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Total Articles: 222

Is the New Moral Exemption From ACA Contraceptive Coverage a Game Changer?

Any privately held, for-profit company could potentially be exempt from the Affordable Care Act’s (ACA) requirement to provide comprehensive contraceptive coverage without cost-sharing based on the company’s “sincerely held moral convictions,” under interim final regulations published in the Federal Register on October 13, 2017.

Trump Issues Executive Orders Aimed at Rolling Back Affordable Care Act

President Trump has issued two executive orders intended to weaken the regulatory structure supporting the Affordable Care Act (ACA) after efforts to repeal the health care law failed in Congress. The first order asks the US Department of Labor (DOL) to propose rules to allow more employers to participate in association health plans. The other order halts payment of subsidies to healthcare insurers.

The ACA Is Alive and Well: Updates to Mandated Preventive Health Care Services Issued for 2018

The Patient Protection and Affordable Care Act of 2010 (ACA) revolutionized the U.S. healthcare system. Among the many major changes the ACA introduced was mandatory first coverage of preventive care services required for most private health plans. Although most plan sponsors are well-aware of the ACA’s requirements for first dollar coverage on preventive care benefits, it may come as a surprise that the list of preventive care services is subject to annual updates, and there are several new requirements for 2018.

Exemption to ACA Contraceptive Mandate Extended to For-Profit Entities and Individuals

Under the ACA, employers must provide plans that cover birth control and other preventative health services with no out-of-pocket costs. Certain religious employers with religious objections to providing contraceptive services have been exempt from the requirement. (Accommodations have also been provided to non-profit religious organizations objecting to the rule and expanded to closely held for-profit entities objecting to the mandate on religious grounds, see http://www.benefitslawadvisor.com/2014/07/articles/employee-health-welfare-plans/1007/).

White House Narrows ACA Contraception Mandate

The Department of Health and Human Services (HHS) just issued new rules which will limit the contraception coverage mandate covering employers under the Affordable Care Act (ACA). The new rules, released Friday, expand the range of employers and insurers that can invoke religious or moral beliefs to avoid the ACA’s requirement that birth control pills and other contraceptives be covered by insurance as part of preventive care.

Employer Health Plan Premiums Rose in 2016, But Just Barely

Premiums for Affordable Care Act (ACA) marketplace coverage continue to sky rocket, with the average cost of a benchmark plan in the individual market place rising 20% this year. There is very different news for employer-sponsored plans. According to the nonprofit Kaiser Family Foundation, in 2016 annual family premiums rose on average a modest 3% to $18,142 per year, of which workers paid on average $5,277, just barely outpacing the average increase in workers’ wages (2.5%) and inflation (1.1%).

Out of Sight, Out of Mind . . . But Don’t Forget the Possibility of ACA Retaliation Claims

While many were hoping that the Affordable Care Act (ACA) would finally be dead by now, and others are lamenting the fact that the “repeal-and-replace” attempts have fallen by the wayside, we thought it may be worthwhile to remind people that the ACA has not gone anywhere. In fact, as we are quickly approaching the end of 2017, employers may soon be receiving employer mandate assessments.

WPI Insider Briefing: After ACA "Repeal and Replace" Effort Fails, What's Next For Employers on Health Care and Other Workplace Policy Issues?

Last month began with significant momentum but long odds that Senate Republicans would pass legislation repealing and replacing the Affordable Care Act (ACA). In the early hours of July 28, GOP efforts came to a screeching halt as a last-ditch "skinny" repeal bill failed, all but ending the seven-year quest to overturn the sweeping health care law.

WPI Insider Briefing: Workplace Policy under the Trump Administration Begins to Take Shape as "Repeal and Replace" of the ACA Faces Crucial Senate Vote

Five months into President Trump's term, his administration's workplace policy is beginning to take shape. From notable developments at the Department of Labor (DOL), to long-awaited nominations to the National Labor Relations Board (NLRB), the administration's departure from the labor and employment policies of its predecessor – or at least the steps to do so – accelerated in June.

Senate Republicans Release Bill to "Repeal and Replace" the Affordable Care Act

On June 22, 2017, Senate Republicans released a draft of their legislation to repeal and replace the Affordable Care Act (“ACA”). After the House narrowly passed its version of ACA overhaul legislation, the American Health Care Act (AHCA), on May 4, 2017, attention shifted to the Senate to craft its own proposal.

ACA Repeal Could Be Bad News For Gig Economy

The replacement for the Affordable Care Act (ACA) – the American Health Care Act (AHCA) – recently passed the House and is now being considered by the Senate. It has the full support of the president, and barring any significant amendments, President Trump will no doubt sign it into law if it passes the Senate. Many independent workers, including those working in the gig economy, are worried because of a belief that a repeal of the ACA could have a huge impact on the way they work.

ACA Repeal Effort Moves to Senate - Employers Should Continue Compliance for Now

Executive Summary: The U.S. House of Representatives has passed legislation that would effectively eliminate the Affordable Care Act’s (ACA’s) employer mandate, open the door for simplified employer coverage reporting, provide greater flexibility for HSAs and FSAs, and delay implementation of the “Cadillac Tax.”

U.S. House of Representatives Approves ACA Repeal Bill

On May 4, 2017, the U.S. House of Representatives narrowly approved a revised version of the American Health Care Act (“AHCA”), a bill that both repeals certain parts of the Affordable Care Act (“ACA”) and provides new provisions that would significantly change how individuals and employers pay for and receive health insurance. The final bill, much like the original version summarized here, would repeal the employer and individual mandate penalties and eliminate many of the ACA’s tax provisions, among several other significant changes.

House Passes American Health Care Act: Fate in the Senate Uncertain

Seven years after the Affordable Care Act (ACA) was enacted, the U.S. House of Representatives voted on May 4, 2017, to dismantle the sweeping law and replace key provisions with a dramatically different vision of health care reform. After modifications were made to try to secure the votes of both GOP conservative and moderate factions, the House passed the American Health Care Act (AHCA) (H.R. 1628) by a vote of 217 to 213. No Democrats voted to approve the bill that was touted as “repealing and replacing” President Obama's signature legislative accomplishment. If enacted, the AHCA would address two of the most vexing provisions for employers by eliminating the “employer mandate” and further delaying the “Cadillac” tax on high-cost employer-sponsored health plans. Enactment of the legislation is by no means certain and faces a rocky road in the Senate.

The Future of the ACA and Break Time For Nursing Mothers

Among the many changes recently proposed to the Patient Protection and Affordable Care Act (“ACA”), one that has not yet occurred is a repeal of the requirement that certain employers provide break time for nursing mothers.

Small Healthcare Provider Pays $31,000 for Failing to Have a Business Associate Agreement With File Storage Vendor

Disclosing protected health information (PHI) to a business associate without a compliant business associate agreement (BAA) is an improper disclosure under the HIPAA privacy and security regulations. According to the HHS Office for Civil Rights (OCR), an error like that can cost a small healthcare provider $31,000.

Treasury Releases Report on Employer Mandate Enforcement

On April 7, 2017, the Treasury Inspector General for Tax Administration (TIGTA) published a report on the “Assessment of Efforts to Implement the Employer Shared Responsibility Provision.” This report1 provides clues to the Affordable Care Act (ACA) enforcement initiatives with regard to the employer mandate.

WPI Insider Briefing: What Happened to Health Care Reform and Where is the Department of Labor Headed?

Republicans hoped to mark the seventh anniversary of the Affordable Care Act's (ACA) enactment by passing legislation in the U.S. House of Representatives to dismantle it. Instead, facing the failure of a bill on the House floor despite President Trump's lobbying push, GOP leadership pulled the legislation from consideration.

Where Do We Stand with Health Care?

The American Heath Care Act was designed to provide health care reform and to replace former President Obama’s Affordable Care Act (the “ACA”). However, the House of Representatives, under President Trump’s direction, cancelled its vote in late March because of lack of overall support from Republicans to get passage of the bill in the House. Now what?

The ACA Survives...Again

We feel like a broken record, because we’ve said it before: the Affordable Care Act is still here. We said the same thing after each of two Supreme Court challenges to central portions of the law, both of which (in 2012 and 2015) fell flat. After campaigning on a promise to swiftly repeal the landmark healthcare law, and signing an executive order stating the new administration’s priority was to repeal and replace the Affordable Care Act (ACA), the president was unsuccessful in convincing Congress to begin dismantling the law. So, we can say it once again: the ACA survives another day, and employers need to continue to operate as if it will be here to stay.

What is the American Health Care Act?

Late in the evening on March 6, 2017, the House Republican leadership introduced a budget reconciliation bill that both repeals certain parts of the Affordable Care Act and offers new provisions that significantly change the rules that govern how individuals and employers pay for and receive health insurance coverage. The bill, labeled the American Health Care Act (“AHCA”), would repeal the penalties associated with the employer and individual mandates, would eliminate many of the Affordable Care Act’s revenue provisions, and would make many other significant changes to the Affordable Care Act.

WPI Insider Briefing: Spotlight on Health Care and Regulatory Reform Under the Trump Administration

On February 28, 2017, President Trump delivered his first address to a joint session of Congress, outlining a broad vision of his agenda. The Trump administration is widely expected to chart a dramatically different course on workplace policy from that of the prior administration. Coming less than six weeks after President Trump was sworn into office, the address offered few details on how his administration's labor and employment policy will unfold.

Introducing the American Health Care Act! Wait! ... Not so fast!

The House Ways and Means Committee and the Energy and Commerce Committee (the two congressional committees having primary responsibility for health care legislation) released draft legislation for repealing and replacing aspects of the Obama administration’s 2010 health care reform law on March 6, 2017 (the “ACA”).

IRS to Process Tax Returns That Lack Certification of ACA-Required Coverage

In the wake of the President’s January 20, 2017 Executive Order directing a reduction in regulatory burdens imposed by the Affordable Care Act (ACA), the IRS has quietly announced that it will continue to process income tax returns lacking confirmation that the taxpayer has maintained ACA-required health coverage.

HHS Expresses Interest in Pre-Existing Condition Exclusions

In proposed regulations published on February 17, 2017, the U.S. Department of Health and Human Services (HHS) has suggested several adjustments designed to help stabilize the individual health insurance market – particularly for coverage offered through the health insurance exchanges, often referred to as “Marketplaces.”

ACA Replacement Bills Encounter Beltway Traffic

Since its enactment in 2010, Republicans in Congress have made numerous attempts to repeal the Affordable Care Act ("ACA"), with little success beyond modest tweaks that garnered bipartisan support (such as delaying the "Cadillac Tax"). With Republicans in control of both houses of Congress and the White House, comprehensive changes are a given, though the substance and timing of the changes remain open questions.

Rubber, Meet Road: The Arduous Task of Translating Campaign-Talk into Action to Repeal (and Replace?) Obamacare

The creation and implementation of the Patient Protection and Affordable Care Act (ACA or Obamacare) was a long, strange trip beset throughout by policy disagreements, shifting political winds, backroom legislative dealings, unexpected costs, legal challenges, and public relations fiascos. It should then come as no surprise that the Trump administration and the new Congress have experienced a similarly bumpy ride thus far in their efforts to dismantle the ACA.

President Trump Signs Executive Order on Affordable Care Act

Executive Summary: On Friday January 20, 2017, President Trump signed an executive order titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.” The Order directs the Secretary of Health and Human Services (HHS) and the heads of all other executive departments and agencies (e.g., Treasury, DOL, Health and Human Services, etc.) to take all actions consistent with law to waive, defer, or delay the implementation of any provision or requirement of the Affordable Care Act (ACA) that would impose a financial (fee, tax, penalty) or regulatory burden on states, individuals, families, healthcare providers, and/or health insurers. The order also encouraged the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance.

New Administration Orders Freeze of Pending Regulations, Takes Aim at the Affordable Care Act

One of the first acts of the new Administration on Inauguration Day was to issue a memorandum putting the brakes—at least temporarily—on federal regulations that have not yet taken effect, and to release an executive order authorizing agencies and departments to "minimize the unwarranted economic and regulatory burdens" of the Affordable Care Act. These two actions are the first of several presidential orders and memoranda expected in the days and weeks to come.

