EMPLOYEE BENEFITS
“ Failing to offer coverage that meets these requirements could result in significant penalties for your business.”
Both covered entities and business associates may be selected for a HIPAA audit.
THE GOAL OF THIS PROGRAM IS TO IMPROVE COMPLIANCE.
However, if an audit reveals a serious compliance matter, the HHS may initiate a compliance review to further investigate the issue.
Entities selected for an audit will have ten business days to draft a response. Communications from the OCR will be sent via email. Make sure to check your spam folder for emails from OSOCRAudits @ hhs. gov to make sure these important emails are not missed.
To prepare for a potential audit, employers should self-audit their compliance with HIPAA rules using the OCR’ s audit protocol. The OCR’ s audit protocol is organized around modules, each representing separate elements of privacy, security, and breach notifications. The protocol pinpoints nearly 180 areas for possible audit inquiry.
In addition, HIPAA’ s Security Risk Assessment( SRA) Tool can be used to perform and document an organization’ s security risk analysis. The SRA tool can be downloaded at www. healthit. gov / providers-professionals / security-riskassessment-tool.
Even if your organization is not selected for a Phase 2 audit, it is important to self-audit your business to ensure compliance since the OCR will likely continue its enforcement efforts after Phase 2 audits are completed.
ACA’ S AFFORDABILITY CONTRIBUTION PERCENTAGE INCREASED FOR 2017 On April 12, 2016, the Internal Revenue Service( IRS) released new guidance on the percentages used to determine what is considered“ affordable” health coverage.
Under the Affordable Care Act( ACA), the affordability of an employer’ s plan may be assessed for an employer shared responsibility payment, the individual mandate, and the premium tax credit. The affordability test varies for each provision.
For plan years beginning in 2017, employer-sponsored coverage will only be considered affordable if the employee’ s required contribution for self-only service coverage does not exceed the following:
• 9.69 percent under the premium tax credit eligibility rules( up from 9.66 percent in 2016). The shared responsibility rules, or play-orpay rules, require applicable large employers( those that employ fifty or more full-time employees or fulltime equivalents) to offer coverage that does not exceed 9.69 percent of an employee’ s household income for the year. If employees’ required contributions exceed 9.69 percent, those employees could be eligible for a premium tax credit through the health insurance marketplace, which could result in penalties for employers.
• 8.16 percent under an exemption from the individual mandate( up from 8.13 percent in 2016). Individuals that lack access to affordable minimum value coverage are exempt from the individual mandate.
Failing to offer coverage that meets these requirements could result in significant penalties for your business.
Please note that these percentages only apply to individual coverage and do not include additional costs for family coverage.
If your company offers various health coverage options, the affordability test applies to the lowest-cost option that also meets the minimum value requirement established by the ACA.
THESE NEW REQUIREMENTS ARE EFFECTIVE FOR TAXABLE YEARS AND PLAN YEARS BEGINNING AFTER DECEMBER 31, 2016.
For more information on these requirements, contact Spectrum Insurance Group today. +
BY: CLARK THEILIG BENEFITS SPECIALIST, PARTNER, SPECTRUM INSURANCE GROUP
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