Human Resources The Affordable Care Act ACA PRESENTED

Human Resources The Affordable Care Act (ACA) PRESENTED BY DONNA GABEL HUMAN RESOURCES MANAGER ALEXANDER CITY HOUSING AUTHORITY

Disclaimer This presentation, related documents, contents, and comments are for informational purposes only and should not be construed as official interpretation of any laws, regulations, requirements, or compliance; or legal advice or legal opinion. You are urged to consult related government agencies or your attorney concerning your own situation and any specific legal questions you have may have. Donna Gabel is a Human Resources Manager with the Alexander City Housing Authority.

Overview • FEDERAL PATIENT PROTECTION & AFFORDABLE CARE ACT WAS SIGNED MARCH 23, 2010 • AMENDED BY THE HEALTH CARE AND EDUCATION RECONCILIATION ACT SIGNED MARCH 31, 2010 • 2, 409 PAGES WITH 10 “TITLES”, NUMEROUS PROVISIONS AND VARIOUS EFFECTIVE DATES

Key Provisions • EXPAND ACCESS TO INSURANCE • INCREASE CONSUMER PROTECTIONS • EMPHASIZE PREVENTION AND WELLNESS • IMPROVE QUALITY AND SYSTEM PERFORMANCE • EXPAND THE HEALTH WORKFORCE • CURB RISING HEALTH CARE COSTS

Expand Access to Insurance Coverage Require ALEs to cover workers or pay penalties, with exceptions for small employers Provide tax credits to certain small businesses that cover specified costs of health insurance for their employees beginning in tax year 2010 Require individuals to have insurance, with some exceptions (financial hardship, religious belief) Require creation of state-based insurance exchanges Expand Medicaid to those with income below 133% of federal poverty guidelines.

Expand Access Cont’d. Require creation of temporary high-risk pools for those who cannot purchase insurance due to preexisting health conditions, beginning 7/01/2010 Require insurance plans to cover young adults (up to age 26) on parents’ policies, effective 9/23/2010 Establish a national, voluntary long-term care insurance program , regulations issued by 10/1/2012 Enact consumer protections to enable people to retain their insurance coverage

Increase Consumer Insurance Protections Prohibit lifetime monetary caps on insurance coverage and limit use of annual caps Prohibit plans from excluding coverage for children with preexisting conditions Prohibit plans from cancelling coverage except in cases of fraud Establish state-based rate reviews for “unreasonable” premium increases Establish an office of health insurance consumer assistance or ombudsman program

Increase Protections Cont’d. Establish the share of premiums dedicated to medical services (minimum medical loss ratios) Prohibit most plans from excluding people for preexisting conditions, discriminating based on health status, and imposing annual $ caps on coverage Reforms to require guaranteed issue and renewal of policies, premium rating rules, nondiscrimination in benefits, and mental health and substance abuse parity

Emphasize Prevention & Wellness Grants to states for prevention activities (health screenings and immunizations) Federal Council to coordinate federal prevention efforts (tobacco use, physical inactivity, poor nutrition) Insurance plans must cover certain preventive care without cost-sharing Increases federal share of Medicaid payment by 1% for certain preventive services

Emphasize Prevention & Wellness Cont’d. Federal home-visiting initiative to help states foster health and well-being for children/families who live in at-risk communities Requires restaurant chains with 20+ locations to label menus with nutritional information Requires Medicaid programs to cover tobacco cessation services for pregnant enrollees Requires federal public education campaign about oral health

Improve Health Quality & System Performance Research on the effectiveness of various medical treatments Projects to develop medical malpractice alternatives and reduce medical errors Projects to develop payment mechanisms to improve efficiency and results Investments in health information technology Improvements in care coordination for Medicare and Medicaid patients who qualify for both

Improve Quality & System Performance Cont’d Options for states to create “health homes” for Medicaid enrollees with multiple chronic conditions to improve care Data collection and reporting mechanisms to address health disparities among populations based on Ethnicity Geographic location Gender Disability Language status

Promote Health Workforce Development Reforms in graduate medical education training Increases in health profession scholarship and loan programs Support for training programs for nurses Support for new primary care models, such as medical homes Increased funding for community health centers Support for school-based health centers and nursemanaged health clinics

Curb Rising Health Costs Provide more oversight of health insurance premiums and practices Emphasize prevention, primary care, and effective treatments Reduce health care fraud and abuse Reduce uncompensated care

Curb Rising Health Costs Cont’d Foster comparison shopping on insurance exchanges to increase competition and price transparency Implement Medicare payment reforms Test new delivery and payment system models in Medicaid and Medicare