Affordable Care Act is Target of Trump Executive Order on Inauguration Day

In one of his first actions in office, President Donald Trump signed an Executive Order to “Minimize the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal.” In a few short paragraphs, President Trump has given a very broad directive to federal agency heads, including the Department of Health and Human Services, to take steps to grant waivers, exemptions, and delay provisions of the ACA that impose costs on states or individuals.

Federal Court Enjoins Health and Human Services Department from Enforcing ACA Protections for Transgender Individuals

The Obama Administration was dealt a blow in its efforts to expand legal protections for transgender individuals relating to the receipt of health care services and health insurance under the Patient Protection and Affordable Care Act (“ACA”). Judge Reed O’Connor of the Northern District of Texas has issued a nationwide preliminary injunction that enjoins the U.S. Department of Health and Human Services (“HHS”) from enforcing protections that prohibit discrimination on the basis of gender identity or termination of pregnancy.

The Ball Dropped on New Year’s Eve for Some ACA Section 1557 Nondiscrimination Rules

Some employers may want to reconsider their approach to gender transition benefits after a federal court enjoined the U.S. Department of Health and Human Services (HHS) from enforcing its 2016 nondiscrimination regulations under Section 1557 of the Affordable Care Act (ACA), which were generally set to take effect on January 1, 2017, to the extent those regulations prohibit discrimination on the basis of “gender identity” and “termination of pregnancy.”

More On What Trump And His ACA Repeal Threat Might Mean For Gig Economy

We’ve already provided a few insights into the impact that the recent presidential election will have on the sharing economy. We offered pre-election predictions, presented a preview of what we expect the gig economy to look like under President Trump, analyzed what the on-demand economy should think of Trump’s choice for Transportation Secretary, and most recently presented an assessment of how the new Secretary of Labor will impact the gig economy. So what more is there to say? As it turns out, plenty.

21st Century Cures Act Eases Small Employer ACA Restrictions

The 21st Century Cures Act provides relief to small employers regarding certain group health plan requirements under the Affordable Care Act (ACA). Specifically, certain qualified small employer health reimbursement arrangements (QSEHRAs) will be allowed under the Act.

IRS Grants Extension of ACA Information Reporting Deadline and Provides Good Faith Standards for 2016 Information Reports

The IRS recently issued Notice 2016-70, which extends certain 2017 deadlines for employer information reporting under the Affordable Care Act (ACA) on health coverage offered to individuals during the 2016 calendar year. The Notice also extends the original “good faith transition relief” for ACA information reports that reporting entities file in 2017.

IRS Extends ACA Information-Reporting Deadline, Penalty Relief

On November 18, the IRS published Notice 2016-70, which provides employers with a little more time to furnish individual information returns to employees under the Affordable Care Act (ACA) and extends penalty relief to employers that comply with the ACA information-reporting requirements in good faith.

January 1st is Quickly Approaching – Have you Reviewed your Health Plan for Section 1557 Compliance?

Earlier this year the U.S. Department of Health and Human Services (“HHS”) finalized regulations that implement Section 1557 of the Affordable Care Act (“Section 1557”). You can read our prior discussions of these regulations in our blog post and newsletter article.

New ACA Marketplace Notices to Employers Require Action

Many employers are receiving Health Insurance Marketplace notices stating:

Are You Down With O.O.P.s?: Opt-Out Payments Under the Affordable Care Act

In Notice 2015-87, the IRS addressed the impact of employer opt-out payments — payments made to employees who decline enrollment in an employer’s group health plan — on affordability for ACA purposes. Employers who do not offer group health coverage that is affordable as defined under the ACA risk significant penalties. For 2016, group health coverage is considered affordable if the employee’s cost for the least expensive self-only coverage under the plan does not exceed 9.66% of the employee’s annual household income. For 2017, the percentage increases to 9.69%.

Affordable Care Act Mid-Year Checkup: Count Your Contingent Workers

The ACA requires “applicable large employers” (those with 50 or more employees) to offer health coverage meeting affordability and other standards to their full-time employees. Failing to offer minimum essential coverage to at least 95% of full-time employees, or offering coverage that is not “affordable,” may result in significant penalties if a full-time employee receives a federal premium tax credit to purchase coverage through an ACA exchange. A full-time employee is one who works on average 30 or more hours per week or 130 or more hours per month. The hours of part-time employees are converted to full-time equivalents to determine whether a business is an applicable large employer, but only full-time employees must receive offers of complying coverage.

IRS Proposes Regulations on Group Health Benefit Opt-Out Payments

The IRS has issued proposed regulations that confirm the position it took in Notice 2015-87 with regard to unconditional opt-out payments - payments made to employees who forgo group health benefits and increase the amount of their monthly premium by the amount of the payments. The proposed regulations, which also cover eligible conditional opt-out payments, would take effect for plan years beginning in 2017. The IRS anticipates issuing final regulations before the end of 2016.

More Clarity on Expatriate Health Plans and the ACA

Expatriate health plans have been surprisingly difficult to reconcile with the Affordable Care Act (ACA). Proposed regulations set to take effect in 2017 provide some useful guidance to U.S. employers that sponsor expatriate plans as they try to avoid triggering ACA penalties.

IRS Issues Proposed Regulations on Health Plan Opt-Out Payments

The Internal Revenue Service (“IRS”) has issued proposed regulations that include additional guidance on the treatment of employer-provided opt-out payments for purposes of affordability under the Affordable Care Act (“ACA”). An “opt-out” payment is a cash payment made to employees who decline to enroll in the employer’s group health plan.

The ACA’s Health Insurance Marketplace Begins Reaching Out To Employers

Last week, employers began receiving notices from the Federal Health Insurance Marketplace / Exchange regarding employees who applied for Exchange coverage and were determined eligible for a tax subsidy to defray part of the cost. These notices offer employers a first line of defense against penalties under the Affordable Care Act's (ACA) employer mandate. If you receive a notice, you should act quickly to determine whether an appeal is appropriate.

ACA Electronic Information Return Filing Deadline Is June 30

The IRS is urgently reminding self-insured employers, applicable large employers and providers of health coverage that the due date to electronically file information returns in compliance with the Affordable Care Act (ACA) is this Thursday, June 30. This includes electronic filing of the 1094 and 1095 series of forms.

HHS Releases Final Health Equity Rule under Section 1557 of the Affordable Care Act

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers and health care providers that receive federal subsidies from HHS. But certain self-insured employer sponsored group health plans are also subject to the rule, and may need to alter their plan designs to comply with the rule.

Final Rule Issued on ACA’s Non-Discrimination Provision for Federally Funded Programs

Section 1557 of the Affordable Care Act (“ACA”), in effect since 2010, prohibits discrimination in any federally funded health program on the basis of race, national origin, sex, age, or disability. The Department of Health and Human Services (“HHS”), through the Office of Civil Rights, has been enforcing the provision since it was enacted in 2010. HHS has now issued the Final Rule, “Nondiscrimination in Health Programs and Activities,” providing guidance to covered entities affected by the civil rights provision. The Final Rule requires certain covered entities to include specific nondiscrimination protections in their benefit plan design by the first day of the first plan year, beginning on or after January 1, 2017.

HHS Final Rule Finds Categorical Exclusions for Health Services Related to Gender Transition Are Generally Unlawful

The U.S. Department of Health and Human Services (HHS) recently published its Final Rule1 implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of, among other grounds, sex in certain health programs and activities. According to HHS’s press release, the Final Rule and Section 1557 outline individuals’ rights, as well as the responsibilities of health insurers, hospitals, and health plans administered by or receiving federal funds, in order to advance protections for underserved, underinsured, and often excluded populations.

Healthcare Subsidies for Grad Students: An ACA Conundrum

Colleges and universities historically have provided graduate student employees (e.g., teaching assistants) with a stipend or reimbursement to help defray (or even fully cover) the cost of their medical coverage under the student health plan. Competing guidance from the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”) under the Affordable Care Act (“ACA”) will soon make such arrangements problematic.

Supreme Court Returns Affordable Care Act Contraceptive-Coverage Cases to Lower Courts

The U.S. Supreme Court has unanimously remanded a consolidated appeal of seven cases addressing the contraceptive-coverage “accommodation” for religious organizations under the Affordable Care Act (ACA) to the Courts of Appeals. Zubik v. Burwell, No. 14-1418 (May 16, 2016).

Supreme Court Decides Not to Decide on Latest Challenge to ACA Contraceptive Coverage

The Supreme Court in a unanimous opinion remanded Zubick v. Burwell — and the six cases consolidated with Zubick — back to the Courts of Appeals to rule on the contraceptive opt-out notice provisions. The Court directed the lower courts to consider the new information presented in the parties’ post-oral argument briefs ordered by the Court on March 29. The petitioners in each of these cases are religiously-affiliated nonprofit organizations which are challenging the requirement that notice be given to the government of religious objections to providing no-cost contraceptive coverage under employee health insurance plans, as required by the Affordable Care Act (“ACA”) and its regulations.

U.S. Supreme Court Declines to Rule on Merits in ACA Religious Accommodation Case

The United States Supreme Court has declined to rule on the merits in a case brought by religious non-profit entities challenging the “religious accommodations” to the contraception mandate under the Affordable Care Act (ACA). In Zubik v. Burwell, the Court issued a per curiam (unanimous) opinion remanding the case back to lower courts, while also vacating the prior judgments issued by those courts.

Why Can’t We Be Friends? The Supreme Court Discovers an Unexpected Meeting of the Minds in Zubik v. Burwell

Regardless of one’s preferred metaphor, the Supreme Court of the United States is adept at ducking, punting, and otherwise avoiding messy and socially divisive interpretive issues. Every once in a while, the parties even help the Court out. Facing the prospect of another evenly divided 4-4 decision on the controversial intersection between the Affordable Care Act’s (ACA) contraceptive care mandate and the Religious Freedom Restoration Act of 1993 (RFRA)— and after having administered some friendly arm-twisting to the parties following oral argument back in March—the Court found just such an exit strategy in Zubik v. Burwell.

Supreme Court Sidesteps ACA Contraception Case

The Supreme Court will not resolve a contentious case involving the Affordable Care Act's (ACA's) contraceptive coverage requirement. Instead, it issued a unanimous ruling that sends Zubik v. Burwell back to the lower courts without any broad pronouncement.

A District Court Just Dealt a Blow to the ACA. Employers, Don’t Get Excited!

On May 12, 2016, the United States District Court for the District of Columbia issued an opinion in U.S. House of Representatives v. Burwell et al., No. 14-1967 (D.D.C. May 12, 2016), enjoining the federal government’s use of unappropriated monies to fund reimbursements to health insurers under Section 1402 of the Patient Protection and Affordable Care Act (the “ACA”). Section 1402 of the ACA provides cost-sharing reductions (e.g., reductions in deductibles, coinsurance and copayments) to certain people who obtain health insurance through the government exchanges. Section 1402 also provides that the insurer is supposed to be reimbursed by the government for the cost-sharing reductions it gave to those people.

So You’ve Filed Your 1095-C…Now What?

As companies complete their Section 6055 and 6056 reporting under the Affordable Care Act (ACA), now it’s time to be on the lookout for notices regarding ACA penalties.

New Affordable Care Act FAQs Released on Rescissions of Coverage, Preventive Care Mandate, Out-of-Network Emergency Service Coverage, and Mental Health Parity

The U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) have jointly issued a new set of answers to frequently asked questions about the Affordable Care Act (the “ACA”). Below are some highlights from the FAQs.

DOL Issues Guidance on Intersection of Affordable Care Act and Federal Prevailing Wage Laws

Long-awaited guidance to governmental agencies on how the Affordable Care Act’s provisions regarding employer shared responsibility interact with the fringe benefit requirements of the McNamara-O’Hara Service Contract Act (SCA), Davis-Bacon Act (DBA) and the Davis-Bacon Related Acts (DBRA) (together DBA/DBRA) finally has been issued by the Wage and Hour Division of the Department of Labor in an All Agency Memorandum 220 (AAM).

Supreme Court Looks for ACA Contraceptive Coverage Compromise for Religious Nonprofits

Less than one week after hearing oral arguments on seven consolidated cases in which non-profit organizations challenged the opt-out process for religious organizations opposing the Affordable Care Act’s contraceptive coverage mandate, the United States Supreme Court took the unusual action of ordering the lawyers on both sides to brief additional issues.

