ACA & PBJ COMPLIANCE GUIDES (A.K.A. HOW TO STAY PENALTY FREE) V4 (0601F)

Transcription

1 ACA & PBJ COMPLIANCE GUIDES (A.K.A. HOW TO STAY PENALTY FREE) V4 (0601F)

2 LEGAL DISCLAIMER ACA and PBJ Compliance, Publications and Content The ACA and PBJ Compliance Guide is intended to be used as a handbook for the reader to reference in conjunction with, but not exclusive of, official regulatory information. The laws, regulations, rulings and other material contained herein may change over time, and the reader should seek out the most current materials. This guide does not include everything that you need to know. We strongly encourage you to read and understand all laws and regulations that are applicable for ACA and PBJ compliance and to follow them closely. We present this guide for informational purposes only. The information in the ACA and PBJ Compliance Guide should not be relied upon or construed as legal advice or legal opinion. It is not an offer to represent you, nor is it intended to create an attorney-client or other confidential, advisory relationship. The content of any Internet sent to us or any of our personnel will not create an attorney-client relationship or other confidential, advisory relationship, and will not be treated as confidential. You should not rely upon the information presented in the ACA and PBJ Compliance Guide to make legal or other professional decisions without seeking personal advice from an attorney or other professional. We are not responsible for the content of any third-party website or information referenced within the guide. If any such third party site violates any laws or ethical rules of your jurisdiction, we are not available to represent you. End users may view and use the content of this guide for personal use. All other uses are prohibited. The ACA and PBJ Compliance Guide does not offer any guaranteed compliance with any law. By using the ACA and PBJ Compliance Guide as a point of reference, the user takes full responsibility for meeting the requirements of ACA and PBJ and indemnifies us from any claims that arise from its use. 2

3 CONTENTS ACA PBJ 3

4 AFFORDABLE CARE ACT COMPLIANCE GUIDE (A.K.A. YOUR GUIDE TO ACA SUCCESS)

5 THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA) AND WHAT YOU NEED TO KNOW ACA SETS MINIMUM COVERAGE STANDARDS FOR HEALTHCARE INSURANCE PLANS AND REQUIRES ALL INDIVIDUALS TO ENROLL IN A PLAN OR PAY A PENALTY. THIS PLAY OR PAY OPTION IS KNOWN AS THE SHARED RESPONSIBILITY MANDATE. EMPLOYERS ALSO HAVE A SHARED RESPONSIBILITY MANDATE, MAKING CAREFUL TIMEKEEPING AND SCHEDULING ESSENTIAL. 5

6 WHY ACA IS MANDATORY ACA defines 10 categories of service that all healthcare plans must cover. The stated goal is to extend essential healthcare to all individuals. Shared responsibility is mandated to help cover costs. Every health plan must cover: Ambulatory patient services Emergency services Hospitalization Pregnancy, maternity, and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services 6

7 INDIVIDUAL RESPONSIBILITY AND OPTIONS Individuals can obtain insurance through their employer, an exchange, or a qualified program such as Medicare or Medicaid. Alternatively, they can pay an annual penalty or request a hardship exemption. 7

8 DID YOU KNOW? 49% 8 20% Medicaid 9% Uninsured 7% Employer Non-Group 14% Medicare 2% Other Public Almost half of all individuals get healthcare coverage through their employer. CLICK HERE TO SEE YOUR STATE BREAKDOWN Source: Kaiser Family Foundation estimates based on the Census Bureau s March 2014, March 2015, and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).

