Laura D. Anderson, Esq. Rahul S. Maitra, Esq. Primar ary pur - - PowerPoint PPT Presentation

August 12, 2014

Laura D. Anderson, Esq. Rahul S. Maitra, Esq.

 Primar

ary pur urpos

• se was

s to to ma make e it t easi asier er fo for in individu dividuals ls to to take h healt lth in insurance wit with th them wh when changin ing j jobs bs

 Addition

dditionally lly, set t natio tional l standards for

• r th

the prot protection tion of

• f an in

individu dividual’ l’s pro prote tected healt lth in informa

• rmation

ion (P (PHI) thro rough it its Priv rivacy R y Rule le and d ele lectr tronic ic pro prote tected health lth in informa rmation ion (EP (EPHI) th thro rough it its Security ity Rule le

 Ex

Expa panded com

• mplia

pliance re requir irements

 Interpreted and

d imple implemented provis d provision ions o

• f

the e HIT HITECH H Act

 Generally

lly re requ quire complia mpliance by by cert rtain in “c “cove vered entitie ities” and d “bu busin iness associa iates”

 Gro

roup healt lth pla plans are “c “cove

• vered entit

titie ies” ” unde der HIPAA and d mu must t comply mply with with cove vered entiti tities’ oblig

• bligation

tions re regardin ing PHI

 Health

lth pla plans, in inclu ludin ding grou roup p health lth pla plans

 Heal

ealth th ca care cl e clearinghou

• uses

 Health

lth care re pro provide viders wh who

• tra

ransmit mit healt lth in informa

• rmation

ion in in ele lectr tronic ic form

• rm

 Indiv

dividu iduals ls or

• r entitie

tities th that t pe perf rform m functio tions

• r
• r pro

provide vide s serv rvic ices for

• r cove
• vered e

d entitie tities, oth ther th than in in the capa pacity ity of a me membe ber of the work workforce, and d that t use or

• r dis

disclo lose PHI in in the cou

• urs

rse of pro providin viding those servic vices

 Curr

rrently, ly, bu busin iness assoc

• cia

iates are held ld to to mo most st of

• f the

he sa same e sta stand ndards as s cov covered ed entiti tities and d are dire directly ly lia liable ble for r vio viola latio tions and impe impermis rmissibl ible dis disclos losures

 Cove

• vered e

d entitie tities a and d bu busin iness a associa iates mu must tra train in all ll me membe bers of

• f th

their ir work workforce on th the re requir irements ts of

• f HIPAA complia
• mpliance

 Must be

be as necessary and d appr pprop

• priate f

for r the me members of

• f th

the work workforc rce to to carry o y out t th their ir function ions

 A cove

vered entity ity must im imple pleme ment polic policie ies and d proc procedures with with re respect t to to PH PHI de desig igned to to com

• mply wit

ply with HIPAA

 Must be

be changed as necessary and d app pprop

• priate to
• comply with

mply with changes in in th the la law

 Sets n

nation ional s l sta tandards f for

• r th

the prot protection ion o

• f

PHI

 Fo

Follo llowin wing the Omn mnibu ibus Fin Final l Rule le, bo both th cove

• vered entit

titie ies and d bu busin iness assoc

• cia

iates mu must comply mply wit with th the Priv Privacy Rule le, and d are bot both subj bject to

• pe

penalti lties for r failu ilure to

• comply

mply

 PHI is

is in individu dividually lly ide identif tifia iabl ble health lth in informa

• rmation

ion

 EP

EPHI is is PHI th that is is tra transmitt itted or

• r ma

main intain ined d in in ele lectron

• nic

ic form rm

 Cre

reated or

• r re

receiv ived by by a cove vered entit ity

 Rela

lates t to

• pa

past, t, pre present or

• r future

re ph phys ysic ical l or

• r

me mental l health lth or

• r con
• ndition

dition of an in individu dividual; l; provis provision ion of

• f care

re to

• an in

individu dividual; or

• r pa

past, pre present o

• r

r future re pa payme yment f for r the pro provis visio ion

• f
• f healt

lth c care re

 Nam

Names es

 Geograp

aphi hic

subdivi visions s smalle aller th than a an a state, tate, i. i.e. e. street treet ad addres ress, c city, ity, county, ty, prec recin inct, zip zip cod code