Supreme Court Hears New ACA Contraceptive Coverage Challenge

The Supreme Court heard arguments this week in a closely-watched case involving the Affordable Care Act's (ACA's) contraceptive coverage requirement. But during the 90 minute argument in Zubik v. Burwell, the now eight-person Court appeared equally divided.

ACA Reporting – Helping Employees Understand Their Obligations

My family loves that I have an HR background. Over the years I’ve helped with such things as preparing for job interviews, salary negotiations and helping to understand their benefit plans, so it came as no surprise when one of my nieces asked me to help her understand the Affordable Care Act (ACA) tax forms and the effect they will have on her tax filing.

When It Comes To The ACA, Change Is The Only Constant: Five Recent ACA Changes You Need to Know About

While many of us were busy celebrating the holidays, Congress and the IRS were hard at work creating and promulgating revisions to the Affordable Care Act (ACA). Here’s what you need to know about the most recent changes.

Limiting Employee Hours To Avoid ACA Could Violate ERISA, Court Rules

In a first-of-its-kind decision, a federal court recently upheld the right of employees to sue their employer for allegedly cutting employee hours to less than 30 hours per week to avoid offering health insurance under the Affordable Care Act (ACA). Specifically, the District Court for the Southern District of New York denied a defense Motion to Dismiss in a case where a group of workers allege that Dave & Buster’s (a national restaurant and entertainment chain) “right-sized” its workforce for the purpose of avoiding healthcare costs.

Student Health Plans and ACA Compliance: New Relief for Educational Institutions

Educational institutions face unique issues when complying with the requirements of the Affordable Care Act (ACA). One such issue relates to the administration of student health insurance plans. On February 5, 2016, three federal agencies—the U.S. Department of Labor (DOL), Department of the Treasury, and Department of Health and Human Services—released Notice 2016-17, which provides temporary transition relief for student health plans with premium reduction arrangements covering employees of the school.

Extension of ACA 2015 Reporting Deadlines Provides Welcome Relief for Employers

The Affordable Care Act (“ACA”) imposes various reporting requirements on insurers, self-insuring employers, and other providers of “minimum essential coverage" and imposes penalties on coverage providers that do not comply. The IRS recently issued Notice 2016-4, which grants extensions of certain important reporting deadlines.1 These deadline extensions are intended to ease the transition under ACA so that employers and others have additional time to adapt and implement systems and procedures to gather, analyze and report the relevant information. These extensions apply to the requirements both to furnish information to individuals and to file information with the IRS.

HRA Access for Spouses and Dependents: A New Wrinkle for Form 1095-C

Imagine that you are filling out Internal Revenue Service Form 1095-Cs for 2015 for an employer that offers employees the opportunity to elect self-only or family coverage under a minimum value group health plan. The plan includes a health reimbursement account (HRA) that the employee can use for copayments and deductibles under the plan. You are about to fill out Part III for an employee who elected self-coverage, by listing only the employee as a covered person when a question occurs to you: If the HRA can be used to pay for copayments and deductibles incurred by the employee’s spouse and dependents, should the spouse and dependents be listed in Part III as covered individuals (even though they are “covered” only under the HRA)? Then another question occurs to you: Can an HRA satisfy the market reform requirements of the Affordable Care Act (ACA) if it reimburses copayments and deductibles incurred by the employee’s spouse and dependents despite the employee’s enrollment for self-only coverage under the group health plan of which the HRA is a component part?

IRS Issues New Guidance on ACA and Other Health Plan-Related Legal Requirements

In Notice 2015-87 the Internal Revenue Service (IRS) issued guidance on various health plan-related topics, including: (1) treatment of employer-provided opt-out payments for purposes of affordability under the Affordable Care Act (ACA); (2) the application of the ACA market reforms to health reimbursement arrangements (HRAs); (3) ACA issues relating to the McNamara-O’Hara Service Contract Act (SCA) and Davis-Bacon and Related Acts (DBRA); (4) the extension of special ACA rules for educational institutions; and (5) issues arising out of the interaction of COBRA with health flexible spending account plans (FSAs) that offer carryover options.

ACA Treatment of Fringe Benefits Provided Under Federal Contracts

Last month the IRS issued Notice 2015-87, providing further guidance for applicable large employers on the employer shared responsibility provisions of Code § 4980H. For federal contractors required to provide a certain amount of health and welfare fringe benefits to employees, the Notice brought some welcome relief, at least for the time being.

IRS Extends 2015 Affordable Care Act Information Reporting Deadlines

In a welcome development for employers and health coverage providers, the IRS has extended the Affordable Care Act information reporting deadlines. Unlike the prior transition relief in which the IRS delayed the information reporting requirements for a full year to 2015, under the new guidance, the IRS only extends the reporting deadlines by a few additional months for coverage offered or provided during the 2015 calendar year.

Happy New Year from the IRS!

For the many employers and health care providers that have thus far been spending their holidays poring over the Affordable Care Act’s (ACA) new tax forms and their cryptic instructions in anticipation of the inaugural round of reporting under Sections 6055 and 6056 of the Internal Revenue Code, the Internal Revenue Service (IRS) just delivered an unexpected gift to welcome the new year. In Notice 2016-4, the IRS has extended two key deadlines for reporting under the ACA’s employer mandate, giving both employers and health care providers additional time to furnish and file the Forms 1094 and 1095.

Health Coverage Made Available ONLY to Wellness Program Participants, OK under ADA “Safe Harbor” Says District Court

With final ADA and GINA wellness program regulations expected this year from the Equal Employment Opportunity Commission (EEOC), 2016 looks to be an important year for regulation of these programs.

ACA Outlook: What Will 2016 Hold for the Affordable Care Act and Employers?

For many employers, 2016 will bring new requirements and challenges with respect to compliance with the Affordable Care Act (ACA). However, their burden in years beyond 2016 may very likely diminish because of recent changes Congress made to the sweeping health care law. While this year the U.S. Supreme Court once again saved the fate of the ACA in the King v. Burwell decision, legislation repealing or delaying some of the law's most problematic provisions potentially reshapes the scope and impact of the law for both employers and employees.

ACA Reporting Delayed

On Monday, December 28, 2015, the Internal Revenue Service announced in Notice 2016-4 that employers will have additional time to file annual reports required under the Patient Protection and Affordable Care Act ("ACA"). The ACA requires certain employers to report minimum essential coverage annually on Forms 1094 and 1095. These forms were originally due to employees on February 1, 2016 and employers had until March 31, 2016 to file the forms electronically with the IRS (February 29, 2016 for non-electronic filers). However, Notice 2016-4 extends both of those deadlines for all employers required to file Forms 1094 and 1095.

A Holiday Gift to Applicable Large Employers – 2015 ACA Reporting is Delayed

In Notice 2016-4, the IRS has extended the due dates for certain 2015 Affordable Care Act information reporting requirements.

ACA’s “Cadillac Tax” Delayed for Two Years to 2020

Today, Congress approved a provision in an omnibus spending/budget bill that will delay for two years the Affordable Care Act’s “Cadillac tax,” the controversial 40% tax on high value health coverage. The tax, described in more detail in a prior alert, was slated to become effective in 2018, but will now become effective on January 1, 2020.

Bipartisan Budget Act of 2015 Repeals ACA Automatic Enrollment Provision

Despite a marked lack of success for efforts in Congress and through the courts to repeal the Patient Protection and Affordable Care Act of 2010 (ACA) completely, or substantially interrupt its implementation, the Bipartisan Budget Act of 2015 (H.R. 1314) has quietly repealed the ACA’s potentially problematic automatic enrollment requirement for health plans.

Final ACA Implementation Regulations Issued by Trio of Enforcement Agencies

The Departments of Labor, Health and Human Services and Treasury have jointly published comprehensive final rules under the Affordable Care Act (ACA), which essentially combine and solidify interim rules, several pieces of guidance and Questions and Answers issued since 2010, when the ACA was first enacted. The final rules, which will replace the interim rules effective January 1, 2017, pertain to grandfathered plan status, pre-existing condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals and patient protections. The following are highlights of the final rules that are of interest to employers.

ERISA Claims Procedures For Disability Benefits To Get An ACA Make Over

The Employee Benefits Security Administration (EBSA) of the Federal Department of Labor plans to publish on November 18, 2015, new claims procedures for adjudicating disability benefits designed to enhance existing procedures for those benefits under Section 503 of the Employee Retirement Income Security Act (ERISA). EBSA’s goal is to apply to disability benefits many of the new procedural protections and safeguards that have been applied to group health plans under the Affordable Care Act (ACA). Interested parties may submit comments to these proposed regulations no later than 60 days after publication.

New ACA Reporting: Frequently Asked Questions About Form 1095-C

For many employers, the employer mandate under the Affordable Care Act (ACA) is already a reality. Having now worked out some of the administrative kinks associated with providing the health plan coverage required by the mandate, employers face a new and daunting challenge: detailed reporting to the Internal Revenue Service (IRS) to document the terms on which their coverage is offered.

Supreme Court to Review Birth Control Mandates Under Affordable Care Act Once More

For the third time in four years, the U.S. Supreme Court will hear a challenge to a portion of the Affordable Care Act (ACA), President Obama’s signature health reform law passed in 2010. On November 6, 2015, the Supreme Court issued a writ of certiorari in seven cases addressing the ACA’s birth control mandates and the rights of religious employers.1

Bipartisan Budget Act of 2015 Includes Pension and ACA Provisions

On November 2nd, the President signed legislation that will raise the debt ceiling through March 2017. The legislation includes important provisions relating to pension funding, PBGC premiums, and the Affordable Care Act.

Portion of Affordable Care Act Requiring Automatic Enrollment for Some Employer Plans Repealed

Since the Affordable Care Act’s enactment in March, 2010, employers with 200+ employees have been awaiting the implementation of regulations that would explain the automatic enrollment rule. Employers with 200+ employees would have had to enroll employees in the company health care plan automatically, while allowing them the option to decline coverage. Most employer plans work the opposite way – employees must affirmatively elect to participate. On November 2, 2015, President Obama signed into law a bill that eliminated this requirement for employers. Employers may, however, choose to automatically enroll employees (subject to state laws governing payroll deductions). The repeal of this provision of the Affordable Care Act simplifies the administrative process for employers and ensures that employees do not end up with unwanted and/or duplicative health benefits by virtue of their failure to opt out.

Supreme Court to Review Birth Control Mandates Under Affordable Care Act Once More

For the third time in four years, the U.S. Supreme Court will hear a challenge to a portion of the Affordable Care Act (ACA), President Obama’s signature health reform law passed in 2010. On November 6, 2015, the Supreme Court issued a writ of certiorari in seven cases addressing the ACA’s birth control mandates and the rights of religious employers.

Federal Budget Agreement Addresses ACA, OSHA and Pensions

President Barack Obama signed into law the Bipartisan Budget Act of 2015, which repeals the automatic enrollment requirement mandated by the Affordable Care Act (ACA), increases penalties under the Occupational Safety and Health Act (the OSH Act) and addresses employer premiums with respect to pensions. Although employers may welcome the repeal of the ACA automatic enrollment requirement, other provisions may raise concerns.

ACA Reporting 101

One of the new Affordable Care Act (ACA) requirements imposed on employers is the obligation to report employee group health plan coverage information to the IRS and employees on Forms 1094-C and 1095-C. The first required filing for these forms occurs in January 2016 for periods covered in 2015. The reporting requirements are complex, so employers should begin gathering data and preparing to complete the forms now.

ACA Auto-enrollment Requirement Repealed

Since the enactment of the Affordable Care Act (ACA), larger employers have wondered about an auto-enrollment provision that the ACA added to the Fair Labor Standards Act (FLSA). Under that provision, employers that are subject to the FLSA and which employed more than 200 full-time employees would have been required to automatically enroll new full-time employees in one of the employer’s health benefits plans (subject to any waiting period authorized by law). Certain notices would have been required giving employees an opportunity to opt out of any coverage in which the employee was automatically enrolled.

New Affordable Care Act FAQs Issued

On October 23, the U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) jointly issued answers to frequently asked questions regarding the market reform provisions of the Affordable Care Act (“ACA”) and the Mental Health Parity and Addiction Equity Act (“MHPAEA”), as amended by the ACA. The FAQs cover issues related to the coverage of preventive services, BRCA testing, wellness programs, and disclosures under MHPAEA. Below are some highlights from the FAQs.