9 EMPLOYER RESPONSIBILITIES AND OPTIONS Pay attention to staffing levels. Rules are based on total FTE Full-Time Equivalent (FTE) WORKERS EACH MONTH <50 FTE 50+ FTE 50+ FTE may be eligible for a tax credit for the month subject to shared responsibilities for month for prior year (average) subject to shared responsibilities for month 9

10 OPTIMIZING ACA COMPLIANCE EFFORTS AS AN EMPLOYER Control schedules and track hours by employees daily. Detailed timekeeping and scheduling help employers forecast costs, even in organizations with seasonal or cyclical work. Compliance begins with establishing the total FTE EMPLOYEES EACH MONTH To do this, employers must know total: 1. TFT Full-time employees defined as working at least 30 hours/week or 130 hours/month 2. PTH Part-time employees Total hours worked FTE = TFT + (PTH/120) for any given month 10

11 DETERMINING WHETHER AN EMPLOYEE IS FULL-TIME Employers have 3 options for determining whether a new hire is full-time according to ACA DESIGNATION Classify the employee as full-time at time of hire. MONTHLY MEASUREMENT Count hours at end of each calendar month. 130 hours during the month is full-time that month LOOK BACK MEASUREMENT Use measurement periods to establish whether employee considered full-time for future periods. Only available when it is not possible to determine at time of hire whether employee will work 30 hrs/wk Detailed timekeeping is a must 4 different measurement periods used in determining status 30 hours/wk during the month or at least 130 hours during month is full-time that month For employees not paid hourly, employer can calculate based on hours worked, days worked equivalent (at least 1 hr/day) or weeks worked (at least 1 hr/week) 11 Detailed timekeeping is a must

12 Calculating Your Monthly FTE (Full-Time Equivalent) Add up all hours worked by part-time employees during the month and divide by 120. For Example: 3 part-timers x 110 hrs/mo + 2 part-timers x 85 hrs/mo = 500 hours 120 = This is easy if you are using a timekeeping system. ROUND the result down to the nearest whole number. If the result is less than one, however, round up to one (1) FTE. In this example, 4.16 rounds down to 4. 3 Add your result to the number of full-time employees 4+20=24 Check eligibility for tax credit based on four criteria. <25 FTE paid average <$50,000 (indexed annually) paid 50% or more of health insurance premium purchased coverage through SHOP marketplace In this example, an employer with 20 full-time employees and 5 part-time employees working less than 30 hrs/week EEs FTE 20 FT 24 5 PT = FTE for a total FTE of 24 might qualify for the tax credit. 12

13 Penalties and Incentives for Employers Under ACA During 2017 Start Here Did the employer have at least 50 full-time equivalent employees in the previous year? YES NO Penalties do not apply to employers with fewer than 50 full-time equivalent employees. NICE! If the employer has <25 full-time employees with average annual wages of about $50,000 or less and covers at least 50% of full-time employees premium costs, the employer may be eligible for a health insurance tax credit to purchase coverage through the SHOP Marketplace. Does the employer offer health insurance coverage to at least 95% of its full-time workers and their dependent children*? NO Did at least one full-time employee receive a premium tax credit or cost-sharing subsidy in the federal or state marketplace? YES The employer must pay a penalty for not offering coverage. YIKES! YES Does the insurance pay for at least 60% of the covered health care expenses for a standard population (called minimum value)? YES Do any employees have to pay more than the 9.69% of their household income** for the employer coverage (called affordable coverage)? NO YES NO Did at least one full-time employee receive a premium tax credit to help pay for coverage in a Marketplace? Did at least one full-time employee receive a premium tax credit to help pay for coverage in a Marketplace? The employer must pay a penalty for not offering coverage that is affordable and provides minimum value. The penalty for each month the employer fails to offer coverage is $2,260 divided by 12, multiply the number of full-time employees (minus up to 30). YIKES! NO There is no penalty payment required for the employer The penalty for each month is $3,390 divided by 12, for each full-time employee receiving a premium tax credit that month (up to a maximum of $2,260 divided by 12, multiply the number of full-time employees (minus up to 30)). 13 *A dependent child is defined as a child of an employee who is under the age of 26. Employers do not face a penalty under the ACA if they do not offer coverage to the spouse of a full-time employee. **Affordability is determined by reference to the taxpayer s household income (i.e., the employee s required contribution for self-only coverage should not exceed 9.69%). Since employers generally do not know the worker s household income, to determine if an employer may be subject to penalty, the employer can measure 9.5% against three separate safe harbor amounts (the worker s Form W-2 wages, the worker s hourly rate of pay as of the first day of the coverage period, or the federal poverty line for a single individual). Note that a worker s and a the worker s dependents eligibility for premium tax credits or costing sharing subsidies are based on family income; not the safe harbor amounts. Source: Henry J. Kaiser Family Foundation, KFF.org.