 Dates

Dates, suc uch as as birth irth date ate an and date ate of hire, ire, and and all all ages ages over ver 89

 Telep

elephone nu e number ers

 Fax n

num umbers

 Email

ail ad addres resses

 Social s

ial sec ecuri urity ty numbers ers

 Med

edic ical al rec record rds numbers ers

 Health

Health p plan lan I ID D numbers ers

 Acco

Accoun unt num numbers rs

 Certif

ifica cate/ e/li license cense numb mbers rs

 Vehicle

ehicle id ident entifie iers and nd seria serial numb number

 Devic

evice id e ident entifier ers and nd seria serial numb numbers

 Web U

Universa versal l Reso Resourc rce Lo e Loca cators rs (URLs) Ls)

 Int

ntern rnet Pro Protoco col l (IP) P) Ad Addres resses

 Bio

iomet etric ic id ident entifiers rs

 Full

ull fa face p ce pho hotos and nd co comp mpara rable e ima images

 Any

Any o

• ther uniq

her unique e ident ntif ifying ying n numb mber r cha chara racter eristic ic, o

• r

r co code e

 Medic

ical l re recor

• rds

ds

 De

Dental l re recor

• rds

ds

 Billin

illing in inform

• rmation

ion or

• r in

invoic voices

 Telep

ephon

• ne no

note tes s

 X-Rays, la

lab b re repo ports ts

 Oral

l dis discussion ions (wh (whether in in pe pers rson

• n or
• r ove
• ver

r th the ph phone)

 Patient a

t appoin ppointment in inform

• rmatio

tion

 Cove

• vered e

d entitie tities ma may y not

• t use or

r dis disclos lose PH PHI except pt as th the Priv Privacy y Rule le pe perm rmits its or

• r

re requ quires, or

• r as authoriz

ized by by th the in individu dividual

 Busi

usiness asso ssoci ciat ate e ma may onl

• nly use

use or

• r discl

sclose

• se

PHI I per te terms of f its s busi usiness ness a associ ssociat ate e agreement or r as re required by d by la law

 Treatme

atment nt

 Paym

yment

 Heal

ealth th ca care op e operat ation

• ns

 The P

Priv rivacy R y Rule le re requ quires that t cove vered d entiti tities and d bu busin iness assoc

• cia

iates use and d dis disclo lose th the min inim imum amo mount o

• f PHI

necessary to

• accomplis

mplish a pa partic rticula lar pu purpo rpose

 Cove

• vered e

d entitie tities a are re re requ quir ired to

• ente

ter in into

• a

BAA with with th their ir bu busin iness assoc

• cia

iates to to ensure th that bu t busin iness a assoc

• cia

iates appr pprop

• pria

iately ly sa safeg feguard P PHI

 BAA re

requ quirements ts have changed unde der th the Omn mnibu ibus Fin Final l Rule le, bu busin iness assoc

• cia

iates and d cove

• vered entit

titie ies must upda pdate BAA to

• be

be in in com

• mplia

pliance wit with HIPAA

 Agreement c

t cla larif rifie ies a and d limit limits th the pe permis rmissibl ible uses and d dis disclos losures of

• f PHI by

by the bu busin iness ass ssoci ciat ate

 Based

d on

• n re

rela lation ionship ip be betwe ween the pa part rtie ies and th the activitie tivities or

• r serv

rvic ices be bein ing pe perf rformed by th by the bu busin iness assoc

• cia

iate

 General

l rig right to to obta btain in and d re review w a copy py of PHI

 Rig

ight to to have PHI amended d wh when in inform

• rmation

ion is is in inaccurate or in

• r incomple

mplete te

 Right

ht to to an n acco ccount unting ng of

• f discl

sclosur sures es of

• f PHI

by by a cove

• vered entity

tity or r bu busin iness assoc

• cia

iate

 Rig

ight to to re requ quest t th that a a c cove

• vered

d entit tity y re restric ict use use or discl sclosur

• sure

e of f PHI

 Rig

ight to to re requ quest t alt lternativ tive me means or r lo locatio tion for r re receivin iving c comm mmunic icatio ions of

• f PHI

 Right

ht to to recei ceive Not Notice ce of

• f Privacy

cy Pract actices es

 A

A co covered ed enti ntity or

• r busi

usines ness a s asso ssoci ciat ate must e must de desig ignate a priva privacy y of

