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Smart Benefits: Next Steps in Healthcare Reform for Employers

Monday, January 13, 2014

 

The time to prepare is now.

With the January open enrollment season finally winding down, it's time for employers to start planning for the next phases of healthcare reform.

While many employers enjoyed a temporary reprieve thanks to delays of some rules, 2015 is just around the corner and the first of four important requirements will kick in then. And the time to prepare is now.

1. 30 is the new 40

Starting in 2015, large employers will face penalties if they don't offer coverage to employees who average 30 or more hours per week. That means, if employers previously only covered employees who worked 40 hours, they will likely have to incur the cost of covering more employees. And if they can't afford to offer coverage to more employees? They may have to cut back workers' hours and risk losing valuable employees.

2. Pay or Play

Not only must large employers offer coverage to employees who average 30 or more hours per week or face penalties, it must be affordable, minimum plan value coverage. If minimum essential coverage is not offered to at least 95% of full-time employees and children to age 26, employers will pay a penalty based on the number

of full-time employees. So, for example, 30 employees x $166.67 month. If coverage is offered but it's unaffordable or below minimum value, the penalty is $250 per month for each full-time employee who gets a premium credit subsidy through a healthcare exchange.

3. IRS Reporting Kicks In

In 2016, insurers will need to report information on minimum essential coverage it provides and covered individuals, while large employers subject to the pay or play rules must report on its affordable, minimum plan value coverage offered to full-time employees. Penalties for both are $50 per failure.

4. Cadillac Tax

Effective January 1, 2018, large and small employers will pay an excise tax if the total cost of medical benefits (including employer and employee contributions) exceeds $10,200 for single plans or $27,500 for family plans. This is indexed for

medical, HRA and Section 125 plans (pre-tax and FSA). The penalty is steep: a 40% non-deductible excise tax on the value of the benefits. Employers will need to determine if their plan designs falls below the threshold and, if not, they should consider plan design changes to avoid the tax -- sooner versus later.

 

Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.

 

Related Slideshow: 13 Biggest Healthcare Stories in Central MA in 2013

The most import stories from one of the most historic years in memory for Central Massachusetts healthcare.

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13 Inspection Scores

INTERACTIVE: Worcester Restaurant Health Inspection Tracker

Before you go out to dinner, make sure you know about the cleanliness of the establishment. GoLocalWorcester spent weeks going through the files of every health inspection in Worcester for nearly 700 restaurants. Use our proprietary interactive map to check any restaurant before you go out to eat. Check out our interactive map and fully sortable and rankable tabular data set to explore how your favorite restaurants did on their latest health inspections.

GoLocal also reported on the 50 Restaurants with the Worst Health Code Scores in Worcester and talked with experts about inspections -- and foodborne illnesses.

Click here to explore the interactive map!

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12 MA's Top 25 Diseases

The 25 Biggest Diseases To Strike Massachusetts

What infectious diseases hit Massachusetts the hardest, and in the biggest numbers? In July, The Centers for Disease Control (CDC) released its latest data for "notifiable diseases," defined as those infectious diseases "for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control fo the disease," according to the CDC. The latest data reports the number of cases in MA from 2011.

Click here to see the most prevalent notifiable diseases in MA!

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11 Famous Twins Thriving

Worcester Twins Thriving 17 Years After Famous Hug

When the Jackson twins were born 12 weeks premature in October of 1995 in Worcester, doctors were not sure if the two newborn girls were going to make it.

When one started to fade at just three weeks old, a nurse thought to put her sister in the same incubator as her, resulting in an immediate improvement in her health and the famous photograph of the "rescuing hug."

Now the girls are thriving 17-year-olds, and their story was recently featured on CNN.

Check out the video of the segment here.

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10 High Stress in MA

Gallup Poll: MA 5th Most Stressed Out State

A new poll from Gallup revealed that Bay State residents are a bunch of worrywarts. According to their most recent ranking, Massachusetts is facing the fifth highest levels of stress in the country.

While the Commonwealth’s ranking in this Gallup poll didn’t change since last year (also fifth place), the figures did shift. 

Click here to find out by how much.

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9 Healthiest Counties

The Healthiest Counties in Massachusetts

Worcester County ranked 9 out of Massachusetts’ 14 counties in overall health according to 2013 rankings by the Robert Wood Johnson Foundation, a national foundation focused on improving public health. The 2013 County Health Rankings place Worcester County somewhere near the bottom of pack. Dukes and Middlesex counties are the healthiest, while Suffolk and Hampden counties are the least healthy.

To see how all of Massachusetts's counties were ranked for overall healthiness, click here.

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8 MA Sexual Health

New National Ranking: How Sexually Healthy Is MA?

Massachusetts came in 4th place for sexual health in New England, according to the brand-new Sexual Health Rankings, just released this week.

The first-ever assessment of state-by-state data on 26 comprehensive health and services measures that speak to sexual health put the Bay State at #5 overall in the US, and #4 among New England states. Vermont was the #1 state in the country for sexual health, while Mississipi was the worst at #51. Variance, LLC, has produced the rankings in collaboration with The Center for Sexual Pleasure and Health, an education and advocacy organization based in Pawtucket, RI.

Click here to see where each New England state fell in the rankings.

