 2015, IRC Sec. 6055 requires health insurance issuers, certain employers, governments, and others that provide minimum essential coverage to individuals to report to the IRS information about the type and period of coverage and furnish related statements to covered individuals. Generally, the required information will be reported on new Form 1095-B. However, some combined reporting may be allowed using Form W-2 and the new Form 1095-C that applicable large employers must use for the Section 6056 reporting requirements.

Proposed Section 6056 Regulations

The IRS has issued proposed regulations providing guidance to employers that are subject to the information reporting requirements under IRC Sec. 6056, which begin in 2015 and require applicable large employers to report to the IRS information about their compliance with the employer shared responsibility provisions of IRC Sec. 4980H and about the health care coverage they have offered full-time employees. IRC Sec. 6056 also requires those employers to furnish related statements to employees so that employees may use the statements to help determine whether, for each month of the calendar year, they can claim on their tax returns a premium assistance credit under IRC Sec. 36B. Generally, the required information will be reported on new Form 1095-C. However, the proposed regulations provide for simplified reporting, using Form W-2, in certain situations.

September 10, 2013

Health Care Reform Developments

Final Regulations on the Individual Mandate

The IRS issued final regulations on the requirement that, starting in 2014, individuals must have minimum essential health insurance coverage or be subject to a shared responsibility penalty. The regulations, which generally finalize proposed regulations issued earlier this year, define minimum essential coverage, explain who is exempt from the individual mandate, and describe how the penalty is calculated and paid.

Proposed Regulations on the Small Employer Health Insurance Credit

The IRS issued proposed regulations on the small employer health insurance credit. The proposed regulations generally incorporate the provisions of IRS Notices 2010-44 and 2010-82 as modified to reflect the differences between the statutory provisions applicable to years before 2014 and those applicable to years after 2013. 

Final Regulations on the State Insurance Marketplaces

HHS released final regulations on a number of provisions related to the Affordable Care Act. The overarching goal of the regulations, which generally finalize proposed regulations issued earlier this year, is to safeguard federal funds and to protect consumers by ensuring that issuers, the insurance marketplaces, and other entities comply with federal standards meant to ensure consumers have access to quality, affordable health insurance. The rules finalize, among other things, standards for the handling of consumer complaints by issuers in the insurance marketplaces, and other provisions meant to ensure smooth operation of the insurance marketplaces, protect consumers, and give flexibility to states. The rules explain the process for employers to contest a determination that they do not provide minimum essential coverage that is affordable and provides minimum value, individuals to appeal eligibility determinations for marketplace participation and insurance affordability programs, and employers and employees to appeal denials of eligibility to purchase coverage through the small business health options program (SHOP). 

August 12, 2013

Draft IRS Form 8960 Released

The IRS released a draft of Form 8960, which will be used by individuals, estates, and trusts to compute the new 3.8% net investment income tax (NIIT). Beginning in 2013, individuals must pay the 3.8% NIIT on the lesser of (1) net investment income or (2) modified adjusted gross income (MAGI) over a certain threshold amount. Trusts and estates will owe it on the lesser of (1) undistributed net investment income or (2) the excess of AGI over the amount at which the highest estate and trust income tax bracket begins.

August 09, 2013

Income Verification by Health Insurance Marketplaces

According to an FAQ on the CCIIO website, HHS has clarified that, for the federally-facilitated marketplaces, CMS intends to verify the income on 100% of the applications for advance payment of the premium assistance credit and cost-sharing reductions. The marketplaces will first try and verify the information electronically using available data from IRS, SSA, and Equifax. If the data on the application cannot be verified, the marketplace will request an explanation or additional documentation from the applicant to substantiate the income. For 2014, a state-based marketplace may choose to verify the income of a statistically significant sample size that is less than 100%, for applicants that meet certain requirements.

August 08, 2013

2013 Culturally and Linguistically Appropriate Services (CLAS) County Data

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


July 03, 2013

Employers To Get An Extra Year To Implement Health Law Requirement On Coverage

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.

To read more:


June 12, 2013

1 Out of Every 3 Docs Plans to Quit - Really?

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


June 03, 2013

Giving Employees Notice of Health Insurance Exchanges

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.



May 15, 2013

Health Care Reform 2014 - Now Is The Time

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.


May 06, 2013

IRS Closes Loophole On ACA's Employer Mandate

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.