• ffic

icer r wh who is is re respon

• nsib

ible le for r de develo lopin ping a and d im imple pleme mentin ing po polic licie ies and d proc procedures of the entity ity

 Ove

versees HIPAA complia

• mpliance for
• r th

the entit tity

 Es

Establis lishes nation ional l securit ity sta tandards ds for r prot protectin ting PHI held ld or

• r tra

transferred in in electr ectronic c fo form m (EPHI) I)

 Goa

• al

l is is to to prot protect t priva privacy o y of EPH EPHI wh while ile allo llowin wing adopt doption ion of new w te technolog logies to

• improv

improve the qu quality lity and d effic icie iency y of pa patie tient care re

 En

Ensure t the con

• nfide

identia tiality lity, in inte tegrit ity, y, a and d availa ilability ility of

• f all

ll EP EPHI cre reated, re receiv ived, ma main intain ined or d or tra transmitt itted

 Ide

dentif ify y and d prote protect again inst re reasonably bly antic icip ipated th thre reats t to

• the securit

ity o y or r in integrit ity y

• f
• f the in

informa rmation ion

 Prot

• tect

t again inst t re reasonably bly antic ticipa ipated, impe impermis issibl ible uses or r dis disclos losures

 En

Ensure work workforc

• rce com
• mplia

pliance

 When de

decidin iding wh whic ich security m ity measures to to use, cove vered entity ity and d bu busin iness assoc

• cia

iate shou

• uld

ld con

• nside

ider

• Its

ts size ize, comple mplexit ity, y, and d capa pabilitie ilities

• Its

s techni chnical cal, ha hardwar are, and nd softw software e infr nfrast astructu cture

• The

he co costs sts of f se secur curity ty me measures

• The lik

likelih lihood

• d and

d pos possible ible impa impact t of pot potenti tial l ris risks t to

• EP

EPHI

 Must m

main inta tain in re reason

• nable and

d appr pprop

• priate

adm dmin inis istrativ tive, te technic ical l and d ph phys ysic ical l sa safeg feguards fo for prot

• tect

cting E EPHI HI

 Requ

quir ires that t cove vered entitie ities and d bu busin iness associa iates pro provide vide not

• tif

ific ication tion follo llowin wing brea each ch of

• f unse

unsecu cured P PHI

 Breach is

is generally lly an impe imperm rmis issibl ible use or

• r

dis disclo losure unde der the Priv rivacy Rule le th that t com

• mpro

promis mises th the security ity or

• r priva

privacy y of PH PHI

 Cove

• vered e

d entitie tities mu must t not

• tif

ify: y:

• Affecte

ted in individu dividuals ls

• The

he Se Secr cret etary of f the he U.S.

• S. Depar

artm tment nt of f Health lth and d Human Servic ices (DH (DHS)

• The me

media dia f for

• r bre

breaches affectin ing mo more re th than 500 re resid idents o

• f a state

te

 If

f a b breach each of

• f PHI occur

ccurs a s at o t or by a busi usines ness ass ssoci ciat ate, e, the he busi usine ness asso ssoci ciat ate e must ust no noti tify fy th the cove vered entity ity follo llowin wing dis discove very of

• f th

the brea each ch

 Impo

mposes c civil ivil mon

• ney

y pe penalti lties for

• r viola

violation ions

• f HIPA

HIPAA r rules es

 Incr

ncreased penal alti ties es effe ffect ctive e Octo ctober 2009

 Previou

viously ly $100 pe per viola r violation tion – ma maxim imum of $25,0 ,000 for

• r all

ll viola violation tions of the same type ype in in a cal alen endar y yea ear

 Curr

rrently ly $10 100 0 to $5 $50, 0,000 00 p per er violation, de dependin ing on

• n de

degree of

• f culpa

lpability bility – ma maxim imum of $1.5 .5 million million for

• r all

ll viola violation tions of th the same me type ype in in a cale lendar ye year

 HITE

HITECH Act re t requ quir ires th that DH t DHS pe perform m pe period iodic ic audits dits of

• f cove
• vered

d entity tity and d bu busin iness associa iate c com

• mplia

pliance wit with Priv Privacy, Security ity, and Bre reach Not

• tif

ific ication tion Rule les

 Employe

Employers re requ quired t d to

• re

repor

• rt th

the cos

• st of
• f

cove

• verage unde

der an emplo ploye yer-sp sponsor sored ed gro roup healt lth pla plan.

