HRI regulatory center: Regulatory and legislative updates and analysis

Regulatory Spotlight: DOJ, FTC focus on busy healthcare deals landscape
Regulatory Spotlight: DOJ, FTC focus on busy healthcare deals landscape
Recent challenges by federal regulatory agencies have stalled large merger and acquisition proposals throughout the healthcare industry.
Regulatory Spotlight: New FDA policies ease access to experimental medications
Regulatory Spotlight: New FDA policies ease access to experimental medications
New guidance documents issued by the FDA offer drug companies more clarity about how to handle requests for their experimental products from physicians treating seriously-ill patients.
Regulatory Spotlight: Risk adjustment continues to vex small insurers
Regulatory Spotlight: Risk adjustment continues to vex small insurers
The ACA’s risk adjustment program, designed to provide extra compensation to health plans with sicker members, continues to trouble smaller, newer insurers that have attracted younger, healthier customers.
MACRA overhauls quality effort
Regulatory Spotlight: MACRA overhauls quality effort
Under MACRA, CMS’s new Medicare payment system, the agency is proposing to replace dozens of long-standing quality-reporting measures and replace them with more streamlined and flexible metrics that more accurately capture patient care.
Regulatory Spotlight: FDA oversight comes to 3-D printing
New regulatory guidance clarifies the path forward for medical device manufacturers.
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February 25, 2014

Final rules on ACA's employer mandate include new transition relief

The IRS issued final regulations providing guidance on the Affordable Care Act's employer shared responsibility provisions, sometimes called the 'employer mandate' or the 'pay or play' rules. The regulations apply for periods after December 31, 2014 to applicable large employers who fail to offer coverage to their full-time employees. The regulations extend earlier transition rules and provide new ones to help employers comply with the requirements.

Highlights of the final regulations include:

  • an extended transition period for employers with between 50 and 99 full-time equivalent employees, so they won't be subject to penalties until 2016
  • a temporary rule for employers with 100 or more full-time employees, so the largest penalty will not apply for 2015 if the employer offers coverage to at least 70% of its full-time employees (rather than 95% as will be required after 2015)
  • final rules for determining full-time employee status reflect the proposed regulations, including the optional look-back measurement period and stability period, with numerous clarifications and new definitions
  • additional guidance for the monthly method of determining full-time status
  • rules for determining full-time status for special categories of employment, including a new definition of seasonal employees
  • an additional year for employers who do not now offer coverage to their employees' dependents to comply, as long as coverage is offered to the children of employees by the 2016 plan year
  • safe harbors for determining if employer-provided coverage is affordable for employees for purposes of the employer penalties
  • The Treasury Department and the IRS plan to issue final regulations soon intended to simplify and streamline the associated employer reporting requirements.

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