90 Day Waiting Period Guidelines Issued

Last week (02/20/2014), the ACA's "trinity" of compliance and enforcement (i.e., departments of Health/Human Services; Labor; Treasury) jointly issued both FINAL and PROPOSED regulations pertaining to the ACA provision addressing new hire waiting period limitations.  This week's post will focus primarily on the FINAL regulations.

Let me start by defining what it is that we received guidance on - the so called "90 day waiting period limitation".  For readers not familiar with this issue...the waiting period is the period of time allowed to pass before health insurance coverage can become effective for an otherwise eligible employee (and his/her dependents).  Per the Affordable Care Act (ACA), this period of time is now restricted, and can be NO LONGER than 90 days.  Thus, the latest possible time that coverage can take effect is the 91st day from the initial date of hire.  This affects any employer that has a waiting period that is:

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Gallup Healthways Well-Being Grades for 2013

There is an old expression - "Figures don't lie…liars do figure".  We all rely on data for various purposes, and the health care industry is no exception in its use of data to explain, defend, describe, or refute various measures.  In fact, there is a relatively quiet movement underway to establish health care standards to better enable providers to utilize a standardized, "best practices" method of delivering care.  If you want to understand this movement better, google - "patient centered outcomes research institute" or PCORI, and check it out.  (By the way, the Affordable Care Act (ACA) requires health insurers and self funded plans to fund the PCORI at a rate of $2 per insured member per year in 2014.)

The absolute "king" of data mining and reporting is, arguably, Gallup Inc.  Back in 2008, Gallup launched its Healthways Well Being Index initiative, and conducts 500 phone calls each day to households throughout the U.S. (The initiative also has a global component to it, which involves roughly 140 countries.)  The goal of Healthways Well-Being is to quantify our state of well being, and relies on the following six (6) criteria to arrive at their index:

1. Physical and emotional health
2. Healthy behaviors
3. Work environment
4. Social and community factors
5. Financial security
6. Access to necessities (e.g., food, shelter, health care)

The 2013 survey relied on 178,000 interviews conducted nationwide, providing a sample representing an estimated 95% of all U.S. households.  As a Nebraska resident, I was both proud and pleased to see our fine state ranked #3 for 2013, a rise from #7 in 2012.  Here are the rankings, and changes, for 2012 and 2013...

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Employer Mandate - Delay and Final Regulations

This past Monday (February 10, 2014) the Treasury Department issued long awaited FINAL REGULATIONS pertaining to the Affordable Care Act's (ACA) "employer mandate", aka "employer shared responsibility"; or "pay or play".  There is a great deal of information and guidance contained in these regulations, thus, I will not attempt to address all of it in this post.  Rather, I'll provide some of the highlights, and embed some links to direct you to more comprehensive details.  To review what, how, and whom the employer mandate affects, click - http://sstevenshealthcare.blogspot.com/2013/06/understanding-employer-shared.html

It is imperative that readers/stakeholders understand there are two (2) aspects to this release:

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ACA Replacement Bill Proposed ~ C.A.R.E. Act

From the time the Affordable Care Act (ACA) was signed into law on March 23, 2010, after having been passed by congress on a 100% partisan basis by the Democrat party, the Republican party has largely expressed opposition to the law.  In fact, the Republican controlled House of Representatives has passed upwards of 40 bills seeking to completely repeal the ACA.  However these bills never made it to the Democrat controlled Senate floor for a full vote, and thus "died on the vine".  Perhaps no other issue facing our country has seen the level of opposition and discourse than has health care "reform".

For the second time since the ACA's passage, a replacement bill has been proposed, and interestingly, its origination is the U.S. Senate.  (Note: Late in 2013, Sen. John McCain and Rep. Tom Price introduced companion ACA replacement bills, which have not gained much traction in either chamber.)  Last week (01/27/2014) Republican Senators Orrin Hatch (UT), Tom Coburn (OK), and Richard Burr (NC) introduced the "Patient Choice, Affordability, Responsibility, and Empowerment Act", or CARE.  Shortly thereafter (01/30/2014) House of Representatives leader Eric Cantor announced the House would be - "taking up a bill that mirrors the Hatch, Coburn, Burr bill later this year".

There are three (3) reasons to believe this bill, or some variation thereof, may actually have a chance of replacing the ACA:

1. In the President's state of the union address last week, he welcomed the offering of other health care reform solutions;
2. The midterm elections could result in a change in the control of the U.S. Senate; and
3. There is growing sentiment the ACA is not the best way forward for health care reform (according to several polls).

Here is a broad brush look at what the CARE Act seeks to accomplish:

• Maintains several ACA provisions including: subsidies to help low income individuals purchase coverage; dependent eligibility to age 26; and bans on lifetime and annual coverage limits.
• Removal of several ACA provisions including: employer mandate; individual mandate; minimum coverage requirements, the ban on pre-existing condition exclusions; and most of the taxes and fees. State health insurance exchanges would become optional.  (Note: under the proposal, pre-existing condition limitations would not apply to those who maintained continuous individual or group coverage, much the same as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires of group health plans now.)
• An income tax on employer provided health insurance of 35% of the portion of premium the employer pays.  Currently, employer provided health insurance is tax free.  This provision would impact roughly 150 million people who currently receive health insurance through their employer.
• Income tax credits for individuals who don't have access to employer provided coverage, the uninsured, and the poor. The amount of the tax credit, available to individuals earning up to three times the federal poverty rate, would be based on age rather than need, and would increase commensurately with age.  Interestingly, under the proposal, eligible tax credit recipients can opt to use the credits to pay for coverage or care.
• Medicaid reform - the bill would make changes to Medicaid, providing states with a fixed amount of money per person enrolled to reduce spending.
• Medical malpractice reforms
• Improving Health Savings Accounts (HSA)
• Health care transparency to better equip patients to be better health care consumers

For those interested in a more in-depth overview of the CARE Act, here is a link to it's Legislative Proposal - http://www.hatch.senate.gov/public/_cache/files/bf0c9823-29c7-4078-b8af-aa9a12213eca/The%20Patient%20CARE%20Act%20-%20LEGISLATIVE%20PROPOSAL.pdf

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