The PACE Act – Changes to the Definition of Small Group for Purposes of ACA Market Reforms

Executive Summary: On October 7, 2015, the Protecting Affordable Coverage for Employees Act ("PACE Act") was enacted, and on October 19, 2015, the Department of Health and Human Services released FAQs providing further guidance on the Act's application to states. The PACE Act gives states the option of continuing to define "small group" for purposes of the ACA market reforms as those with up to 50 employees instead of mandating the expansion of that definition to those with up to 100 employees as originally required by the ACA. This means that in states that choose to continue to define small group as up to 50 employees, mid-sized employers will be able to avoid the potential increase in premiums that could result from being included in the small group market. Importantly, the PACE Act does not affect definitions of large and small employer for purposes of the employer mandate.

President Obama Signs ACA Change Into Law

While Republican efforts to effectively repeal the Affordable Care Act (ACA) through the budget reconciliation process have garnered attention, Congress's recent passage of a bipartisan bill making targeted changes to the law has received less fanfare. On October 7, 2015, President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Act, a measure that maintains the current definition of small group health plans. Senator Tim Scott (R-SC) sponsored the Senate version of the bill (S. 1099), with Congressman Brett Guthrie (R-KY) introducing the House version (H.R. 1624). Although narrow in nature, the PACE Act is on the short list of ACA amendments approved by both Congress and the President.

How the ACA is Changing the Face of the Workplace

The Affordable Care Act (ACA), more commonly—and sometimes dismissively—referred to as “Obamacare” has had a significant impact on organizations and employees around the nation.

President Obama Signs ACA Change Into Law

While Republican efforts to effectively repeal the Affordable Care Act (ACA) through the budget reconciliation process have garnered attention, Congress's recent passage of a bipartisan bill making targeted changes to the law has received less fanfare. On October 7, 2015, President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Act, a measure that maintains the current definition of small group health plans. Senator Tim Scott (R-SC) sponsored the Senate version of the bill (S. 1099), with Congressman Brett Guthrie (R-KY) introducing the House version (H.R. 1624). Although narrow in nature, the PACE Act is on the short list of ACA amendments approved by both Congress and the President.

Health Care Reform: Employer Reporting and Other Upcoming Key Dates

The following is a list of certain key dates for employers that provide group health benefits to their employees. Many of the requirements were created by the Patient Protection and Affordable Care Act (the ACA) and are new or relatively new. This includes the employer shared responsibility reporting obligations under Internal Revenue Code (Code) Sections 6055 and 6056.

IRS Launches New ACA Resource Center for ALEs

The IRS has launched a helpful new resource on its website chock full of information for employers that qualify as applicable large employers (ALEs) under the Affordable Care Act - ACA Information Center for Applicable Large Employers (ALEs).

IRS Issues Final ACA Information Reporting Forms and Instructions

With three months remaining in 2015, the IRS has issued final forms and instructions that employers will need to use to satisfy the Affordable Care Act (ACA) information reporting requirements. The final forms and instructions, which implement the reporting requirements under Internal Revenue Code (Code) Sections 6055 and 6056, largely adopt the structure and format of the draft forms and instructions that were released in August of 2015 and described in our prior alert. The information reporting obligations generally require employers with 50 or more full-time employees to report certain information to their employees and to the IRS that will allow the IRS to enforce the penalty mechanism set forth in the ACA’s employer and individual mandates.

The Affordable Care Act: What’s Ahead?

More than five years after its enactment, the Affordable Care Act (ACA) continues to be one of the top concerns for employers, and rightly so: the ACA is one of the most comprehensive laws impacting employee benefits since the Employee Retirement Income Security Act of 1974.

Appeals Court Rules Against ACA's Contraceptive Mandate

The 8th Circuit Court of Appeals has ruled that forcing religiously-affiliated employers to offer contraceptive coverage to their employees, even indirectly, would violate those employers' religious freedoms. The decisions in these two related cases could set up another Supreme Court challenge involving the Affordable Care Act (ACA) as they conflict with all other federal appellate court decisions on the issue.

ACA Reporting Deadlines Are Just Around the Corner...Are You Ready?

Beginning in 2016, many employers will have to comply with the annual health care reporting requirements under the Affordable Care Act (ACA). The reporting requirements promote transparency regarding health plan coverage and costs. They also provide the IRS with the information needed to enforce the employer and individual mandates and determine eligibility for premium tax credits for individuals purchasing coverage through the health insurance marketplace.

Final Regulations on Contraceptive Coverage under Affordable Care Act – the Religious Exemption

The Departments of Treasury, Labor and Health and Human Services have released Final Regulations providing much-needed guidance with respect to defining a “closely-held corporation.” The Final Regulations, released on July 14, 2015, also provide guidelines for establishing a religious objection for purposes of qualifying for exemption from the Affordable Care Act (“ACA”) mandate to provide contraceptive coverage under an employer health plan in light of the U.S. Supreme Court’s decision in Burwell v. Hobby Lobby Stores, Inc., et al., 134 S. Ct. 2751, 573 U.S. ___ (2014).

IRS Issues Draft 2015 Instructions for ACA Reporting Forms

The IRS has issued draft 2015 Instructions for Forms 1094-C and 1095-C, which employers are required to complete and file with the IRS to report on the terms and conditions of the health care coverage offered to their employees, as required by the Affordable Care Act (ACA) and Internal Revenue Code (IRC) § 6055 and § 6056. Draft Instructions for Forms 1094-B and 1095-B have also been issued; these forms are used to report information to the IRS on each individual to whom minimum essential coverage was provided.

ACA Cadillac Tax: Cruising Toward Proposed Regulations

Effective 2018, Section 4980I of the IRC — the so-called “Cadillac Tax,” which was added to the IRC by the ACA — will impose a 40% nondeductible excise tax on the aggregate cost of applicable employer-sponsored health coverage that exceeds an annually-adjusted statutory dollar limit. For 2018, the dollar limits are $10,200 for self-only coverage and $27,500 for other than self-only coverage, subject to any potential upward adjustment based on age and gender characteristics of an employee population or other applicable adjustment factors. The cost of coverage that exceeds the dollar limit is referred to as the “excess benefit.”

Is Your Health Plan Affordable? If You Offer an Opt-Out, Payment You Better Check Again

An “applicable large employer” is subject to a penalty if either (1) the employer fails to offer to its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage (MEC) under an eligible employer-sponsored plan and any full-time employee obtains a subsidy for health coverage on a government exchange (Section 4980H(a) liability) or (2) the employer offers its full-time employees (and their dependents) the opportunity to enroll in MEC under an eligible employer-sponsored plan, but one or more full-time employees obtains a subsidy on an exchange because the employer’s coverage was not affordable or does not provide minimum value (Section 4980H(b) liability).

The ACA Is (Apparently) Here To Stay: What Employers Need To Know

Now that the Supreme Court has, for the second time, upheld a major portion of the Affordable Care Act (ACA), it might be a good time to review your practices to ensure you are in compliance. The ACA’s new concept of what it means to be a full-time employee can significantly change how you administer benefits during employee leave, and might require you to alter your practices.

Reducing Employee Hours to Avoid ACA Obligations to Offer Coverage Violates ERISA § 510, Class Action Suit Alleges

One strategy for minimizing exposure to the employer shared responsibility penalties under the Affordable Care Act (ACA) is to minimize the number of “full-time employees” – that is, the number of employers working 30 or more hours per week on average.

Health Care Reform Stands & Employers Must Now Take Action

After months of anticipation and speculation, the U.S. Supreme Court has upheld the massive health care reform law, the Patient Protection and Affordable Care Act (ACA). Surprising many who predicted the demise of the law's individual mandate and, perhaps, the rest of the ACA with it, the Court concluded that Congress had the constitutional authority under its taxing power to require most Americans to obtain health insurance in 2014 or pay a penalty. By a 5-4 margin – Chief Justice Roberts cast the deciding vote – the Court voted in favor of upholding the individual mandate as a tax—despite its label as a penalty—although the Chief Justice, along with Justices Scalia, Kennedy, Thomas, and Alito, rejected the Obama administration's primary argument that the individual mandate fell within Congress's power to regulate interstate commerce. The Court also concluded that the government cannot penalize states for not expanding their Medicaid programs by taking away existing Medicaid funding.

Federal Agencies Issue Final ACA Contraceptive Mandate Rules

The Departments of Health and Human Services (HHS), Treasury and Labor have issued final rules regarding coverage under the Affordable Care Act (ACA) for contraceptive services. The coverage was debated in the 2014 Supreme Court Hobby Lobby ruling. The rules are scheduled to be published in the July 14, 2015 Federal Register, and will become effective 60 days later, or September 12, 2015.

ACA Information Return Penalties to Increase Substantially Under Trade Act

Employer penalties relating to information returns and payee statements under the Affordable Care Act (ACA) will increase in 2016 under revenue offset provisions buried in the Trade Preferences Extension Act of 2015 (Act) signed into law by President Obama on June 29.

U.S. Supreme Court Holds Premium Tax Credits Available on All Exchanges — Key Group Health Plan Action Items

On June 25, 2015, Chief Justice John Roberts announced the U.S. Supreme Court’s second decision to uphold the Patient Protection and Affordable Care Act (“ACA”). In King v. Burwell, a 6-3 decision, the Court ruled that the premium tax credits created by the ACA are available to all qualifying individuals who purchase coverage on an Exchange, regardless of whether the Exchange was created by a state or the federal government. At issue in the case was language in the ACA that, on its face, could be read to provide that these premium tax credits would be available only to qualifying individuals who purchase coverage on an Exchange “established by the State” — thereby foreclosing such credits to individuals who reside in states that chose not to establish their own Exchanges and instead relied on the federal government to establish Exchanges within their borders. This Alert reviews the decision and offers action items that group health plans need to consider.

Employers: Adapt to Obergefell

Employers must adapt to Obergefell v. Hodges. Prior to the Supreme Court’s June 26, 2015 decision, many states did not require employers to recognize and provide benefits for married same-sex couples. Only 36 states and Washington D.C. legalized same-sex marriage. Now, the Supreme Court determined that the 14th Amendment requires states to license same-sex marriages and to recognize lawfully licensed same-sex marriages performed out-of-state. In light of this holding, employers must ensure that their policies, procedures and the benefits comport with federal law.

US Supreme Court Upholds IRS Interpretation of ACA Subsidy Structure

In King v. Burwell, the U.S. Supreme Court held that federal tax credits created by the Affordable Care Act (ACA) are available to individuals who purchase health insurance coverage from a federal or state established Health Insurance Exchange (“Exchange”).

Supreme Court Upholds Affordable Care Act Subsidies for Coverage Purchased on Federally Facilitated State Health Care Exchanges

King v. Burwell challenges the implementation of federal insurance marketplaces under the Affordable Care Act.

U.S. Supreme Court Upholds Affordable Care Act Subsidies

Today, in King v. Burwell, the United States Supreme Court held that subsidies for coverage under all marketplace health exchanges pursuant to the Patient Protection and Affordable Care Act (the “ACA”) remain available.

King v. Burwell: The Supreme Court Rules in Favor of the Administration and the Affordable Care Act Survives

The U.S. Supreme Court has once again ruled in favor of the Affordable Care Act (ACA). At issue in King. v. Burwell was whether the landmark legislation allows federal subsidies to be given to low-income consumers residing in the 34 states that did not set up their own health insurance Exchange. In a 6-3 decision, the Court answered in the affirmative, preserving subsidies for millions of Americans who purchased their health insurance through a Federal Exchange. Affirming the decision of the U.S. Court of Appeals for the Fourth Circuit, the Supreme Court opined that the tax credits are, indeed, available to individuals in states that use a Federal Exchange. The majority decision was written by Chief Justice Roberts, and joined by Justices Kennedy, Ginsberg, Breyer, Sotomayor, and Kagan, while Justices Scalia, Thomas and Alito dissented.

Impact on Employers After Supreme Court's Ruling to Uphold Key Provision of Affordable Care Act

In a 6-3 decision issued today, the United States Supreme Court once again upheld President Obama’s signature legislation, the Patient Protection and Affordable Care Act, keeping the employer mandate in effect for all states — even those without their own health insurance exchange.

