Patient Protection And Affordable Care Act Pdf

patient protection and affordable care act pdf

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PPACA directly regulates healthcare providers, insurance companies, individuals, and employers. The law is quite broad, affecting insurance companies, hospitals, individuals, and employers. The employer mandates, or rules in PPACA which require employers to provide certain levels of coverage to certain employees, went into effect in Since PPACA regulates a number of different areas regarding healthcare coverage, it naturally contains a number of separate provisions.

Affordable Care: Harnessing the Power of Nurses

PPACA directly regulates healthcare providers, insurance companies, individuals, and employers. The law is quite broad, affecting insurance companies, hospitals, individuals, and employers.

The employer mandates, or rules in PPACA which require employers to provide certain levels of coverage to certain employees, went into effect in Since PPACA regulates a number of different areas regarding healthcare coverage, it naturally contains a number of separate provisions. Many of these provisions also have associated regulations which offer further guidance.

We offer Affordable Care Act Recordkeeping services and can help you navigate through the extensive ACA requirements, determine any penalty exposure, and develop strategies to eliminate or reduce future penalty exposure.

Comprehending the ACA and every change it has gone through can be tough, which is why it is always a good idea to seek professional advice to ensure you are compliant when trying to navigate all of its complexities.

The balance of PPACA is the expansion of a number of individuals who receive healthcare coverage in the United States against tighter rules on what kind of healthcare coverage may be offered to such individuals. In general, this balance was reached by first enacting a number of regulations on insurance companies. By regulating insurance companies, healthcare coverage will improve and offer a greater benefit to individuals who obtain such coverage.

However, these increased regulations will increase the cost of healthcare coverage. Second, the individual mandate was included to ensure that individuals would obtain health insurance coverage.

By expanding the number of individuals seeking health insurance coverage, the price of such coverage decreases. A number of arguments have been presented by different interest groups and unbiased studies concerning the overall effect of this balance on the price of healthcare coverage. Under certain assumptions and pricing methodologies, PPACA could be shown to either cause a cost decrease or a cost increase.

As implementation of PPACA continues, these arguments will be readjusted to better reflect the effects. While some arguments exist on whether PPACA will improve the benefit of healthcare coverage in the United States, the arguments tend to stem from ancillary issues, such as smaller healthcare networks or problems with healthcare exchanges.

The rules which regulate insurance companies, such as a prohibition on pre-existing condition stipulations for certain benefits or guaranteed issue requirements, are generally seen as beneficial to individuals from a benefit perspective. PPACA has been controversial and highly contested since its inception. It has been challenged in a number of different venues for a litany of reasons.

These provocations have included legal challenges, political challenges, and implementation challenges. The highest-level challenge to PPACA questioned, among other things, the constitutionality of the individual mandate. Sebelius, Secretary of Health and Human Services et al. On June 28, , the Supreme Court issued its opinion on this case, deeming the individual mandate to be constitutional. PPACA has also been challenged on its ability to issue subsidies and excise taxes in States which do not form a health insurance exchange.

Two cases, Pruitt v. Sebelius and Halbig v. This case also reached the Supreme Court, who ruled against this challenge. The HHS Mandate, which requires employers to provide contraceptive coverage in their healthcare coverage to eligible employees, has also been challenged by dozens of different groups. The results of these challenges have been varied, but a national precedent has yet to be set.

Other tactics, such as amending certain provisions or defunding implementation, have also been explored. Overall, these efforts have yet to see tangible success. Compliance has had its importance magnified by increasing government interference in and scrutiny of employer-sponsored health plans.

PPACA includes compliance requirements for supplementary documents such as a Summary of Benefits and Coverage or exchange notification. PPACA takes a dim view of noncompliance, with a multitude of excise tax penalties for those who violate its provisions.

This penalty is for general violations of PPACA provisions, especially the insurance and plan design reform statutes. Some of the most important ways health care reform can benefit small businesses are by broadening coverage options, maximizing purchasing power, reducing costs, and granting back control over health care as a whole. Small businesses may even qualify for tax credits that can make ensuring employees more affordable. Above all, the effects of health care reform on small businesses and employees can take on many forms and can be an ongoing process.

Even more, a PEO can take the pressure off small business owners when it comes to staying compliant with new and rapidly-changing health care regulations.

From helping calculate the number of full-time employees to employee classifications to medical coverage reporting, a PEO can offer solutions that help point small businesses toward success. With rapid provisions taking shape and growing in complexity, having a reliable partner to tackle health care reform is more important than ever. If this is not met, employers have to pay a penalty. Two things might happen:.

There are more changes for businesses with 50 to employees. While they may be considered a small group employer for insurance purposes, they will be considered a large group employer for Employer Mandate penalty calculations. Employers are now required to offer affordable, minimum essential health coverage to at least 95 percent of their full-time employees, as well as their dependents up to age 26 , or pay a penalty.

Previously, this mandate had only applied to businesses with over employees but will now apply to employers who have between 50 and full-time employees. The employer mandates only apply to full-time employees. Employers are not obligated to provide health care coverage to part-time employees, seasonal employees, or unlawfully present individuals.

Note that future healthcare non-discrimination rules may affect employer obligations towards these types of employees. This penalty applies to applicable large employers, not small employers.

