DB - DC Consultant / Relationship Manager Boyce & Associates, Inc. Phoenix AZ / Telecommute
	Employee Benefits Investigator (Recent Graduate) Employee Benefits Security Administration [EBSA] San Francisco CA / Telecommute
	Employee Benefits Investigator Employee Benefits Security Administration [EBSA] San Francisco CA / Telecommute

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Update on 2019 Affordable Care Act Employer Reporting
January 7, 2020 WEBCAST
HRWebAdvisor

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[Official Guidance]

Text of IRS Publication 5223: General Rules and Specifications for Substitute Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C (PDF)

18 pages; Nov. 2019. "The purpose of this publication is to set forth the tax year 2019 requirements for: [1] Using official [IRS] forms to file information returns with the IRS, [2] Preparing acceptable substitutes of the official IRS forms to file information returns with the IRS, and [3] Using official or acceptable substitute forms to furnish information to recipients.... Where permitted, filers may truncate the identification number of a recipient or other covered individuals (SSN, ITIN, or ATIN) on the recipient statement furnished to the recipient in paper form or electronically. In addition, on Form 1095-B furnished to the recipient, filers may truncate the identification number of the employer reported in Part II (EIN). The filer's EIN may not be truncated on the statement."

Internal Revenue Service [IRS]

[Guidance Overview]

Applying the ACA Employer Mandate to Rehired Employees

"[W]hen an employee who was full-time leaves and comes back in the same position, are they still full-time or can an employer treat them like a newly hired employee? In other words, the employer has to figure out whether they are a 'continuing' full-time employee or a newly hired employee for purposes of the ACA employer mandate."

HUB International

Employees Spend an Average 11% of Income on Premiums, Deductibles

"On average, employees spent $1,427 on their share of single-plan premiums in 2018, ranging from $755 in Hawaii to $1,903 in Massachusetts. The combined cost of premiums and deductibles accounted for 10% or more of median income in 42 states in 2018, up from seven states in 2008."

AISHealth

Surprise Billing in Private Health Insurance: Overview and Federal Policy Considerations

47 pages. "This report discusses selected policy issues that Congress may want to consider as it assesses surprise billing proposals. The report concludes by providing an overview of how surprise billing proposals may affect some combination of insurers, providers, and consumers." [R46116]

Congressional Research Service [CRS]

Billions in Estimated Medicare Advantage Payments from Chart Reviews Raise Concerns

"[OIG] found that [Medicare Advantage organizations (MAOs)] almost always used chart reviews as a tool to add, rather than to delete, diagnoses -- over 99 percent of chart reviews in [this] review added diagnoses.... [These] findings raise potential concerns about the completeness of payment data submitted to CMS, the validity of diagnoses on chart reviews, and the quality of care provided to beneficiaries.... [CMS] has not yet performed audits that validate diagnoses reported on chart reviews in the encounter data against beneficiaries' medical records."

Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS]

HHS OIG Questions Billions of Dollars Paid to Private Medicare Plans

"The findings showed that insurers were adding on conditions like diabetes and even cancer, reporting that patients were sicker, to receive higher payments from Medicare. While the inspector general’s office did not conclude that insurers were overbilling the program, it raised concerns about whether the payments were justified and whether patients were getting appropriate care."

The New York Times; subscription may be required

Drug Pricing Bill Passes House, But Faces Likely Defeat in Senate

"The Elijah E. Cummings Lower Drug Costs Now Act [HR 3] would give [HHS] the power to negotiate prices for the priciest drugs offered on Medicare. The drug companies would also be required to offer that rate to commercial health plans.... Now the legislation heads to the Senate, where Senate Majority Leader Mitch McConnell has said that it will essentially be dead on arrival. President Donald Trump has also opposed the legislation[.]"

FierceHealthcare

New California Health Insurance Subsidies: Some Rejoice, Others Get Shut Out

"Some of the subsidies will go to people who already qualify for the federal tax credits ..., primarily those with low incomes. But the assistance will also be extended to middle-income people ... who make too much money to qualify for the federal tax credits and have had to bear the entire cost of their premiums. California will be the first state to offer such help to middle-class consumers."

Kaiser Health News

Californians Without Health Insurance Will Pay a Penalty -- or Not

"California's penalty is modeled on the one originally in the federal [ACA]. Congress eliminated the federal penalty, effective this year.... The penalty will amount to $695 for an adult and half that much for dependent children. Some people with higher incomes instead will have to pay 2.5% of their income ... Penalty payments are expected to raise $317 million in the first year they are collected[.]"

Kaiser Health News

Press Releases

Work Shield’s Workplace Harassment Solution Expands to Full Title VII Protection
Work Shield

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Most Popular Items in the Previous Issue

Ten Charts on Proposals to Lower Prescription Drug Costs
Henry J. Kaiser Family Foundation

DOL Restores Over $2.5 Billion to Employee Benefit Plans and Participants During FY2019
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

Solicitor General Weighs in on ERISA Preemption Battle Over State PBM Statutes
Morgan Lewis via Mondaq