 Ef

Effective ive f for r cale lendar ye year 2 2012 (W (W-2’s ’s provid provided in in Ja January 2013) ) and d future re ye years.

 Cert

rtain in emplo ploye yers and d cert rtain in type types of cove

• verage exe

xemp mpted until il the IRS pu publis blishes guida idance.

 Repo

portin ting by by these e emplo mploye yers and d for r these type types o

• f co

coverag ages ma may be y be ma made de on

• n a

volu volunta tary ba basis is.

(1 (1) ) employe ployers filin iling fewe wer than 250 Forms Forms W-2 for

• r th

the pre previo ious cale lendar ye year; (2 (2) ) multi lti-emplo mployer pla plans; (3 (3) ) Healt lth Reim imbu bursement Arr rrangements;

(4 (4) ) de dental l and d vis vision ion pla plans that t eit ither

 are not

t in integrated in into

• anoth

ther grou roup p health lth pla plan o

• r

 give

ive pa partic ticip ipants ts the choic

• ice of de

declin linin ing th the cove

• verage or

r ele lectin ing it it and d pa payin ying an additio dditional l pre premiu ium

(5 (5) ) self lf-in insured pla d plans of

• f employe

mployers n not t subj bject t to to CO COBRA A cont continua nuation

• n co

coverage; e; (6 (6) ) employe ployee a assis istance prog programs ms, o

• n-site

ite me medic dical l clin linic ics, , or

• r we

welln llness prog programs; and (7 (7) ) employe ployers furn rnis ishin ing Form Forms W-2 t to emplo mployees wh who

• te

term rmin inate be before

• re th

the end d of

• f

a cale lendar ye year and d re requ quest a t a Fo Form rm W-2 2 be befor

• re the end

d of

• f th

that ye year.

Addition dditional l Medic dicare ta tax of 0.9 .9% applie pplies to

• wa

wages, compe mpensation tion or

• r self

lf-emp mplo loym yment in income me exceedin ing

 $250,000.00 for

• r ma

married d ta taxpa payers filin iling join intly; ly;

 $125,000.

00.00 0 fo for ma married ed fi filing ng se separ aratel ely;

 $20

200, 0,00 000.00 00 for singl gles es;

 $200,000.

00.00 0 fo for he head ad of

• f house

household; or

• r

 $200,000.00 for

• r a qu

qualif lifyin ying wido widow w wit with a de dependent t child. ild. The ta tax mu must be t be with withheld ld on

• n all

ll excess com

• mpe

pensatio ion in in a cale lendar ye year be begin innin ing afte ter 2012, , with withou

• ut re

regard to

• th

the in individu dividual’ l’s filin iling status or r wa wages pa paid id by by anoth ther emplo mployer.

 Fin

Final l ru rule les to to imple implement th the in informa

• rmatio

tion re repo portin ting provis provision ions for

• r in

insurers and d cert rtain in emplo mployers unde der ACA ACA take ef effec ect in 201 015. 5.

 Rule

les on

• nly

ly apply pply to

• employe

ployers wit with 50 or

• r

mo more re employe ployees th that are subj bject t to to the emplo mployer shared re respon

• nsib

ibilit ility y pro provis vision ions.

The fin inal l ru rule les in inclu lude de th the followin

• llowing key

y provis provision ions:

 Str

treamlin mlined re d repo portin ing f for r self lf-insure red d emplo mployers;

 Optio

ption to to avoid void ide identif tifyin ying in in the re repo port t wh whic ich of

• f it

its emplo ploye yees a are re f full ll-tim time;

 Simplif

implifie ied d re reportin ing for r employe ployers wh who

• provid

provide a a “qu qualif lifyin ying offer.” r.”

What is is a “qu qualif lifyin ying of

• ffer”

r”?

 min

minimu imum va valu lue e employe ployee-only cov coverag age at t a cos

• st

t to

• th

the emplo ploye yee of no more

• re th

than abou bout t $1, 1,10 100.00 in 201 015, 5,

 co

comb mbine ned with h an n offe ffer of f cov coverag age fo for the the emplo mployee’s f family. mily.