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7 Health Code Experts

Experts Weigh in on Restaurant Inspections and Foodborne Illness

While restaurant inspections are required throughout the country, how they are conducted, recorded, and utilized varies greatly among towns and cities. While our custom interactive let you explore the inspections, its improtant to temper and contextualize your discoveries (some of them surprising!) with input from chefs, doctors, and national experts.

We reached out to a wide array of each when we conducted our look into the worst health inspection offenders in Worcester.

Click here to read their take on the story.

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6 Rampant Opioid Abuse

Massachusetts Drug Overdose Deaths Up 47% Since 1999

Last year we reported that Worcester's heroin use was twice the national average - Massachusetts is the top state in the country for opioid overdoses, and lifetime heroin use in Worcester is almost 5%, twice the state and national average.

This year a report recently released by the Trust for America’s Health (TFAH) showed that overall drug overdose deaths in Massachusetts have climbed 47% since 1999. The Bay State is now ranked 32nd out of 50 states in annual drug overdose deaths, with nearly 11 of every 100,000 deaths resulting from an overdose. The majority of these deaths were the result of prescription drug abuse- opioids.

Click here to read more.

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5 Curbing Candy Craze

11 Ways To Help Kids Curb Their Halloween Candy Craze

This Halloween, while Central Massachusetts kids were gearing up for a candy extravaganza, their parents were dreading the sugar assault on their children's health.

Statistics that show that Americans buy nearly 600 million pounds of candy during the Halloween season. That boils down to about 1.9 pounds of candy per person.

Kate Roberts, a consulting psychologist to school districts throughout Rhode Island and Massachusetts, says that with obesity and diabetes on the rise, not to mention the scare you’ll get at the dentist’s office parents may want to limit some of this devilish behavior. 

Check out her tips for curbing the crave here.

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4 Sale of St. Vincent's

Controversy Surrounds Buyer of St. Vincent + MetroWest Hospitals

On June 24th, Major US hospital operator Tenet Healthcare Corporaton announced its intention today to buy Vanguard Health Systems Inc for $1.73 billion, a purchase that would include Worcester's St. Vincent Hospital. The purchased marked the re-entry of Tenet Healthcare, a familiar and legally challenged for-profit hospital chain, back to Central Massachusetts.

Tenet owned the Central Mass. hospital once before, selling it to Vanguard in 2004. At the time, Tenet faced federal charges of Medicaid fraud. It wasn’t the first time that would happen, and it wouldn’t be the last. In the past decade, Tenet has shelled out more than $1 billion to settle a laundry list of legal charges. Read on to learn about the charges and for expert commentary on what their re-entry means for St. Vincent's and its patients.

Read the full report here.

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3 Nursing Home Rankings

Massachusetts Ranked #19 on National Nursing Homes Report Card

Massachusetts received a "B" ranking for nursing home quality of care from "Families for Better Care," a national nursing home resident advocacy group -- and earned the #19 top spot in the country overall.

The group published the nation’s "first-ever state-by-state nursing home report card" by analyzing eight federal measures to rank nursing home quality.

But local experts warned that MA's ranking did not directly mirror the more local picture in Worcester. While roughly 2/3 of nursing home residents in Massachusetts are there under Medicaid programs, the number is closer to 3/4 in Worcester County, according to Ernie Corrigan with the Massachusetts Senior Care Association. So do some more local research- check out our complete ranking and ensure the nursing homes you choose are not among the 1/3 of Worcester nursing homes graded "below average".

Click here for the full report.

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2 Nurses Fight at UMass

UMass Memorial Nurses Vote to Strike

Staff members at UMass Memorial hospital were embroiledinvolved in heated talks with the hospital’s administration, with the Massachusetts Nurses Association (MNA) union at their side. 2,000 of the hospital’s nurses were ready to take it to the next level. The nurses alleged that they were under staffed and putting patients at risk. The standoff dated back to mid-2012 and culminated around midnight on May 23rd, the night before the one-day strike was set to begin when a deal was reached to avert the strike.

The timeline:

November 15, 2012: UMass Memorial and Nurses Union Clash Over “Dangerous Mismangement”

December 13, 2012: Nurses Picket UMass Memorial Over Staffing + Pension Cuts

February 23, 2013: Local Nurses Say Hospitals “Skirting the Law”

April 11, 2013: UMass Memorial Nurses Prepared to Strike

April 12, 2013: UMass Memorial Nurses Vote to Strike

May 10, 2013: UMass Memorial Nurses to Hold One-Day Strike

May 18, 2013: UMASS Memorial/Hahneman Nurses Settle, University Nurses Pending

May 20, 2013: UMass Memorial Univ. Campus Nurses Strike Still Looming

May 23, 2013: No Strike—UMass Memorial and Nurses Reach Agreement

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1 Patients Rank Hospitals

New England’s Best Hospitals Rated By Patients

Traditionally, hospitals are rated and ranked on a combination of sound technical care, adequate resources, and impressive statistics. But an increasing emphasis is being placed on perhaps one of the more important measures: the patient’s perspective. With that in mind, GoLocal has sifted through and analyzed the results from a government-sponsored survey of more than 50,000 patients in 176 hospitals in New England (full chart here), and emerged with the first-ever patient-based ranking of the region’s top hospitals.

GoLocal consulted with patients, experts, and hospital administrators for their take to contextualize the rankings- click here to read the story.

Click here for the ranking of New England's Top 20 Hospitals

 
 

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