Supreme Court Once Again Saves the ACA: Rules Yes on Tax Credits For Purchasers From a Federal Exchange

On June 25, 2015, the Supreme Court of the United States ruled that tax credits are available to individuals in states that have a federal Exchange under Section 1321 of the Affordable Care Act (the Act or the ACA). In a 6-to-3 ruling, the majority opinion declined to treat the issue as merely a matter of deference to the Internal Revenue Service’s interpretation of the Act.

Supreme Court Upholds ACA Federal Subsidies

The Supreme Court upheld federal subsidies under the Affordable Care Act (ACA) in King v. Burwell. By a margin of 6-3, the Court upheld a 4th Circuit Court of Appeals decision that allowed individuals residing in states with no state-run exchanges to receive tax credits through a federal exchange. Chief Justice Roberts authored the majority opinion, explaining in plain terms how the law works and the central role that the subsidies play in keeping "Affordable" in the ACA.

Supreme Court Upholds Affordable Care Act Subsidies

In the 6-3 opinion, the Supreme Court held subsidies available to Exchange enrollees under the Affordable Care Act (“ACA”) are available regardless of whether coverage is purchased through state-based or federal Exchanges. This means that individuals who get their health insurance through an Exchange established by the federal government still are eligible for tax subsidies.

IRS Publishes FAQs Related to ACA Reporting for Employers

The Internal Revenue Service (IRS) recently published a set of questions and answers on its website providing additional guidance on ACA reporting obligations for employers. As we have written in previous alerts, these reporting rules are set forth under Internal Revenue Code Sections 6055 (for sponsors of self-insured plans) and 6056 (for large employers).

Departments Issue Additional Guidance on Preventive Services

The Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, the Departments) issued guidance in the form of FAQs on the ACA’s preventive services mandate. The ACA requires non-grandfathered plans to cover certain preventive services, including contraceptive coverage and BRCA testing (screening and genetic counseling for breast cancer susceptibility genes), among others, at no cost to participants. The FAQs provided guidance on the following preventive services topics.

Class Action Suit Alleges Dave & Buster’s Cut Employee Work Hours to Skirt ACA Obligation to Offer Health Coverage

In the first lawsuit of its kind, a purported class of approximately 10,000 workers at Dave & Buster’s, the restaurant chain, filed a lawsuit in the Southern District of New York (Marin v. Dave & Buster’s, Inc., S.D.N.Y., No. 1:15-cv-03608) alleging that their employer reduced the workers’ hours to keep them from attaining full-time status for the purpose of avoiding the requirement to offer them health coverage under the Affordable Care Act’s (ACA’s) employer mandate. The ACA’s employer mandate generally requires large employers to offer affordable and minimum value health coverage to their full-time employees (employees who regularly work an average at least 30 hours per week). Employers are not generally required to offer coverage to employees working less than 30 hours per week on average. After the employer mandate took effect, many employers have been moving employees to part-time status to avoid triggering penalties under the employer mandate.

Employers with Premium Reimbursement Arrangements Risk Draconian Penalties Under ACA; Brief Reprieve for Small Employers

Prior to the Patient Protection and Affordable Care Act (the “ACA”), it was not uncommon for small employers who did not want to spend time and money obtaining a group health plan to instead reimburse employees for all or part of the cost of individual health insurance obtained by the employee. Such arrangements, however, are inconsistent with the ACA, which provides different rules for individual and group health plans and generally allows employers to offer only group plans. Accordingly, between 2013 and 2014, the DOL, IRS and HHS issued several pieces of guidance shutting the door on this practice. The guidance also warned that noncompliant employers could face a hefty ACA excise tax of $100 per day for each employee who receives reimbursement of individual health plan costs ($36,500 per year per employee). The penalties apply even if the employer is not required to offer health insurance in the first place (as a small employer not subject to the employer mandate).

IRS Issues Final ACA Coverage Reporting Forms and Instructions

The IRS has issued final versions of the forms and accompanying instructions to be used by employers for health coverage information reporting required under the ACA’s employer mandate rules. These information reporting rules are set forth under Code Sections 6055 and 6056.

IRS Releases Preliminary Guidance on "Cadillac Plan" Tax under ACA

The IRS released Notice 2015-16, which represents the first piece of guidance issued by a regulatory agency on the excise tax on high cost employer-sponsored health coverage, colloquially known as the “Cadillac plan” tax. The Cadillac tax was a key, and particularly controversial, provision in the Affordable Care Act. The Cadillac tax, which is found in Internal Revenue Code Section 4980I, imposes on plan sponsors and insurers an excise tax of 40 percent of the “excess” total cost, i.e. amounts exceeding a statutory dollar limit set by the IRS, of employer-sponsored coverage. Although insurers of fully insured plans are responsible for paying the tax, the cost of the tax will almost certainly be passed on to plan sponsors of fully insured plans. The tax will be assessed beginning January 1, 2018.

King v. Burwell: What to Expect From the Supreme Court Argument

On Wednesday, March 4, 2015, the Supreme Court of the United States will hear argument in King v. Burwell, a case involving premium tax credits under the Affordable Care Act (ACA). Among its many provisions, the ACA includes one that authorizes a refundable federal income tax credit to assist low-income taxpayers to pay for health coverage obtained through a health insurance marketplace (referred to as an “Exchange”) established by a state under ACA § 1311. The only issue before the Court in King is the validity of a Treasury regulation implementing the premium tax credit provision of the ACA.

Eligibility Rules Need To Be In Writing

Healthcare reform continues to roll on. 2014 saw the implementation of the health insurance exchanges, the Individual Mandate, and a host of new rules relating to employer-provided health coverage. 2015 marks the start of yet another major component of the Affordable Care Act (ACA): the Employer Mandate.

Healthcare Reform: Plan Eligibility Rules Need To Be In Writing

Steven Witt’s article “Healthcare Reform: Plan Eligibility Rules Need To Be In Writing” was featured in Orange County Business Journal magazine on January 19, 2015.

Heads Up – The ACA Employer Mandate Is Now In Effect: Beware of Actions that Could Result in ACA Whistleblower Liability

Executive Summary: Effective January 1, 2015, certain employers became subject to the employer mandate of the Patient Protection and Affordable Care Act (ACA), and thus subject to liability under the ACA Employer Shared Responsibility provisions. Specifically, effective January 1, 2015, employers with at least 100 full-time employees, including full-time equivalents, became subject to a penalty if: 1) they fail to offer minimum essential coverage to substantially all of their full-time employees and their dependents, 2) if they fail to offer coverage that provides minimum value and is affordable to all full-time employees and their dependents, and 3) any full-time employee receives a tax credit or subsidy through a government health care exchange.

New ACA Guidance Permits Employer-Initiated Measurement Period Changes

The Internal Revenue Service (IRS) recently released Affordable Care Act (ACA) guidance addressing how to determine full-time status when an employee’s measurement period changes. The guidance, IRS Notice 2014-49, introduces a proposed method for applying the look-back measurement period in two scenarios. The first one involves a transfer of employment within the same applicable large employer (ALE) between two positions with different look-back measurement periods. In the second scenario, the employer changes the applicable look-back measurement period for an entire employee classification group. The final regulations previously released addressed movement from a look-back measurement period method to the monthly measurement method (and vice versa), but did not clarify how to apply the look-back measurement period methodology in either of these two cases.

ACA Fees, and Forms, and Delays, Oh My!

In the latest round of delays under the Affordable Care Act (ACA), the Employee Benefits Security Administration recently announced that the deadline for health plans to provide enrollment information to the transitional reinsurance program has been extended to December 5, 2014.

Obamacare Subsidies in 34 States May Not Be Legal

One of the Patient Protection and Affordable Care Act’s (“Act”) major selling points, the subsidies that certain individuals within 400% of the federal poverty level can receive if they purchase health insurance on state or federal exchanges, has recently been called into question.

Supreme Court to Determine Validity of Federal Subsidies of Health Insurance Purchased on Federally Established Exchanges

The U.S. Supreme Court has agreed to weigh in on the issue of whether the IRS has the authority, under the Affordable Care Act (ACA), to extend tax credits to consumers shopping on the federal Marketplaces.

Supreme Court to Decide Who Is Entitled to the Federal Health Care Subsidy

Are the federal government’s subsidies to purchasers of health insurance available only to those who purchase insurance from state-run exchanges or to those who purchase from federal health care exchanges as well? Was the Internal Revenue Service’s rule making the subsidy available to purchases from both federal- and state-run exchanges lawful? On Friday, November 7, the Supreme Court of the United States agreed to put to rest these controversial issues related to federal health care subsidies established under the Affordable Care Act by granting review in King v. Burwell. The outcome of this case will affect to whom the federal government’s program of tax credits will apply: only those individuals who enroll in health plans through an exchange established by the state in which they reside or also to those individuals who enroll in health plans through an exchange established by the federal government.

Affordable Care Act Update: Hospitalization Services Required for Plan to Meet Minimum Value

On November 4, 2014, the Internal Revenue Service (IRS) released guidance (Notice 2014-69) clarifying that certain group health plans that do not provide for hospitalization services or physician services or both will fail to satisfy the minimum value requirements for purposes of the employer mandate of the Affordable Care Act (ACA). This means employers that do not qualify for transition relief and offer such health plans will not be considered to meet the requirements of the employer mandate and may be subject to a penalty.

Identify Yourself! Deadline for Health Plan Identifiers is Fast Approaching

One of the lesser-known health plan requirements adopted by the Patient Protection and Affordable Care Act (ACA) has an initial deadline that is fast approaching, and most employers will need to take action to ensure that their group health plans remain in compliance. As discussed below, the ACA built upon an earlier directive in the Health Insurance Portability and Accountability Act (HIPAA) to require unique identifiers for health plans and health care providers, among others. The unique identifiers, along with data formatting standards previously adopted under HIPAA, are intended to facilitate transactions between participants in the health care delivery and payment system. In 2012, the U.S. Department of Health and Human Services (DHHS) finalized regulations relating to the health plan identifier (HPID) requirement, and that requirement will soon become effective.

Identify Yourself! Deadline for Health Plan Identifiers is Fast Approaching

One of the lesser-known health plan requirements adopted by the Patient Protection and Affordable Care Act (ACA) has an initial deadline that is fast approaching, and most employers will need to take action to ensure that their group health plans remain in compliance. As discussed below, the ACA built upon an earlier directive in the Health Insurance Portability and Accountability Act (HIPAA) to require unique identifiers for health plans and health care providers, among others.

Resistance WAS Futile—California Conforms to ACA Waiting Period Requirement

After wandering in the wilderness for a year, California has now come in from the cold and conformed its requirements for eligibility waiting periods to the federal standard adopted in the Affordable Care Act (ACA). Effective January 1, 2015, SB 1034 imposes a 90-day limit on eligibility waiting periods for insured health benefits issued by insurers subject to regulation by the California Department of Insurance and/or the California Department of Managed Health Care.

Big Win for Religious, Closely-Held Corporations Under Obamacare

The U.S. Supreme Court released one of its biggest decisions since it struck down the Defense of Marriage Act one year ago, captioned Burwell v. Hobby Lobby Stores, Inc., 189 L. Ed. 2d 675 (U.S. 2014). In the first decision of its kind, the Court held closely-held corporations can exercise religion, are afforded religious freedom under the law, and are therefore not required to pay for employees’ birth control in the face of religious objections. To understand this, we need to turn back over 200 years.

Federal Courts Issue Conflicting Decisions on Affordable Care Act Subsidies

Executive Summary: On July 22, 2014, two different federal appeals courts issued conflicting decisions on the availability of subsidies for health insurance purchased by individuals on Exchanges established by the federal government under the Affordable Care Act (ACA). A three-member panel of the D.C. Circuit Court of Appeals held that the subsidy is only available for insurance purchased on an Exchange established by one of the 50 states. Accordingly, that court invalidated an IRS regulation that authorizes the subsidy also for insurance purchased on a federal Exchange. Halbig v. Burwell, (D.C. Cir. July 22, 2014). However, Fourth Circuit Court of Appeals reached the opposite conclusion, finding the language of the ACA ambiguous and deferring to the IRS interpretation. Thus the Fourth Circuit upheld the IRS regulation. King v. Burwell (4th Cir. July 22, 2014).

