MDNews - Cleveland-Akron-Canton

++++++++++++++++++++++++ + + ++++++++++++++++++++++++ BUSINESS SECTION +++ +++ The Affordable Care Act: By Stephen P. Bond L AST SUMMER, THE Supreme Court settled the fundamental question of whether or not the Affordable Care Act was going to be enforceable. While we wait for a political decision as to whether the federal government is going to remain dedicated to the Act, we have a chance to take a breath and review what has already taken effect, and what is in the offing in the months ahead. The major provisions which have already taken effect include the Small Business Tax Credit, a provision protect- ing the interest of nursing mothers, a new "high risk" insurance pool, revisions for children's pre-existing con- ditions, extended children's coverage, a prohibition on rescinding coverage, no lifetime limits; no annual limits, and elimination of flexible spending on OTC Drugs. In addition, now, newly-issued plans are expected to include these provisions: + Preventive care, immunizations, and screening must be covered. + Insurers must provide consumers with detailed/standardized appeal rights. + If the plan covers emergency service, no prior authorization can be required. + Patients can choose their own primary doctors. + Non-profit hospitals are required 34 | Cleveland/Akron/Canton MD NEWS s MDNEWS.COM s NOVEMBER-DECEMBER 2012 What's Already in Place and What's Ahead t o c omple t e C ommu n i t y Needs Assessments. + Final Regulations for Accountable Care Organizations have now been published by the federal government, and 154 of these organizations (4 in Ohio) have been approved. + No Medicaid reimbursement for nosocomial infections. + And here are changes you should be aware of that are coming now, in the future: + Medical Loss Ratio Rebates — At least 85% of all premium dollars collected by insurance companies for large employer plans must be spent on health care services and health care quality improvement. If not, they are required to issue rebates. + Beginning with open enrollment after September 23, 2012, health insurers are required to utilize a "Uniform Explanation of Coverage." + Employers with 250 FTE's must issue W-2 forms during 2013 reflecting health plan costs during 2012. + Beginning with 2013, there is a $2,500 maximum annual limit on Flexible Spending Accounts. + In plan years beginning 2014, there will be a 90-day limitation on waiting periods. + The Mandatory Coverage Provisions — As the foundation of the new law, beginning in 2014, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of the program. In turn, employers with at least 50 FTE's will be required to offer coverage meeting stated criteria, or pay a $2,000 penalty for not doing so. + Beginning in 2014, the law implements the second phase of the small business tax credit, increasing it up to 50%. Once regulat ions are adopted, employers will be required to provide a written notice to newly-hired and current employees informing them that health care exchanges are available and their options for help to fund coverage. Also, employers with more than 200 employees will be required to automatically enroll employees in coverage without waiting for their request to do so. As for penalties for new plans that discriminate in favor of highly compensated employees, a ruling has been postponed indefinitely until IRS promulgates regulations. Stephen Bond, is an attorney at Brouse McDowell in Akron and a partner in the Labor & Employment Practice Group. s

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