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Employers will not remain in compliance with the 2010 healthcare reform law if they replace their insurance coverage with subsidies for insurance bought through new government-run marketplaces, the IRS recently warned.
The IRS ruling that employers will face fines through the Affordable Care Act (ACA) if they switch from offering coverage to providing subsidies effectively prevents employers from “dumping” their employees into the new health exchanges rather than providing workers with health coverage, according to media reports.
The announcement, which came through an answer to a question posted this month on the IRS website, sought to address the question, “What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the Marketplace or outside the Marketplace)?”
The response from the IRS underscored a November 2013 IRS notice that described such employer subsidy arrangements as employer payment plans and stated that employers cannot apply after-tax funds toward health coverage or reimburse substantiated premiums with cash compensation. Employers choosing to take an employer-payment-plan approach rather than offering employees health insurance could face penalties of up to $100 per day per employee.
The November notice stated that “these employer payment plans are considered to be group health plans subject to the market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing.”
The November notice also explained that the ACA provisions also applied to some types of group health plans, including health reimbursement arrangements, health flexible spending arrangements, and certain other employer healthcare arrangements.
The Labor Department also issued a similar notice in September 2013.
The U.S. Department of Health and Human Services (HHS) plans to issue guidance “soon” regarding the issue, according to the IRS.
Various ACA health reimbursement arrangements were addressed in series of FAQs issued in January 2013 by HHS and the Labor Department.
Publication Date: Tuesday, May 27, 2014
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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