CMSA Today - Issue 4, 2013 - (Page 26)

CMSA Case Management and the Law PPACA Spotlight: Understanding the Employer Shared Responsibility Provisions O n January 1, 2014, the employer mandate provisions of the Patient Protection and Affordable Care Act (PPACA) will kick in. Case managers need to be aware of how these “employer shared responsibility” provisions will impact the companies they work for or own, as well as their employees. In the wake of this law, compliance experts are recommending that employers assess the applicability of the mandate to their company sooner rather than later to adequately prepare for the new legal requirements. By assessing whether the employer mandate applies, the complexity of PPACA is clear. Under the new law, large employers must offer health benefits to virtually all of their full-time employees and their dependents to avoid a tax penalty. For this requirement, dependents include children under age 26. Spouses are not included. An employer could be subject to a tax penalty if the coverage offered to full-time employees is either “unaffordable” or does not provide the requisite level of “minimum value” with respect to the employee. Penalties also might be assessed based on full-time 26 CMSA TODAY BY GARRY CARNEAL, JD, MA employees who are either not offered coverage or affordable coverage. calendar year or other designated measurement period. WHO MUST COMPLY? EMPLOYEE TYPES If you are an employer with less than 50 employees, you don’t need to worry about the mandate to offer coverage or pay a penalty.1 However, all employers need to factor in their part-time and seasonal employees or contractors to determine whether they are over this threshold. A company is considered an applicable large employer if it employs 50 or more full-time employees, or a combination of full-time and parttime employees equaling 50 full-time equivalent employees (FTEs). Applicable large employer status is determined based on the actual hours of work performed by employees in the prior Under PPACA, a full-time employee (www.irs.gov/pub/irs-drop/n-12-58. pdf) is someone employed an average of at least 30 hours of service per week. Likewise, a part-time employee is anyone who does not fall under the fulltime designation. Further, per diem or non-hourly employees will be counted as full-time or part-time depending on the average hours of service worked during the look-back period chosen by the employer. In addition to full-time employees, all part-time, per diem and/ or non-hourly employees are included in the calculation to determine whether an employer will be required to offer health insurance starting January 1, 2014. Issue 4 • 2013 • DIGITAL http://www.irs.gov/pub/irs-drop/n-12-58 http://www.naylornetwork.com/cms-nxt

Table of Contents for the Digital Edition of CMSA Today - Issue 4, 2013

2012-2014 President's Letter
Message From CMSA's President-Elect
2011-2012 President's Letter
Association Department
Ready to Launch: An Update on Career and Knowledge Pathways
Collaborative Care Team and the Benefits of Communicating Across Disciplines
View From Capitol Hill
Case Management and the Law
Ethics Casebook
Mentoring Matters
CMSA Corporate Partners
Index of Advertisers

CMSA Today - Issue 4, 2013

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