These penalties are assessed against applicable large employers who fail to offer mandate 1 minimum essential coverage, as well as mandate 2 affordability and minimum value. Employers may prevent this subsidy access by offering a plan with affordability and minimum value. Affordability means roughly that the premium for the plan costs the employee no more than 9.

Most plans meet this test, but employers are encouraged to have minimum value certified by any plan designer they may utilize.

Note that employers can only meet mandate 2 by denying subsidy access to employees. Great care must be taken by employers to sufficiently educate employees on the necessity of subsidy access denial. Even if employers offer a compliant plan, they may still face excise tax liability due to the method by which exchange subsidies are granted.

Subsidies are granted based on the application of the employee only. Once pre-qualified, the employer will be notified that unless an appeal is filed, subsidy access will be granted and the employer will be excise taxed. Employers are encouraged to keep all necessary documents in place and at the ready, as these appeals will likely be necessary exercises for most employers this fall.

The penalty is an excise tax and is thus not deductible as an ordinary and necessary business expense. The penalty is only assessed for each full-time employee who qualifies for an exchange subsidy. Qualified and affordable coverage is a higher standard of health care coverage than minimum essential coverage. Affordable coverage is health care coverage which costs an employee no more than 9. Note that any individual must also satisfy an income test to qualify for an exchange subsidy.

Penalties were not assessed in as well. Due to the delay, the employer mandates went into effect on January 1, Other forms of transitional relief are no longer applicable, as they applied only to Exchange subsidies are granted when an individual applies for a state exchange plan. According to current regulations, full-time employees who apply for and are eligible to receive exchange subsidies will be granted the subsidies on a pre-qualified basis. Employers will have a small window of time to appeal this status and dispute excise tax liability.

To prevent excise taxes, excess costs, and the interference of appealing exchange subsidies, employers have a couple of solutions available: deny and design.

Denial may be achieved through management of look-back and stability periods. If an employer must offer a plan, the least expensive plan should at least be considered by the employer for certain employees or classes of employees. These issues include state exchange plans attracting a smaller number of insurance companies than desired, the main enrollment hub www. While certain issues will likely be resolved over time, some outstanding matters, such as the potential for adverse selection on state exchange plans, may threaten the viability or economic efficiency of PPACA, which could have lasting effects.

They can help you navigate through the extensive ACA requirements, determine any penalty exposure, and develop strategies to eliminate or reduce future penalty exposure.

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These cookies do not store any personal information. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website. Recent Updates. The case is likely to be appealed to the U. Supreme Court. The judge sided with 20 states that argued that eliminating a penalty for not having health insurance invalidated the ACA.

Once the tax penalty was eliminated, he concluded the law was no longer constitutional. History of ACA. About 8 million of those people receive subsidies through federal exchanges. Changes include expanding the definition of a small employer, from employees, to full-time equivalent employees, allowing businesses with employees to use the Small Business Health Options Program SHOP , increasing the out-of-pocket maximum for employees, and increasing the dreaded penalties for failing to provided individual statements to full-time employees, or worse, failing to enroll for health insurance at all.

Individual Mandate The highest-level challenge to PPACA questioned, among other things, the constitutionality of the individual mandate.

PEO to the Rescue. Two things might happen: The definition of a full-time employee could potentially change. This allows employers to decide how they want to cover the to hour working employees from a business standpoint.

The Employer Mandate could be removed altogether, which allows employers to decide what they want to offer to their employees for health insurance. The Individual Mandate could be repealed altogether, too, which takes away the requirement of purchasing insurance at all.

Applicable Large Employers.

Affordable Care: Harnessing the Power of Nurses

Original Medicare produced an increased index of suspicion regarding health costs in As services expanded, costs escalated. Policy makers moved to control upward spending trends in an attempt to leverage resources across the population. Changes in reimbursement accompanied by the expansion of levels of care during an episode of illness caused stakeholders to carefully analyze value based opportunities. The groundbreaking Patient Protection and Affordable Care Act ACA compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements. This article discusses the nurse impact on national health cost reduction , value based healthcare reimbursement , and opportunities for nurses to impact healthcare quality. In addition, we consider the nurse impact on healthcare quality and access to care , as well as continued opportunities for nurses to impact access and lead change.


[For continuous pagination in electronic, PDF version, add 19 pages]. Page. Patient Protection and Affordable Care Act (Public Law –).


What Does the Affordable Care Act Say about Hospital Bills?

PLoS Med 16 2 : e This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The law is persistently contentious as a matter of public opinion, but represents a historic achievement in United States healthcare reform.

Senate Tracker: Sign Up Login. Javascript must be enabled for site search. The Select Committee on Patient Protection and Affordable Care Act PPACA was appointed during the legislative term to launch a comprehensive assessment of the impact of the law on Florida, to evaluate the state's options under the law, and to make recommendations to the full Senate membership on any actions necessary to mitigate cost increases, preserve a competitive insurance market, and protect Florida's consumers. The Select Committee utilized the guiding principles of protecting individual choice, limiting the regulatory burdens on Florida's businesses, and promoting better value in health care purchasing when forming their recommendations to the full Senate. Go to Bill: Year: Org.

What Does the Affordable Care Act Say about Hospital Bills?

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The Patient Protection and Affordable Care Act

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