Impact of Hobby Lobby: Closely Held Corporations May Object to ACA’s Contraceptive Mandate

In a highly anticipated decision in Burwell v. Hobby Lobby, 573 U.S. ___ (June 30, 2014), the United States Supreme Court ruled that the contraceptive mandate of the Patient Protection and Affordable Care Act (ACA) as applied by the Department of Health and Human Services (HHS) to closely held corporations violates the Religious Freedom and Restoration Act.

Supreme Court's Contraceptive Decision Not a One-Size-Fits-All Religious Exemption from the Affordable Care Act's Requirements

Executive Summary: In Burwell v. Hobby Lobby, the Supreme Court ruled 5-4 that closely-held, for-profit corporations have standing under the Religious Freedom Restoration Act of 1993 (RFRA). In addition, the Court held that while the government may have a compelling interest in providing contraceptive coverage to participants at no charge, there are less burdensome ways to provide such coverage other than the Affordable Care Act (ACA)'s Contraceptive Mandate.

Supreme Court Rules In Favor Of Religious Beliefs Of Business Owner

Today, a divided U.S. Supreme Court held in a 5-4 decision that closely-held for-profit corporations providing group healthcare to their employees could, on religious grounds, be exempted from providing contraception coverage to employees required under the Patient Protection & Affordable Care Act.

OFCCP’s New Tricare Moratorium Directive: Delay of Game

On March 7, 2014, the Office of Federal Contractor Compliance Programs (OFCCP) issued Directive 2014-01, TRICARE Subcontractor Enforcement Activities concerning the affirmative action obligations of subcontractors of TRICARE—a health care program of the U.S. Department of Defense that pays for the medical benefits of active duty and retired military personnel and their families. Effective immediately, the directive establishes a five-year moratorium on the enforcement of affirmative action obligations of health care entities deemed by OFCCP to be TRICARE subcontractors, and provides for technical outreach and assistance to those entities about their obligations under the laws administered by OFCCP. In addition to the moratorium, OFCCP will close any open and scheduled compliance evaluations for TRICARE health care entities covered by the moratorium within 30 business days of the effective date of the directive.

Healthcare Reform Watch List: Top Five Concerns for Healthcare Industry HR Departments

Keeping up with healthcare reform regulations is a challenge for all employers, but healthcare providers may face unique burdens. Here are the top five issues human resources professionals should keep on their radar as healthcare reform rolls out.

Healthcare Reform In A Nutshell: Top Five Concerns for Employers

Keeping up with changes under the Affordable Care Act (ACA) is a challenge for all employers. Here are the top five issues to keep on your radar as healthcare reform rolls out.

IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans

The IRS issued final regulations on the employer shared responsibility provisions of the Patient Protection and Affordable Care Act (ACA), often referred to as the "play or pay" mandate, on February 11, 2014. The final regulations contain 227 pages of detailed rules implementing these provisions.

Religious Freedom, Contraceptive Services, and The ACA: The Dilemma of the Self-Certification Provision

On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act (ACA) that affect how religious non-profit employers contract with their health care providers for the provision of contraceptive services. In University of Notre Dame v. Sebelius, the University of Notre Dame claimed that the self-certification provisions violate the Religious Freedom Restoration Act (RFRA) in light of the Employee Retirement Income Security Act (ERISA) constructs that were adopted in the ACA concerning third-party administrators (TPAs) and plan fiduciaries.

Latest Employer Mandate Guidance Brings Additional Relief, Clarity

After granting all employers a reprieve from the employer mandate penalties for 2014, the IRS has provided additional headline-making temporary relief from the employer mandate penalties for some employers for 2015, and additional transition relief for all employers. Prior to the latest round of guidance, employers with at least 50 full-time equivalent employees during 2014 were to be required in 2015 to either offer affordable health insurance coverage providing minimum value to at least 95% of their full-time employees or pay a penalty under the employer mandate.

Navigating a New Era of Health Care

As physicians search for new revenue streams in response to declining reimbursement and additional administrative complexity, a new law passed in 2013 should provide added flexibility and time to expand practices through the use of physician assistants. The health care markets continue to realign as the Affordable Care Act is implemented and if all goes as planned, there will be more patients.

What Does the ACA Shared Responsibility Final Rule Mean to Large Employers?

As many small employers rejoice over a delayed effective date, large employers should be rolling up their sleeves to adapt their evolving shared responsibility compliance strategies for 2015 to a new final rule from the U.S. Department of Treasury and Internal Revenue Service (IRS).

IRS Final Rule on ACA Play or Pay Mandate Allows Employers to Finalize Compliance Plans

The IRS issued final regulations on the employer shared responsibility provisions of the Patient Protection and Affordable Care Act (ACA), often referred to as the "play or pay" mandate, on February 9, 2014. The final regulations contain 227 pages of detailed rules implementing these provisions.

Legal Alert: Final Regulations on Affordable Care Act's Employer Mandate Issued – Part 1

Executive Summary: Under final regulations issued by the U.S. Treasury Department on February 10, 2014, employers with at least 50 but fewer than 100 employees will not be required to comply with the employer shared responsibility provision of the Affordable Care Act (ACA) until January 1, 2016. Employers with at least 100 employees will be required to comply with this provision beginning January 1, 2015.

IRS Issues Final Affordable Care Act “Pay or Play” Regulations February 14, 2014

On Monday, the IRS issued final regulations regarding the implementation of the employer shared responsibility provisions under the Affordable Care Act (the ACA), otherwise known as the “pay or play” rules. The final regulations provide some helpful guidance and welcome relief to employers. For higher education institutions, the final regulations provide concrete guidance on how to count the hours of adjunct faculty and student workers. The IRS also provided transitional relief for all employers and delayed enforcement of the rules for medium-sized employers (employers with 50-99 full-time employees).

Employer “Pay or Play” Mandate Final Regulations Issued—Major Impact on Educational Institutions

Like all other employers across the country, educational institutions have been awaiting final rules to determine their compliance strategy for the Affordable Care Act’s Employer Shared Responsibility provisions (better known as the employer “pay or play” mandate). Under the employer pay or play mandate, employers with 50 or more full-time employees are required to offer qualifying health coverage to all of their full-time employees and their dependents or risk incurring penalties under the Affordable Care Act (ACA).

Small Employers Catch a Big Break!

Employers with 50 to 99 employees were granted a break on Monday when the U.S. Treasury Department gave them an additional year to comply with the employer mandate of the Affordable Care Act (ACA). This relief was granted as part of the final regulations issued in connection with the employer mandate. Employers subject to the employer mandate must offer affordable minimum value coverage to all of their full-time employees or risk exposure to significant penalties.

Legal Alert: Volunteer Hours of Firefighters and Emergency Responders Can be Excluded from ACA's Shared Responsibility Calculation

Executive Summary: The Department of Treasury has posted a statement on its blog indicating that the volunteer hours of volunteer firefighters and volunteer emergency medical personnel do not need to be included in determining whether the employer meets the 50 employee threshold for the Affordable Care Act's (ACA) shared responsibility provision.

Legal Alert: Affordable Care Act Transitional Policy for Individual and Small Group Plans

Executive Summary: On November 14, 2013, the Obama Administration announced a transitional policy, whereby insurers may, but are not required to, renew existing health plans in the individual and small-group markets in 2014, even if those plans do not meet the market reforms and plan design requirements of the Affordable Care Act.

Legal Alert: Health Care Reform Provisions for 2014 and Beyond

Executive Summary: Earlier this year, the Obama Administration delayed implementation of the employer mandate, a major provision of the 2010 health care reform law (the Affordable Care Act or "ACA"). The delay of the employer mandate, however, did not impact other provisions of the ACA, many of which are going forward as scheduled. Additionally the reprieve may be short-lived because, unless additional guidance is issued, January 1, 2014, will start the clock on determining an employer's size for purposes of the employer mandate, and for determining which employees will be considered full- and part-time for purposes of offering health care coverage.

Healthcare Reform Update

Despite glitches and long wait times, the Health Insurance Marketplace created by the Patient Protection and Affordable Care Act (ACA) came online October 1, 2013, and along with it arrived a new notice obligation for employers. Employers were required to distribute a notice of coverage options to all of their employees no later than October 1, 2013; and after that date, to all new hires within 14 days of their start date.

Employment & Employee Benefits Developments – Fall 2013: Health Care Compliance Burdens Continue to Weigh on Employers

Since the beginning of 2013, multiple federal departments and agencies have issued a variety of rules and regulations for group health plans that will impact employers and plan sponsors both now and in the coming years. Coupled with the Supreme Court’s recent DOMA decision, plan sponsors should be reviewing their plan documents, policies and procedures, and participant communications to make sure they comply with the most up-to-date rules and regulations. This issue of the SRZ Employment & Employee Benefits Developments newsletter summarizes these rules and regulations — including the new requirements imposed on HIPAA-covered entities and business associates and the new participant communications required under the Patient Protection and Affordable Care Act — as well as some of the key health care reform requirements set to take effect in 2014.

Brakes Pulled on Employer Shared Responsibility Penalties Under Obamacare

On July 2, 2013, the Obama Administration announced that the penalty and reporting provisions of the employer shared responsibility portion of the Affordable Care Act (“ACA”) will be delayed until January 1, 2015.

Remember to Send Out Obamacare Notice of Coverage Options by October 1, 2013

Under a new section of the Fair Labor Standards Act (“FLSA”) created by the Patient Protection and Affordable Care Act, employers subject to FLSA (which is almost all employers) must provide employees with notice of coverage options in the Health Insurance Marketplace. In other words, employers must announce what insurance plans are available and what they cost.

Employer Notice of Health Insurance Exchange Coverage Options: Deadline Fast Approaching, but No DOL Penalty for Late Notice

Sometimes lost in the temporary reprieve from employer mandate penalties for 2014 is the fact that employers still have much to do this year to comply with the Patient Protection and Affordable Care Act ("ACA"). One such responsibility is the requirement to distribute notices to all employees regarding the pending availability of health insurance exchanges (now referred to as "marketplaces" by federal agencies), by October 1, 2013. This requirement is found under Section 18B of the Fair Labor Standards Act ("FLSA"), which was added by Section 1512 of the ACA

Newsletter: Exchange Notice to be Delivered to All Employees by October 1, 2013

As part of the ongoing compliance efforts related to the Patient Protection and Affordable Care Act (PPACA), employers who are subject to the federal Fair Labor Standards Act (FLSA) must provide notice to their employees of the existence of health insurance exchange marketplaces no later than October 1, 2013. While there is no penalty for failing to comply, the U.S. Department of Labor (DOL) has simplified the requirement by providing the following model notices:

Employers’ Response to Affordable Care Act May Complicate Workers’ Compensation Claims

The coming implementation of the Patient Protection and Affordable Care Act may result in unintended consequences at the state level in reference to worker’s compensation designs and regulations.

All Employers Face October 1st Health Reform Deadline

With the Health Insurance Marketplace created by the Patient Protection and Affordable Care Act (PPACA) set to open its figurative doors for enrollment on October 1, 2013, employers face a new obligation. Nearly all employers must distribute a notice of coverage options to their employees no later than October 1, 2013; and after that date, to all new hires within 14 days of their start date. The Department of Labor (DOL) has issued two model notices that may be used to meet this obligation. One notice should be used by employers who offer employer-sponsored health insurance to some or all of their employees, and the other should be used by employers who do not offer coverage. The model notices can be found on the DOL website under the header “Notice to Employees of Coverage Options.”

All Employers Face October 1st Health Reform Deadline

With the Health Insurance Marketplace created by the Patient Protection and Affordable Care Act (PPACA) set to open its figurative doors for enrollment on October 1, 2013, employers face a new obligation. Nearly all employers must distribute a notice of coverage options to their employees no later than October 1, 2013; and after that date, to all new hires within 14 days of their start date. The Department of Labor (DOL) has issued two model notices that may be used to meet this obligation. One notice should be used by employers who offer employer-sponsored health insurance to some or all of their employees, and the other should be used by employers who do not offer coverage. The model notices can be found on the DOL website under the header “Notice to Employees of Coverage Options.”

Healthcare Reform: What Was and Was Not Delayed?