 Rela

laxed the healt lth FS FSA “u “use-or-los lose” ” ru rule le.

 Partic

icip ipants ts ma may y carry ove y over r up p to

• $500.0

.00 in in unused funds ds in into

• th

the next xt ye year.

 Applie

pplies if if a pla plan doe does not t als lso in incorpo rporate an extended de d deadlin line, or r gra race pe perio riod, afte ter th the end d of th the pla plan ye year to to use health lth FS FSA funds ds. .

 Ava

vail ilable le be begin innin ing with with th the 2013 pla plan ye year.

 Rest

strict cted ed the he use use of f FSAs SAs, H , Healt lth S Savin vings Account Accounts s (HSAs SAs), and d Arc rcher Medic dical l Savin vings Account Accounts s (Ar Arch cher er MSAs SAs) t to

• pa

pay y for r ove ver-the he- cou

• unte

ter me medic dicatio ion, effective ive Ja January 1 y 1, , 201 011. 1.

 The H

Healt lth S Savin vings Account (HSA SA) ) out-of- poc pocket lim limit its will will be be $6,3 ,350.00 for

• r

in individu dividuals ls and d $12,7 ,700.00 for

• r familie

milies in in 201 014. 4.

 Fin

Final l Regulatio tions is issued Ju June 26, , 2014, , applic pplicabl ble for r taxa xable le ye years be begin innin ing in in or

• r

after 20 2014 14.

 No

Now avai ailab able e onl

• nly for

for cov coverag age pur urch chas ased th thro rough the Sma mall ll Busin iness Health lth Option ptions Program ( m (SH SHOP OP) Mar arketplac ace. e.

 Sma

mall ll bu busin inesses entitle itled to to th the cre redit dit in in earlie lier ta tax ye years ma may y file ile ame mended re retu turn if if not

• t cla

laim imed th d then.

Sum ummar ary of

• f Ben

enef efits ts and and Cover

• verag

ages es (“ (“SB SBC”) Ins Insurance e com

• mpani

panies es and and gr group h

• up heal

ealth th pl plans ans mus ust t provid ide consu sume mers rs wi with an SBC. C.

 Final Re

Regulations iss ssued Ju June 26, 26, 2014, 2014, appl applicab able e for

• r tax

taxabl able y e year ears begi beginn nning in n or

• r af

after ter 2014. 2014.

 Now

Now avai availabl able onl e only for

• r cover
• verage

age pu purchas ased ed thro rough the Sma mall Busin siness He ss Health Optio ions Progr

• gram

am (SHOP) Mar Marketp etplac ace. e.

 Sm

Small b busi sinesses entitled to the cre redit in earl rlier r tax tax y year ears m may ay file am e amended r ended retur eturn if not not clai aimed ed then.

Not

• tic

ice of

• f Ex

Exchange and d Subs bsidi idies

 Effec

ective Oc October er 13, 13, 201 013, 3, em employers wer ere re requ quired d to to dis distribu tribute a N Notic tice of

• f Exc

Exchanges and Subs bsidi idies to to all ll emplo ploye yees.

 The n

notic

• tice mu

must t be be provide provided to

• each n

new w emplo mployee with within in 14 da days ys of

• f th

the emplo ploye yee’s sta tart t da date.

 Internal R

l Reve venue C Code

• de (I

(IRS) S Section ion 105(h (h)’s form rmerly ly proh prohibit ibited self lf-in insured pla plans f from rom dis discrim rimin inatio ion in in favo vor r of

• f hig

ighly ly com

• mpe

pensated in individu dividuals ls (“ (“HC HCIs Is”) as to to pla plan e elig ligibility a ibility and d be benefits its

 ACA

ACA extended th d thos

• se re

restric iction ions to to non

• n-

gra randfathered in insured gro roup p health lth pla plans as we well. ll.

 Dif

Different pe penaltie lties for

• r non
• n-com
• mplia

pliance:

 Se

Self-in insured pla plan fails ils to

• comply:

mply: hig ighly ly com

• mpe

pensated in individu dividuals ls lo lose a tax x be benefit. it.