14 ACA REPORTING REQUIREMENTS Employers with 50 or more FTE employees must complete a 1095-C: Employer-Provided Health Insurance Offer and Coverage form for each full-time employee and distribute to them annually. A 1094-C: Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns form and all 1095-Cs must be submitted to the IRS. W-2 Reporting Requirements In addition, employers that filed 250 or more W-2s the prior year must include the cost of employer-sponsored health coverage on the current year W-2s. This includes employer and employee contributions. For more information on W-2 filing requirements, visit THIS LINK HERE 14

15 WHERE TO BEGIN PUT A TIMEKEEPING AND SCHEDULING SYSTEM IN PLACE TO TRACK EMPLOYEE DATA AND HOURS. Proactively manage your workforce time and attendance. Schedule part-time employees to maximize hours. Automatically calculate actual FTE for prior periods and forecast FTE for upcoming periods. Run reports that identify full-time status and FTE fraction by employee. 15

16 UNDERSTANDING MEASUREMENT PERIODS CAN GET A LITTLE COMPLICATED, AND EMPLOYERS WHO ARE SUBJECT TO THE MANDATE SHOULD SEEK PROFESSIONAL LEGAL ADVICE. FOR MORE INFORMATION PLEASE GO TO: THIS LINK HERE 16

17 OUR WORKFORCE MANAGEMENT SUITE INCLUDED FEATURES THAT SUPPORT ACA COMPLIANCE ACA Employee data (title, gender, date of hire, term date, EE ID, etc.) Track hours worked Auditable reporting Work Week and Work Month reports (calculation of employee status reports) Employee status (FT, PT) Staffing and schedule management Communication/collaboration via & text Dashboard accrued & total overtime hours Timekeeping data records Hours threshold indicator and alerts Time card approvals Finalized pay period (lock-down data) Employee groups Time card audit Manageable, editable time cards (with audit trail) Alert indicators (overtime, max hours, etc.) Daily Auto report (view OT, missing punches, total hours) Schedule Preferences Proactive Time Management Forecasting of hours Mobile Access (Punch IN/OUT, tracking hours for off-site employees) 17

18 LET US HELP YOU IMPLEMENT OUR WORKFORCE MANAGEMENT SUITE We re ready to help you get the peace of mind you re looking for and deserve. Call your workforce management solutions provider To learn how we can help with ACA compliance. Disclaimer: The PBJ and ACA reporting requirements provided are subject to change. See page 2. For more information follow these links:

19 PAYROLL-BASED JOURNAL COMPLIANCE GUIDE V1 (041416)

20 OUR WORKFORCE MANAGEMENT SUITE FEATURES THAT SUPPORT PAYROLL-BASED JOURNAL REPORTING FIRST THINGS FIRST Below is a list of all the features that showcase our Workforce Management Suite and how its powerful components will help you become and remain compliant. PBJ PBJ Employee data (title, gender, date of hire, term date, EE ID, etc.) Track hours worked Job code tracking Auditable reporting Employee status (FT, PT) Staffing and schedule management Communication/collaboration via & text Mobile access (punch IN/OUT, tracking hours for offsite employees) Dashboard accrued & total overtime hours Timekeeping data records Hours threshold indicator and alerts Time card approvals Finalized pay period (lock-down data) Employee groups Time card audit Manageable, editable time cards (with audit trail) Certification tracking/expiration (RN, PT, LPN, etc.) Alert indicators (overtime, max hours, etc.) Daily Auto report (view OT, missing punches, total hours) Schedule Preferences Proactive Time Management Forecasting of hours 20