On July 2, 2013, the U.S. Treasury Department delayed enforcement of the employer “play or pay” mandate penalties and reporting requirements one year to 2015, stating that covered employers should still comply with the requirement to offer medical coverage to their full-time employees on a good-faith basis. However, removing the penalties for noncompliance and the requirement to report compliance or noncompliance essentially allows employers one more year to prepare for implementation of the play or pay provisions.

Gerrymandering Hours To Avoid The Obamacare Mandate

Employers may try to restructure/reduce their workforces such that they have fewer full-time employees working to whom they must provide health care insurance. Such strategies must be approached with great caution.

Legal Alert: Guidance Released on Delay of "Pay or Play" Penalties Under ACA

Executive Summary: The Obama Administration has released formal guidance on the delay of the Affordable Care Act's (the "ACA") employer mandate and certain reporting requirements.

Another Provision of Health Care Reform Delayed

Last week, the Internal Revenue Service announced that the “shared responsibility” provisions of health care reform, including certain related reporting requirements, would be delayed until January 1, 2015. Yesterday evening, the Internal Revenue Service confirmed that the information reporting requirements under Sections 6055 and 6056 of the Internal Revenue Code were included in the postponement. IRS Notice 2013-45 postpones until 2015:

ACA Employer Mandate Penalties Delayed Until 2015

On July 2, 2013, the Department of Treasury ("Treasury") announced a delay in the Affordable Care Act ("ACA") employer reporting and penalty provisions until 2015. This means that employers will not be subject to shared responsibility taxes ("pay or play penalties") for 2014.

Legal Alert: ACA "Pay or Play" Penalties Delayed Until 2015

Executive Summary: The Obama Administration has announced that implementation of the penalties under the Affordable Care Act's ("ACA") employer mandate (also known as the "pay or play" penalties) have been delayed until 2015.

Obama Administration Announces Delay of Pay or Play Penalties under Affordable Care Act

In 21st Century America, a single blog post can apparently change everything.

Update: Key Health Care Reform Provision Delayed

On July 2, the U.S. Department of the Treasury issued a press release announcing that enforcement of the employer "shared responsibility" provisions of health care reform, Section 4980H of the Internal Revenue Code, would be delayed until January 1, 2015. The "shared responsibility" provisions potentially impose two non-deductible excise taxes on large employers (employers with more than 50 full-time employees). The first tax may be assessed if an employer fails to offer coverage to at least 95% of its employees. The second tax may be assessed if an employer offers coverage, but one or more employees obtain coverage through an exchange and receive a premium subsidy.

Healthcare Employer "Play or Pay" Mandate Penalties Delayed to 2015

On July 2, 2013, the U.S. Treasury Department issued a statement that enforcement of the employer “play or pay” mandate penalties under the Internal Revenue Code – and therefore the coverage obligations to avoid such penalties – will be delayed one year to 2015. This is a significant event for a number of reasons.

Healthcare Reform And Seasonal Guest Workers

Many employers are eagerly watching the U.S. Congress as it debates comprehensive immigration reform legislation. However, employers of foreign workers need to be aware of another comprehensive reform already enacted—the Affordable Care Act (“ACA”).

Health Care Reform Adds to the Web of Anti-Retaliation Laws Applicable to Employers

While many employers have focused on the requirements for health coverage, they must be mindful of the new whistleblower and anti-retaliation protections established by the Patient Protection and Affordable Care Act (the "PPACA"). Section 1558 of the PPACA amends the Fair Labor Standards Act to protect employees from retaliation for (i) reporting alleged violations of the PPACA or (ii) receiving premium tax credits or subsidies for participating in health insurance exchanges. This provision applies to both private and public employers and protects current and former employees as well as applicants for employment. Earlier this year, the Department of Labor, through the Occupational Safety and Health Administration ("OSHA"), issued an interim final rule that governs whistleblower complaints under the PPACA.

Affordable Care Act – Guidance on Notice Requirement

The Patient Protection and Affordable Care Act (“ACA”) created a new section of the Fair Labor Standards Act (“FLSA”) that requires employers to provide employees with notice of coverage options in the Health Insurance Marketplace, i.e., what plans are available and what they cost. (The “Marketplace” is what was previously referred to as the “Exchange.”) Originally, the deadline for the notice was March 1. The Employee Benefits Security Administration of the Department of Labor (“DOL”) released temporary guidance on May 8, 2013, regarding the notice requirement as well as model notices that many employers have long been awaiting.

Employee Notices About PPACA Insurance Exchanges - Guidance Issued

One of the 2013 action items for employers under the Patient Protection and Affordable Care Act (PPACA) is the production and distribution of a notice to employees about the health insurance exchanges that will become effective in 2014. Under the statute, these notices were originally required to be distributed by March 1, 2013. However, in January 2013, the U.S. Department of Labor (DOL) delayed this distribution requirement until it had an opportunity to issue further guidance. On May 8, 2013, the DOL issued that guidance in the form of Technical Release 2013-02 and a model notice published on the DOL's website. The DOL describes the insurance exchanges as "Marketplaces," a term we will use in this alert.

Legal Alert: Notice of Health Exchange Coverage Options Guidance Released

Executive Summary: The Affordable Care Act added section 18B to the Fair Labor Standards Act (FLSA), which requires certain employers to send out notices to employees regarding the availability of the state-based Health Insurance Exchanges ("Exchange Notice"). Under the FLSA, these Exchange Notices were supposed to be provided to employees no later than March 1, 2013. However, on January 24, 2013, the Department of Labor (DOL) issued guidance delaying the Exchange Notice requirement until the summer or fall of 2013.

Healthcare Reform: To Play Or Pay – That Is The Question

Probably the most important mandate for employers is the “play or pay” mandate, also known as the employer-shared responsibility, which will require large employers (those with the equivalent of 50 or more full-time employees) to provide adequate and subsidized group health plan coverage to all full-time employees beginning in 2014. If an employer fails to satisfy this requirement, it will be subject to a penalty. This could have a significant economic impact on many employers. Accordingly, it is very important for employers to now start modeling how this mandate will impact their bottom line in 2014.

Legal Alert: Full Implementation of SHOP Health Exchanges Delayed

Executive Summary: The Department of Health and Human Services ("HHS") recently announced that full implementation of the SHOP component of the state-based health insurance exchanges created by the Affordable Care Act (the "ACA") run in full or in part by the federal government will be delayed until 2015. States setting up their own exchanges will be given the option to elect to similarly delay full implementation of their SHOPs until 2015.

U.S. Healthcare Reform, Foreign Employers, And Employers Of Foreign Workers

Since the landmark 2012 U.S. Supreme Court decision in NFIB v. Sebelius, largely upholding President Obama’s Patient Protection and Affordable Care Act (the “ACA”), the U.S. government has been moving full-steam ahead on implementation of healthcare reform mandated by the ACA. The ACA places a number of new regulations, restrictions, and requirements on employers, including U.S. companies employing foreign workers, and potentially foreign companies, depending on various factors, including those outlined below in this article.

Monthly Benefits Update - February 2013

The Department of Health and Human Services issued final regulations on the Affordable Care Act’s standards for essential health benefits, actuarial value, and accreditation.

Employee Notification Requirement Under Affordable Care Act

With 2013 in full swing, now is an excellent time to begin preparing for the changes that will take place as a result of the Affordable Care Act. Although most of these changes are set to take place in 2014, there is one important change that is right around the corner. Beginning on March 1, 2013, all employers with 50 or more full-time employees will be required to provide each employee at the time of hiring ' or, with respect to current employees, not later than March 1, 2013' with written notice, in plain language, of certain provisions of the Affordable Care Act, including

Health Care Reform: Employer Shared Responsibility Requirements Require Action

This alert discusses two recent regulatory developments under the Patient Protection and Affordable Care Act (PPACA).

Freaked Out By the ACA? Freak No More

A plethora of helpful ACA resources for employers

PPACA Produces Plan-Design Surprises

One surprising result of the Patient Protection and Affordable Care Act (PPACA) may be that lower-paid employees hope their employers will offer no or unaffordable health insurance.

Health Care Reform: Preparations for 2014 Pay or Play Rules Should Begin Now

By far the most important issue for employers to consider under the Affordable Care Act (ACA) is the employer “free rider penalty,” often referred to as “pay or play.” Instead of forcing employers to provide group health insurance to employees, ACA imposes a tax on employers if they don’t offer coverage to all or substantially all of their full-time employees (and their dependents), or if that coverage fails to meet certain conditions. This “pay or play” tax is memorialized in Section 4980H of the Internal Revenue Code. The IRS recently issued comprehensive proposed regulations on pay or play, which summarize and synthesize previous IRS notices and sub-regulatory guidance.

Health Care Reform: Details Regarding Significant New Fee Payable by Health Plan Sponsors Beginning in 2014

Although it has not been well publicized, a significant new fee on sponsors of group health plans is scheduled to go into effect in 2014 under the Patient Protection and Affordable Care Act (“Affordable Care Act”). Earlier this month, the Department of Health and Human Services (HHS) issued proposed regulations that provide more clarity on the amount of the fee, who is required to pay it, and other details. The two most important details to emerge from this recent guidance are (1) that the proposed amount of the fee is $63 per covered life in 2014, and (2) that the fee must be paid by self-insured health plans (in addition to insured plans). For a large employer that has tens of thousands of covered lives in its group health plans, the annual fee amount will be in the seven figures.

Fees Under The New Healthcare Reform Act Set To Begin

The new healthcare reform law includes a number of new taxes and fees which are rarely mentioned by the law’s supporters. On December 5, IRS announced final regulations governing new fees on health insurers and employer sponsors of self-insured health plans, designed to fund the “Patient-Centered Outcomes Research Trust.” This Trust finances an “Institute” tasked with “advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings.” Got that?

Legal Alert: Health Care Reform is Here to Stay

Executive Summary: With the reelection of President Obama, health care reform is here to stay. Challenges to the law are still pending; however, employers need to comply with existing requirements and begin preparations for compliance with future requirements. In addition, new guidance and regulations are likely imminent.

Obamacare: Full Steam Ahead!

With the re-election of President Obama behind us, and the composition of the Congress relatively constant, it looks like Obamacare (Patient Protection and Affordable Care Act) is here to stay. Employers must now look ahead to the next two years, when the major portions of the legislation will become effective, and start their plans for compliance.

Health Care Reform – Medical Loss Ratio Rebates Issued

As provided under the Patient Protection and Affordable Care Act (PPACA), insurance companies that failed to meet the Medical Loss Ratio mandate with respect to group health plan policies, must now pay rebates to the policyholders (i.e., the group health plan itself or the employer). This does not apply to self-insured or excepted benefit plans (i.e., stand alone dental or vision plans that are not integrated with major medical plans).

Patient Protection and Affordable Care Act: Upcoming Deadlines Require Employer Action

After months of anticipation and seemingly endless public debate, the U.S. Supreme Court announced its decision upholding the key individual mandate provision of the Patient Protection and Affordable Care Act (PPACA). While the significance of the decision cannot be overestimated, the real import is its practical effect on employers.

Affordable Care Act Runs Into Religious Freedom Issues in Court

Although the Supreme Court, in a landmark decision earlier this summer, affirmed the constitutionality of the Patient Protection and Affordable Care Act (ACA), the challenges to and controversies surrounding that Act are far from over. One implementing guideline in particular has been the target of considerable opposition from religious institutions: the requirement that all non-grandfathered health plans and insurers provide coverage for contraceptives and other preventative care for women. Although certain religious groups, primarily churches, are exempt from this requirement, the guideline does not exempt other religious employers such as schools, hospitals, and universities. The Department of Health and Human Services (HHS) has provided certain of these non-exempt religious employers with a temporary enforcement “safe harbor,” under which these selected employers are allowed an extra year to comply with the contraceptive coverage requirement (or, perhaps, work out an accommodation). Accordingly, because many non-exempt religious employers are not presently required to begin providing contraceptive services, the legal challenges they have raised to the contraceptive care mandate have yet to gain real traction in the courts.

Timeline Of Health Insurance Reform

As everyone knows, the Patient Protection and Affordable Care Act was upheld in a somewhat surprising Supreme Court decision last month. (For a recap of the decision see our Legal Alert on the case).

