2014 Compliance Expectations Arizona Group Updates

1. 2014 Compliance Expectations Arizona Group Updates November 6, 2014 Jason N. Sheffield, J.D. National Legal & Research Group

2. Program Overview

3. section one Affordable care act update

4. Employer Mandate • “Pay or play” threshold

5. Employer Mandate • “Pay or play” workbook No $2,000 / Full Time Employee (less first 30)* Do you offer coverage to all full-time employees? YES YES YES Does the plan provide “minimum value”? (60%+ of total allowed costs) No $3,000 full-time employee receiving tax credit* Is the coverage affordable? (< = to 9.5% of income) No No penalty *80 for plan years beginning in 2015; 30 for PYB in 2016 and after

6. Employer Mandate • “FULLTIME” employee performs an average of 30+ hours of service per week or 130+ hours of service in any calendar month • “FULLTIME EQUIVALENTS” equals the sum of all hours of service performed by all employees: = 16 FTEs • = 16.11  2,080 33,500

7. Employer Mandate • Employee classifications post-aca

8. Employer Mandate • Part-time, variable Hour & Seasonal employees

9. Employer Mandate • Variable Hour process 2014 Hired 10/5/14 Measurement Period 10/5/14 - 10/4/15 2015 First Ongoing Measurement Period 1/15/15 - 1/14/15 First Administrative Period 10/5/15 - 11/30/15 First Ongoing Administrative Period 1/15/16-3/31/16 2016 First Stability Period 12/1/15 – 11/30/16 First Ongoing Stability Period 4/1/16-3/31/17 2017

10. EMPLOYER MANDATE • FINAL REGULATIONS ON WAITING PERIODS

11. EMPLOYER MANDATE • PROPOSED RULEMAKING ON THE FEDERAL ORIENTATION PERIOD

12. section two Agency auditson the rise

13. AGENCY AUDITS • WHO DOES WHAT? 12

14. AGENCY AUDITS • WHO DOES WHAT?

15. AUDIT TRIGGERS • What triggers an agency audit?

16. current standards of worker classification

17. identifying misclassification within the organization • Part A – Employee Relations

18. identifying misclassification within the organization • Part B – Organizational Alignment

19. managing agency audits Audit Process

20. managing agency audits • Negotiation & Settlement of Audit Penalties & Civil Liabilities

21. section three Privacy & securityupdate

22. NEW HIPAA Regulations • Designed to Build on Existing Rules

23. 2013 RULE NO. 1 – part i • Final Modifications to HIPAA’s Privacy, Security & Enforcement Rules

24. 2013 RULE NO. 1 – part ii • Final Modifications to HIPAA’s Privacy, Security & Enforcement Rules

25. 2013 RULE NO. 2 • HITECH – Final Rule Modifying the Enforcement Rule

26. 2013 RULE NO. 3 • HITECH – Final Rule on Breach Notification

27. 2013 RULE NO. 4 • GINA – Final Rule Prohibiting Genetic Information Disclosure for Underwriting

28. THE NEW TIERED BREACH SCHEME

29. THE NEW TIERED ENFORCEMENT SCHEME

30. FACTORS AFFECTING CIVIL MONETARY PENALTY

31. HISTORY OF OCR ENFORCEMENT OCR – Resolutions by Year & Type April 14, 2003 – December 31, 2013

32. ADMINISTRATIVE SIMPLIFICATION • UTILIZATION OF UNIQUE HEALTH PLAN IDENTIFICATION NUMBERS & OTHER ENTITY IDENTIFIERS DELAYED

33. ADMINISTRATIVE SIMPLIFICATION • HIPAA-REQUIRED CERTIFICATIONS DELAYED

34. ADMINISTRATIVE SIMPLIFICATION • HIPAA-REQUIRED CERTIFICATIONS DELAYED

35. Questions?

36. Participant resources

37. participant resources employee misclassification assistance

38. participant resources general hipaa compliance

39. participant resources health and human servicescenters for medicare & medicaid

40. participant resources health and human services office for civil rights

41. participant resources department of the treasury internal revenue service employer plans unit

42. participant resources united states department of laboremployee benefits security admin.

43. participant resources united states department of laborwage & hour division