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2014 Compliance Expectations Arizona Group Updates

2014 Compliance Expectations Arizona Group Updates. November 6 , 2014. Jason N. Sheffield, J.D. National Legal & Research Group. Program Overview. section one. Affordable care act update. Employer Mandate. “Pay or play” threshold. Employer Mandate. “Pay or play” workbook. No.

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2014 Compliance Expectations Arizona Group Updates

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  1. 2014 Compliance Expectations Arizona Group Updates November 6, 2014 Jason N. Sheffield, J.D. National Legal & Research Group

  2. Program Overview

  3. section one Affordable care act update

  4. Employer Mandate • “Pay or play” threshold

  5. Employer Mandate • “Pay or play” workbook No $2,000 / Full Time Employee (less first 30)* Do you offer coverage to all full-time employees? YES YES YES Does the plan provide “minimum value”? (60%+ of total allowed costs) No $3,000 full-time employee receiving tax credit* Is the coverage affordable? (< = to 9.5% of income) No No penalty *80 for plan years beginning in 2015; 30 for PYB in 2016 and after

  6. Employer Mandate • “FULLTIME” employee performs an average of 30+ hours of service per week or 130+ hours of service in any calendar month • “FULLTIME EQUIVALENTS” equals the sum of all hours of service performed by all employees: = 16 FTEs • = 16.11  2,080 33,500

  7. Employer Mandate • Employee classifications post-aca

  8. Employer Mandate • Part-time, variable Hour & Seasonal employees

  9. Employer Mandate • Variable Hour process 2014 Hired 10/5/14 Measurement Period 10/5/14 - 10/4/15 2015 First Ongoing Measurement Period 1/15/15 - 1/14/15 First Administrative Period 10/5/15 - 11/30/15 First Ongoing Administrative Period 1/15/16-3/31/16 2016 First Stability Period 12/1/15 – 11/30/16 First Ongoing Stability Period 4/1/16-3/31/17 2017

  10. EMPLOYER MANDATE • FINAL REGULATIONS ON WAITING PERIODS

  11. EMPLOYER MANDATE • PROPOSED RULEMAKING ON THE FEDERAL ORIENTATION PERIOD

  12. section two Agency auditson the rise

  13. AGENCY AUDITS • WHO DOES WHAT? 12

  14. AGENCY AUDITS • WHO DOES WHAT?

  15. AUDIT TRIGGERS • What triggers an agency audit?

  16. current standards of worker classification

  17. identifying misclassification within the organization • Part A – Employee Relations

  18. identifying misclassification within the organization • Part B – Organizational Alignment

  19. managing agency audits Audit Process

  20. managing agency audits • Negotiation & Settlement of Audit Penalties & Civil Liabilities

  21. section three Privacy & securityupdate

  22. NEW HIPAA Regulations • Designed to Build on Existing Rules

  23. 2013 RULE NO. 1 – part i • Final Modifications to HIPAA’s Privacy, Security & Enforcement Rules

  24. 2013 RULE NO. 1 – part ii • Final Modifications to HIPAA’s Privacy, Security & Enforcement Rules

  25. 2013 RULE NO. 2 • HITECH – Final Rule Modifying the Enforcement Rule

  26. 2013 RULE NO. 3 • HITECH – Final Rule on Breach Notification

  27. 2013 RULE NO. 4 • GINA – Final Rule Prohibiting Genetic Information Disclosure for Underwriting

  28. THE NEW TIERED BREACH SCHEME

  29. THE NEW TIERED ENFORCEMENT SCHEME

  30. FACTORS AFFECTING CIVIL MONETARY PENALTY

  31. HISTORY OF OCR ENFORCEMENT OCR – Resolutions by Year & Type April 14, 2003 – December 31, 2013

  32. ADMINISTRATIVE SIMPLIFICATION • UTILIZATION OF UNIQUE HEALTH PLAN IDENTIFICATION NUMBERS & OTHER ENTITY IDENTIFIERS DELAYED

  33. ADMINISTRATIVE SIMPLIFICATION • HIPAA-REQUIRED CERTIFICATIONS DELAYED

  34. ADMINISTRATIVE SIMPLIFICATION • HIPAA-REQUIRED CERTIFICATIONS DELAYED

  35. Questions?

  36. Participant resources

  37. participant resources employee misclassification assistance

  38. participant resources general hipaa compliance

  39. participant resources health and human servicescenters for medicare & medicaid

  40. participant resources health and human services office for civil rights

  41. participant resources department of the treasury internal revenue service employer plans unit

  42. participant resources united states department of laboremployee benefits security admin.

  43. participant resources united states department of laborwage & hour division

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