CMSA Today - Issue 6, 2013 - (Page 22)

CMSA Case Management and the Law Tracking the Affordable Care Act: Top 10 Issues to Watch I n early July, it wasn’t just the fireworks raising eyebrows. The Obama administration also caused a stir when it announced delayed enforcement of the Employer Shared Responsibility requirements (aka the “Employer Mandate”) by a full year. This surprising move may have pleased the employer community, since employers with 50 or more employees now have an extra year to prepare their Employer Mandate. However, the delay also reflects the fluid and unpredictable nature of the Patient Protection and Affordable Care Act (PPACA) implementation process, which can make it difficult for case managers to track its progress. In an effort to narrow the focus, here is a list of the Top 10 PPACA issues for case managers to monitor*: 1 OPERATIONALIZING THE EXCHANGES The open enrollment period for the Health Insurance Exchanges (HIX) begins October 1, 2013. The Exchanges are operated by the federal government, individual states, or by a federal-state partnership. There are 27 federally facilitated Exchanges, 17 state-based Exchanges, and seven states that will operate Exchanges in partnership with the federal government. A number of key questions remain: First, will all of the state-based and federal Exchanges be ready by October 1? For example, the U.S. Department of Health and Human Services (HHS) issued a final rule ( OFRData/2013-13149_PI.pdf) delaying implementation of a significant portion of the Federal Small Business Health Options Program (SHOP) Exchanges. Further, the Exchanges are in various *Note: this list is not exhaustive and top issues are subject to change as the federal government and states continue to hammer out PPACA’s details. 22 CMSA TODAY stages of development, with many speculating that some states will not be ready by the open enrollment deadline. Also, will people enroll in the Exchanges? HHS Secretary Sebelius hopes to enroll 7 million people in the first year and 24 million by 2023. As a result, there is a need to reach out to young and healthy Americans to support insurance pools. Finally, which insurance companies will participate in the Exchanges? The Obama administration released data in May showing more than 120 insurers have applied to sell plans through federally-run health insurance Exchanges. The number of insurance carriers participating at the state level will vary depending on the state Exchange requirements. 2 IMPLEMENTING THE INDIVIDUAL MANDATE Beginning January 1, 2014, all individuals are required to have health insurance, with a few exceptions. As reported by the National Federation of Independent Businesses, the Individual Mandate penalties will kick in next year, which consist of: • Taxes begin in 2014 and rise in years following. In each year, the tax consists of the higher of a dollar amount Issue 6 • 2013 • DIGITAL BY GARRY CARNEAL, JD, MA or a percentage of household income. For a given household, the tax applies to each individual, up to a maximum of three. Following is the schedule of taxes: 2014: The higher of $95 per person (up to 3 people, or $285) OR 1.0% of taxable income. 2015: The higher of $325 per person (up to 3 people, or $975) OR 2.0% of taxable income. 2016: The higher of $695 per person (up to 3 people, or $2,085) OR 2.5% of taxable income. After 2016: The same as 2016, but adjusted annually for cost-of-living increases. Some Americans might be exempt from the Individual Mandate if they meet certain criteria which include religious observance, financial hardship, and nationality if they are American Indians, among other exceptions. ° ° ° ° 3 ASSESSING EMPLOYER ATTITUDES Although the Employer Mandate has been delayed to January 1, 2015, it remains a cornerstone of PPACA and is worth tracking as the federal government revises employer reporting requirements. Under the law, employers with 50 or more employees are required to offer coverage with the option to opt out, or face a $2,000 tax/penalty per employee (in excess of 30 employees if coverage is not offered and if they have at least one employee that receives a premium credit through an Exchange.) Employers with less than the equivalent of 50 full-time employees are not required to offer coverage. It will be

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2013

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Health IT and Vulnerable Populations: Barriers and Opportunities

CMSA Today - Issue 6, 2013