Key Effective Dates for Employers 3/31/16 – FORMS 1095 B/C FURNISHED TO EMPLOYEES • 5/31/16 – PAPER TRANSMITTAL FORMS 1094 B/C DUE IRS • 6/30/16 – ELECTRONICALLY FILED TRANSMITTAL FORMS 1094 B/C DUE IRS • 2017 – STATES MAY OPEN EXCHANGES TO LARGE GROUP MARKET • 2020 – 40% EXCISE (CADILLAC) TAX ON HIGH COST PLANS, I. E. $10, 200+ SINGLE COVERAGE AND $27, 500+ FAMILY COVERAGE – INDEXED •

ACA Employer Mandates • EMPLOYERS WITH 50 OR MORE FTES CONSIDERED LARGE EMPLOYER AND MUST: • • Offer coverage to F/T employees and their dependents, OR Pay taxes if an employee obtains Exchange coverage and a premium tax credit

Determining Large Employer Status For each calendar month of the preceding calendar year: Count # F/T employees (including seasonal) who work an average 30 hours per week per month Calculate # FTEs by aggregating # hours worked by non -F/T and dividing by 120 Add # F/T and FTEs for each of the 12 months in the preceding calendar year Add the monthly totals and divide by 12. If average > 50 FTEs, determine if seasonal exemption applies.

Seasonal Employee Exception IRC Section 4980 H does not apply to employers whose workforce exceeds 50 F/T employees for no more than 120 days or 4 calendar months during a calendar year…IF The employees in excess of 50 who were employed during that period were seasonal employees. The 120 days or 4 calendar months are not required to be consecutive.

Who is a F/T Employee Under ACA? Full-Time = works average 30 hours per week, per month or 130 hours of service per calendar month. Hour of Service = each hour an employee is paid or entitle to payment for performance of duties, vacation, leave, holiday, illness, incapacity, layoff, jury duty, military duty, or other leave of absence.

Who is a F/T Employee - Cont’d. Calculation for Hourly /Non-Hourly Employees: Hourly employees – count actual hours served Non-hourly employees – select 1 of the 3 methodologies that does not understate hours: Count actual hours Days worked equivalence – count 8 hours for each day credited with at least one hour of service Weeks worked equivalence – count 40 hours of service for each week credited with at least one hour of service

Small Employer Provisions Employers with fewer than 50 FTEs will NOT face tax penalties if they don’t offer coverage to F/T employees SHOP Exchange: Employer can select and pay for coverage through special insurance market place. Exchange will manage administrative elements for employers. Tax Credit: Available to employers with up to 25 FTEs with average wages of no more than $50, 000 IF employer covers @ least 50% of cost of health insurance coverage. Sliding scale covered up to 35% in 2013 and up to 50% in 2014. Essential Health Benefits: Must cover 10 essential benefits

Minimum Essential Coverage Includes: Government-sponsored programs Eligible employer-sponsored plans Individual market plans Other coverage the Dept. of Health & Human Services designates as minimum essential coverage Does not include: Vision and dental coverage not part of a comprehensive health insurance plan Workers’ compensation coverage Coverage limited to a specified disease or illness

Minimum Value Coverage A plan fails to provide minimum value if “the plan’s share of the total allowed costs of benefits provided under the plan is less than 60% of such costs (% of medical expenses – deductibles, co-insurance, co-payments, etc. – paid for by the plan for a standard population and set of allowed charges.

Affordability General Rule Employee’s share of the self-only premium for the employer’s lowest-cost plan that provides minimum value cannot exceed 9. 5% of household income or the employee may be eligible for a premium tax credit to purchase Exchange coverage. Safe Harbors Form W 2 - Employee share does not exceed 9. 5% of the amount required to be reported in Box 1 of Form W 2 Rate of pay – Hourly rate X 130 hours per month Federal poverty line – Employee share does not exceed 9. 5% of the Federal poverty line for one person.

Employer Reporting Requirements Every person that provides minimum essential coverage to an individual during a calendar year must file an information return reporting the coverage. 1094 – B (transmittal form) < 50 employees 1095 – B (returns) 1094 – C (transmittal form) 1095 – C (returns) 50+ employees

ACA & Prevailing Wage Laws DOL “All Agency Memorandum Number 220” Issued March 2016 Guidance on interaction of the ACA ALE (applicable large employer) shared responsibility provisions and the fringe benefit requirements of the: Mc. Namara-O’Hara Service Contract Davis-Bacon Act Davis-Bacon Related Acts – that’s us!

QUESTIONS?

Contact Information DONNA GABEL HUMAN RESOURCES MANAGER ALEXANDER CITY HOUSING AUTHORITY 2110 COUNTY ROAD ALEXANDER CITY, AL 35010 (256) 329 -2201 EXT. 205 (256) 329 -6535 FAX EMAIL: DONNAGABEL@ALEXCITYHOUSING. ORG