Patient Protection and Affordable Care Act Passes Constitutional Muster; IRS Issues Guidance on W-2 Reporting Requirement

On June 28, 2012, the U.S. Supreme Court surprised many observers by upholding, by a 5-4 margin, the constitutionality of the “individual mandate” (the requirement that most Americans purchase health insurance) contained within the Patient Protection and Affordable Care Act (“PPACA”).

Obamacare – It Is Here to Stay – Do You Know What to Do With It?

By now it’s old news: the Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (commonly called “Obamacare”). What does this decision mean for employers?

Healthcare Reform: Top 7 Things Businesses Need to Know Now

The court battle over the Patient Protection and Affordable Care Act (ACA) is over. The US Supreme Court says the law is valid. Whether you agree or not, it is now time for businesses to start getting ready for what this means.

Health Care Reform – Getting Back on Task in the Wake of the Supreme Court’s Decision

As discussed in our alert last week, the Supreme Court upheld the “individual mandate” provided under the Patient Protection and Affordable Care Act (“PPACA” or “the Act”) on the basis that the mandate is a constitutional exercise of the power of Congress to tax. Further, while the Court found part of the Act unconstitutional insofar as it affects the power of the federal government to terminate state Medicaid funding, the Court did not find the remainder of the Act unconstitutional as a result of this flaw. Therefore, employers are left with the continuing duty to comply with the Act, including several upcoming requirements that affect group health plans. The following provides a more detailed summary of the most significant obligations and deadlines under the Act that must be considered by employers in the future.

Supreme Court Renders Decision Upholding Health Care Reform as Constitutional

On June 28, 2012, the United States Supreme Court rendered its decision in National Federation of Independent Business v. Sebelius, a consolidation of three cases challenging the constitutionality of the Patient Protection and Affordable Care Act, commonly called “heath care reform” or the “ACA.” The three cases, one of which was filed by 26 state Attorneys General, challenged, among other provisions of the ACA, the individual mandate. In a 5-4 decision, the Court held the mandate constitutional.

The Supreme Court's Health Care Ruling (In 100 Words or Less)

The ruling made simple

Supreme Court Upholds Healthcare Reform - It's Time for Employers To Get To Work

Today the U.S. Supreme Court issued its long-awaited decision on the Patient Protection and Affordable Care Act (ACA). In what is easily the most significant decision this term, and arguably one of the most important rulings in decades, the Supreme Court upheld the so-called "individual mandate" and all of the provisions of ACA that impact employers. NFIB v. Kathleen Sibelius, Secretary of Health and Human Services.

Legal Alert: Supreme Court Upholds Health Care Reform Law

Today, in a 5-4 decision, the U.S. Supreme Court upheld the individual mandate provision of the 2010 Patient Protection and Affordable Care Act (PPACA) as a valid tax, imposed within Congress' taxing power. See Nat'l Federation of Independent Businesses v. Sebelius (No. 11-393, June 28, 2012)[1]. The Court held that the individual mandate (which requires most Americans to purchase insurance or face an IRS tax) is not a penalty because the only consequence of not complying with the mandate is the requirement to pay the tax. Although the Court also held that Congress exceeded the power granted to it under the Commerce Clause when it enacted the individual mandate, the provision is nevertheless valid under Congress' taxing authority. The Court also held that the Anti-Injunction Act does not preclude the Court from ruling on the issue because the PPACA does not require that the penalty for failing to comply with the individual mandate be treated as a tax for the purposes of the Anti-Injunction Act. Chief Justice Roberts authored the majority opinion.

Supreme Court Upholds Federal Health Care Reform Law

Today, the United States Supreme Court upheld the Patient Protection and Affordable Care Act. In a 5-4 decision authored by Chief Justice Roberts, the Court upheld the “individual mandate”—the requirement that everyone must have health insurance or else pay a tax—on the basis that the mandate is a constitutional exercise of Congress’s power to tax. In its opinion, the Court stated that “[o]ur precedent demonstrates that Congress had the power to impose the [individual mandate] under the taxing power, and that [the individual mandate] need not be read to do more than impose a tax. This is sufficient to sustain it.”

Obamacare Decision: The Perils of Instant Analysis and Related Thoughts

I have not and will probably not read today's Supreme Court decision holding that the Affordable Care Act is (for the most part) constitutional any time soon.

Supreme Court Upholds Federal Health Care Reform

On June 28, 2012, the U.S. Supreme Court issued its highly-anticipated opinion deciding the constitutionality of the federal health care overhaul known as the Affordable Care Act (ACA). The Court upheld the entire Act except a provision related to expanding eligibility for Medicaid. Chief Justice John Roberts, writing for the Court, construed the individual mandate as an option to have “minimum essential coverage” or to pay a tax and upheld the provision on the basis that the Act merely uses a tax penalty as a means of incentivizing an individual to have minimum essential coverage. The Court also held that the Medicaid expansion provision, although unconstitutional, can be severed so that the remainder of the Act can stand despite the unconstitutionality of one portion. Florida, et al. v. United States Department of Health and Human Services, et al., Nos. 11-393, 11-398, and 11-400, U.S. Supreme Court (June 28, 2012).

FAQs Regarding Summary Of Benefits And Coverage

In response to the February 14, 2012 final rules and regulations issued by the Labor Department regarding the summary of benefits and coverage (SBC) provisions of Health Care Reform, the DOL, in conjunction with Health and Human Services and the Treasury Department issued a new set of 24 Frequently Asked Questions to address some of the pertinent questions raised to date and to help consumers, employers and individuals understand the new law.

Guidance On MLR Rebates For Insured Plans

One of the provisions in the recent healthcare reform law is the medical loss ratio (MLR) that requires insurance companies to spend a certain proportion of their income on healthcare benefits for their customers. If an insurance company does not meet its MLR standard, it is required to issue a rebate to its policyholders. (The MLR standards do not apply to self-insured medical plans.) In 2011, the Labor Department issued a Technical Release, which provided guidance on how sponsors of group health plans covered by ERISA should handle such rebates.

Health Care Reform – Summary of Benefits and Coverage Final Rule

The Patient Protection and Affordable Care Act added Section 2715 to the Public Health Service Act, introducing a new disclosure requirement known as the “Summary of Benefits and Coverage” or “SBC.” The SBC requirement is applicable to both group health plans and insurers. As a result, in addition to the existing obligation to provide summary plan descriptions (“SPDs”), plan sponsors and insurers must now provide another type of summary, more concise than the SPD, which accurately describes the benefits and coverage under the particular plan in an understandable manner. The U.S. Departments of Health and Human Services, Labor and Treasury (“Departments”) have recently released final regulations on the implementation of this new requirement. A copy of these regulations is available here. The Department of Labor has also recently issued Part VIII of the FAQs about Affordable Care Act Implementation providing additional guidance on SBCs. The FAQs are available here. This alert outlines some of the most notable aspects of the SBC requirement.

U.S. Supreme Court Hears Oral Arguments For Constitutional Challenge of Affordable Care Act – Day Three (Severability and Medicaid Expansion Issues)

The U.S. Supreme Court’s three days of oral arguments in Department of Health and Human Services v. Florida (and two companion cases), which challenges the constitutionality of the Affordable Care Act, concluded on Wednesday. As outlined in our prior alerts (Day One, Day Two) this week, the last day of hearings was dedicated to two separate issues. First, the Court considered whether the remainder of the Act can stand if the “individual mandate” is struck down by the Court (in other words, whether the individual mandate is “severable” from the remainder of the Act). Second, the Court considered whether Congress’s expansion of Medicaid coverage under the Act is permissible.

U.S. Supreme Court Hears Oral Arguments For Constitutional Challenge of Affordable Care Act – Day Two (Challenges to Individual Mandate) March 28, 2012

As discussed in our alert from yesterday, the Supreme Court is hearing oral arguments this week in Department of Health and Human Services v. Florida, a case that challenges the constitutionality of the Affordable Care Act. On Tuesday, the Court heard arguments on the constitutionality of the Act's "individual mandate."

Supreme Court Wades Into Health Care: What It All Means

Potential outcomes of the Supreme Court review of various challenges to the President's health reform law

Obamacare By The Numbers

Two new studies just out highlight the extraordinary problems now facing the United States health system, and some of the consequences that could befall the country if critical parts of health reform are stripped away.

Health Care Reform – Significant New Changes to Claims and Appeals Requirements

As summarized in a previous FR Alert, non-grandfathered group health plans are subject to new claims and appeals requirements under the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act of 2010. In July and August of 2010, the Departments of Treasury, Labor, and Health and Human Services (the “Agencies”) issued interim final regulations and other guidance regarding these new requirements. On June 24, 2011, the Agencies released an amendment that significantly changes many of the original requirements in the interim final rules.

Health Care Reform – Pending Litigation Cases

Since the Patient Protection and Affordable Care Act (PPACA) was enacted last year, several state attorneys general and other private plaintiffs have filed lawsuits to repeal it. These lawsuits, among other issues, challenge the constitutionality of the mandate under PPACA that individuals purchase health insurance no later than 2014 or face a penalty. This is known as the “individual mandate.” This alert highlights the most prominent cases which have been decided at the federal district court level. It is very difficult to predict the eventual outcome of any of these cases. As a result, plan administrators, employers and insurers should be extremely cautious in making a decision to rely on any court decision, short of a decision of the U.S. Supreme Court, to avoid compliance with any part of PPACA.

Where Does The Healthcare Law Now Stand?

The Patient Protection and Affordable Care Act (PPACA) – better known as Healthcare Reform, or even "Obamacare" – continues to make news. The recently-passed act to keep the government open eliminated the free choice voucher – a requirement that would have placed an additional burden on employers in the administration of their health plans by requiring them to give some employees a voucher for the amount the employer pays for an employee's insurance that could be used by the employee to purchase insurance on the state exchange.

The Affordable Care Act: Something to Think About While Waiting for the Courts of Appeals to Rule

As the first anniversary of the Patient Protection and Affordable Care Act approaches on March 23, five district courts have issued final judgments on the issue of whether the Act itself is constitutional. The score is 3-2 in the federal government’s favor, but all five cases are on appeal at this time. The principal issue in those cases is the Act’s “individual mandate,” which requires most individuals to purchase health insurance beginning in 2014 or to pay a penalty for not doing so.

Affordable Care Act: New Grandfathered Health Plan Guidance

On June 17, 2010, the Departments of Health and Human Services, Treasury, and Labor (the “Departments”) jointly published Interim and Final Regulations (the “grandfathered health plan rules”) providing extensive guidance on “grandfathered health plan” status under the health care reforms mandated by the Patient Protection and Affordable Care Act (the “Affordable Care Act”). Grandfathered health plans are exempt from certain health care reform mandates, and the regulations help sponsors determine whether their plans are grandfathered.

Health Care Reform Implementation – Additional Guidance Issued

The Internal Revenue Service, the Department of Labor and the Department of Health and Human Services have published a series of frequently asked questions (FAQs) providing guidance on the implementation of the Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, as modified by the Health Care and Education Reconciliation Act of 2010 (“Reconciliation Bill” and combined, “Health Care Act”). The FAQs emphasize the attitude of these agencies towards assisting employers and insurers rather than enforcing compliance with the Health Care Act at this time. There are four installments of FAQs issued thus far (Parts I through IV). Most noteworthy among the issues discussed and clarified in these FAQs are the following:

Timeline For Health Insurance Reform

The effect of the recent healthcare legislation is beginning to be felt. Several changes (including pool coverage for high-risk people, extension of tax-dependent status of children to age 26, and a 10% excise tax on tanning salon services) have already been implemented and are not included on the chart. A huge number of other changes are now scheduled to phase in over the next several years.

Health Care Reform – On the Eve of the New Health Care Reform Mandates

As mentioned in a previous alert, the Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, as modified by the Health Care and Education Reconciliation Act (“Reconciliation Act,” and combined, the “Health Care Act”) prohibited group health plans and insurers from imposing preexisting condition exclusions, annual and lifetime dollar limits on benefits, and from rescinding coverage retroactively. The Health Care Act also imposed additional mandates related to preventive care. The Departments of Labor, Health and Human Services, and Treasury issued interim final regulations relating to these rules last June. The new rules are effective for the first plan year beginning on or after September 23, 2010. For calendar-year plans, the following significant changes will go into effect on January 1, 2011.