 Insured grou

roup p health lth pla plan fails ils to to com

• mply:

ply: pla plan or

• r pla

plan s spon ponsor may be y be s subj bject t to

• an

excis ise ta tax, , civil ivil mon

• ney

y pe penalty lty, or r a civil ivil actio ion to to com

• mpe

pel l it it to to pro provide vide non

• ndis

discrim imin inatory be y benefits its.

 Imple

mplementation tion wa was in init itia ially lly schedu duled f d for r January 1 1, 201 014. 4.

 IRS has not

t ye yet fin inaliz lized d imple impleme mentin ing re regulatio ions and d has announced th that t no enfor

• rcement action

ion will will be be t taken until til th the re regulatio ions are in in pla place.

 Effective Ap

Apri ril 25, 25, 2014, m 2014, maxi ximum w waiting per period

• d bef

befor

• re c

e cover

• verage bec

age becom

• mes

es ef effec ecti tive ve is 9 90 days. ys.

 Applie

lies t s to both grandfa fathere red and non- gr grand andfat ather ered ed gr grou

• up

p heal health pl th plans ans and and gr group

• up

ins nsurance e cover

• verage f

age for

• r pl

plan an year ears begi beginn nning Ja January 1, y 1, 2014. 2014.

 If

If the i the indi ndividual al can el an elec ect t cover

• verage that

age that bec becom

• mes

es effectiv ive o

• n a

a date that does n s not exc xceed 90 90 days, ys, the the cover

• verage

age com

• mpl

plies es with th the the 90-day day wai aiti ting g per period

• d l

limitat ation.

 If an in

individu dividual l enrolls rolls as a la late enro roll llee or

• r

spe pecial l enrolle llee, any y pe period riod be before

• re th

the la late te or r spe pecial l enrollm llment in in not t a wa wait itin ing pe period riod.

 Bein

ing ot

• therwis

wise elig ligible ible to

• enroll
• ll in

in a pla plan me means havin ving met t the pla plan’s ’s subs bstantiv ive elig ligibility ibility con

• ndit

dition ions.

 Fee on

e on issuer ssuers of s of sp speci cifi fied he heal alth th i insur nsuranc ance e polic policie ies and d pla plan spo ponsors of applic pplicable self lf- in insured health lth pla plans.

 Fu

Fund d th the Pa Patient-Ce Cente ntered ed Outcomes s Rese sear arch h Institute ute (PCO CORI RI). ).

 Applie

pplies to to self lf-in insured health lth pla plans with with pla plan years en ending g af after er Sep eptember 30 30, 201 2012, an and bef efore Oc October er 1, 1, 201 019. 9.

 Equ

Equal l to

• th

the ave verage numbe mber of

• f live

lives cove

• vered

d du durin ring t the po polic licy y ye year or

• r pla

plan ye year mu multiplie ltiplied d by by th the applic pplicabl ble dolla dollar r amou

• unt

t for

• r th

the ye year.

 Polic

licy y and d pla plan ye years endin ding after Sept ptember 30, 0, 201 013, 3, an and bef efore Oc October er 1, 1, 201 014, 4, fee ee $2. 2.00 00.

 Will

ill be be adj djusted for in r infla lation tion f for polic

• r policy

y and d pla plan ye years be begin innin ing on

• n or
• r afte

ter Octobe

• ber 1,

, 201 014, 4, and bef efore Oc October er 1, 1, 201 019.

 Fo

Four r alte lternativ tive com

• mpu

putatio tion me methods

• ds

avai ailab able e to to issuer ssuers s of f sp speci cifi fied he heal alth in insurance polic policie ies.

 Three com

• mpu

puta tation ion meth thods ds ava vail ilabl ble to

• pla

plan spon ponsors of applic pplicable healt lth pla plans.

 Generally,

lly, all ll in individu dividuals ls wh who

• are cove
• vered

du durin ring t the po polic licy y ye year or

• r pla

plan ye year mu must t be be co count unted ed.

 Repo

ported on Form Form 720, , Quarterly ly Fe Fede deral l Ex Excis ise T Tax Retu turn.

 Ele

Electron

• nic

ic filin iling is is a ava vail ilable le bu but not re

• t required.

Payment t du due at t t the time time t the Form Form 7 720 is is du due. .

 Laur

ura a Anderso son LDA@TORKILDSON.COM 523-6000

 Rah

ahul Ma Maitra RSM@TORKILDSON.COM 523-6000