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Q1 2022 Compliance Update

Forms 1094-C and 1095-C, Build Back Better Act, and Georgia’s Surprise Billing Law for Self-Funded Health Plans

Important changes for Forms 1094-C and 1095-C for the 2021 reporting season

 

What it is: In September 2021, the draft instructions for Forms 1094-C and 1095-C (hereinafter collectively, “Form C’s”) for the 2021 reporting season were released with important changes. For the first time since the Affordable Care Act’s inception, employers who file incorrect or incomplete Form C’s may endure costly penalties.

 Status: Notice 2020-76, which extended the good-faith efforts relief for the 2020 reporting season and was incorporated into the final instructions for Forms 1094-C and 1095-C in 2020, stated that the good-faith efforts relief would not continue for tax reporting seasons past 2020.

 What you need to know:

As a result of the good-faith efforts relief no longer applying, an employer could be penalized $280 per return if a Form 1095-C is submitted to the IRS incorrectly or incomplete to the IRS or to an employee.

The penalty would apply twice for the same incorrect or incomplete Form 1095-C:

– $280: for the Form 1095-C that is provided to the employee; and,

– $280: for the Form 1095-C that is submitted to the IRS.

– $560: total penalty for the incorrect or incomplete Form.

The 2021 Instructions for Form C’s, among other things, extended the due date for employers, health insurance issuers, and government agencies to furnish Form C’s from January 31, 2022 to March 2, 2022.

 

“Build Back Better” Act includes provisions on paid leave for all workers

 

What it is: On November 19, 2021, The U.S. House of Representatives passed H.R. 5376, the Build Back Better Act (“BBB Act”). While the BBB Act contains several retirement and benefits provisions, this article focuses on the provisions pertaining to paid leave for all workers.

Status: With recent news that Joe Manchin (D – WV) does not intend to put his key vote behind supporting the BBB Act, it is at great risk of failing to pass to law.

 What you need to know:

Currently, public entities and private companies with 50 or more employees must offer up to 12 weeks of unpaid time off under the Family and Medical Leave Act (“FMLA”). Under the BBB Act, eligible individuals could receive up to 4 weeks of paid leave in a 52-week period.

  This leave provision would be paid directly through a new federal program or through each state (or employer), which would be reimbursed for most of the costs. According to the current version of the BBB Act, the following details also apply:

– Payment amounts would vary depending on weekly income, with lower-paid workers receiving a higher percentage than higher-paid workers, but in no event would those making in excess of $1,192 weekly (1/52 of $62,000 in 2024, subject to indexing) be eligible;

– Unlike the FMLA, all workers would be eligible for the BBB Act’s paid leave, including self-employed business owners; and

– As with the FMLA, leave could be taken for events such as the birth or adoption of a child, the worker’s own serious health condition, or to care for a family member with a serious health condition. The BBB Act would also expand the definition of “family members” to include those whose care would qualify for paid leave.

If passed, the BBB Act would become effective January 1, 2024; for more information about the current status of the BBB Act and all of its provisions, please visit https://www.congress.gov/bill/117th-congress/house-bill/5376/text.

 

Georgia’s Surprise Billing Law for Self-Funded Health Plans

 

What it is: In February 2020, Rep. Lee Hawkins, R-Gainesville, introduced the Georgia Surprise Billing Consumer Protection Act (the “Act”) (formerly titled House Bill 888) which states that health insurers cannot send balance bills (commonly referred to as “surprise” medical bills) to patients who received emergency service from an out-of-network provider. House Bill 234 aims to amend Georgia Code Title 33 and provide an option for self-funded health care plans exempt from state regulations under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”) to opt-in to the Act.

Status: The Act was signed by the Governor on July 16, 2020, and the corresponding Rules and Regulations (Chapter 120-2-106) implementing the Act were finalized by the Office of the Commissioner of Insurance (OCI) on December 30, 2020. Both the Act and its regulations became effective January 1, 2021.

What you need to know:

 – The Act protects patients by ensuring a covered person cannot be held liable for any amount that exceeds the in-network deductible, coinsurance, copayment, or other cost sharing amount defined in their health plan for the surprise bills.

Hawkins said that allowing employers the opportunity to opt-in to the Surprise Billing Consumer Protection Act can be a flexible alternative to ensure employees don’t get balanced billed.

The following services and bills are subject to the Act:

Emergency Services – Insurers must pay for covered emergency medical services for covered persons regardless of network participation of the providers or facilities, without prior authorization and without retrospective denial of services deemed medically necessary.

Non-Emergency Services (Surprise Bills) – If charges arise from a covered person receiving non-emergency services from an out-of-network provider at an in-network facility, this is considered a “surprise bill,” and insurers must pay for covered services regardless of network participation of the provider.

For more information:

View the FAQs here

Click here to visit the Georgia Hospital Association website

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