21 PAYROLL-BASED JOURNALS: WHAT YOU NEED TO KNOW STAFFING LEVELS CORRELATE TO CARE QUALITY. CMS MANDATES PBJ TO GATHER DETAILED STAFFING AND CENSUS DATA FOR THIS REASON. PBJ DATA WILL BE USED IN THE FIVE-STAR QUALITY RATING SYSTEM. 21

22 WHY PBJ IS MANDATORY CMS mandates a standard reporting method for long-term care facilities so that direct care staffing levels can be PBJ REPORTING BECAME MANDATORY JULY 1, 2016 compared. PBJ reporting provides detail on direct care hours provided by facilities, including agencies or contractors that do not directly bill patients. PBJ also fulfill requirements of Section 6106 of the Affordable Care Act. 22

23 PBJ DATA REPORTING COMPLETE, ACCURATE, DAILY STAFFING RECORD FOR EACH PERSON PROVIDING DIRECT CARE AT EACH FACILITY Unique facility ID for each facility Unique employee ID for each individual providing direct care Classification of each direct care provider as employee or agency/contract staff Job codes and pay types as defined by CMS Census data Direct care hours by specific job codes per day Direct care hours by individual per day Direct care staff turnover and tenure 23

24 DIRECT CARE STAFF Those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being. Direct care staff does not include individuals whose primary duty is maintaining the physical environment of the long term care facility (for example, housekeeping). CMS PBJ Policy Manual 24

25 DID YOU KNOW? USE THE QUALITY IMPROVEMENT AND EVALUATION SYSTEM (QIES) TO SUBMIT PBJ DATA. YOU MUST HAVE A CMSNET USER ID OR REGISTER TO OBTAIN USER IDS. CLICK TO REGISTER Map your job codes to CMS-defined codes Check that each individual delivering direct care has a unique ID Submit data digitally (XML zip file), manually (by typing) or a combination Format your data as specified by CMS before logging in Do not expect to copy & paste, because QIES prevents access to other programs while logged in Do not wait until the last minute; if there are errors, there may not be time to fix them Keep a record of all hours reported for direct care staff, agency and contractors in case of audit 25

26 OPTIMIZING PBJ REPORTING EFFORTS PBJ reporting takes time. You cannot eliminate the cost, but you can control the process. Start by keeping a detailed, digital record of who does what job when and where. Track all hours with job codes and pay types. Map your codes to CMS codes. Once set up, you have an efficient process for generating both payroll and PBJ reporting. 26

27 IMPORTANT DATES FOR PBJ REPORTING PBJ REPORTING IS CURRENTLY DONE QUARTERLY. REPORTS MUST BE SUBMITTED NO LATER THAN 45 CALENDAR DAYS A F T E R EACH QUARTER. BEST PRACTICE ENCOURAGES EARLY SUBMISSION TO ALLOW FOR ERROR CORRECTION. CHECK CMS.GOV REGULARLY T O DETERMINE ANY CHANGES TO PBJ REQUIREMENTS. 27

28 OUR WORKFORCE MANAGEMENT SUITE FEATURES THAT SUPPORT PBJ INCLUDE: PBJ Employee data (title, gender, date of hire, term date, EE ID, etc.) Track hours worked Job code tracking Auditable reporting Employee status (FT, PT) Staffing and schedule management Communication/collaboration via & text Mobile access (Punch IN/OUT, tracking hours for off-site employees) Dashboard accrued & total overtime hours Timekeeping data records Hours threshold indicator and alerts Time card approvals Finalized pay period (lock-down data) Employee groups Time card audit Manageable, editable time cards (with audit trail) Certification tracking/expiration (RN, PT, LPN, etc.) Alert indicators (overtime, max hours, etc.) Daily Auto report (view OT, missing punches, total hours) Schedule Preferences Proactive Time Management Forecasting of hours 28

29 LET US HELP YOU IMPLEMENT OUR WORKFORCE MANAGEMENT SUITE We re ready to help you get the peace of mind you re looking for and deserve. Call your workforce managment solutions provider today. Disclaimer: The PBJ and ACA reporting requirements provided are subject to change. See page 2. For more information follow these links: