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Don't HR Alone #24 - Senate ACA Replacement, and Q&A

Senate releases its version of health care replacement bill — PROPOSED LEGISLATION

The Senate has released an amended version of H.R. 1628 (the American Health Care Act of 2017). The “discussion draft” will, according to a statement on the website of the U.S. Senate Committee on the Budget, help stabilize collapsing insurance markets by creating a stabilization fund that would provide $15 billion per year in 2018 and 2019, and $10 billion per year in 2020 and 2021. It also provides for a short-term stabilization fund and cost-sharing reductions through 2019.

The amended version of the house bill is also touted as improving the affordability of health insurance in the following ways:

• through a Long-Term State Innovation Fund, which would dedicate $62 billion, over 8 years, to encourage states to assist high-cost and low-income individuals to purchase health insurance by making it more affordable;

• through tax credits targeted at defraying the cost of purchasing insurance. The tax credits would be advanceable and refundable, and they would be adjusted for income, age and geography;

• through expanded tax-free Health Savings Accounts (HSAs). The HSAs would have increased contribution limits to help pay for out-of-pocket health costs and to help pay for over-the-counter medications;

• through a repeal of the ACA taxes on health insurance, prescription drugs, medical devices, and the Cadillac tax on “high-cost” employer sponsored plans; and

• through providing states additional flexibility to use waivers that exist in current law (Obamacare 1332 Waivers) to decide the rules of insurance on their own, and through allowing the Department of Health and Human Services (HHS) to fast-track applications from states experiencing an “Obamacare emergency.”

The statement on the Budget Committee website also claims that the amended H.R. 1628 specifically preserves access to care for Americans with pre-existing conditions, and allows children to stay on their parents’ health insurance through age 26.

Medicaid. Much has been made of the deep cuts to Medicaid contained in the new version of H.R. 1628. The Senate amendments would, in 2021, begin gradual reductions in the amount of federal funds that had been provided under the ACA for Medicaid expansion, restoring levels of federal support to preexisting law by 2024. The amended version of the bill is also said to provide additional state flexibility to address substance abuse and mental health issues, while still guaranteeing that children with medically complex disabilities will continue to be covered. The Senate version allows states to choose between block grant and per-capita support for their Medicaid population beginning in 2020, with a flexibility in the calculation of the base year. It allows states to impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid.

SOURCE: U.S. Senate Committee on the Budget,, June 22, 2017.

Service Recognition Program

Question: Can you suggest a best practice policy for a service recognition program?

Answer: Awards for length of service are a common form of employee recognition. Employees like service award programs because they provide all employees with an equal opportunity to receive recognition, and the criteria is objective because it is based on the date of hire. Likewise, employers find these programs to be both useful and beneficial because they are easy and inexpensive to administer

. Here are some things to keep in mind when crafting a service recognition program:

  • Be sure to outline the eligibility criteria. Many employers go by years of service in multiples of five.

  • Within that criteria, include a rehire policy that states how long an employee may be gone from the workplace before their seniority date “resets” for tenure award purposes. Consider a statement such as: “Employees who leave XYZ Company and are rehired after more than [____ days/weeks/months/years] will be eligible for service awards based on their rehire date.”

  • Determine the substance of the actual award. Some employers offer a menu of awards for each tier and some have set awards that become more valuable as the years of service accumulate. Be sure the awards are applied consistently and that program changes are publicized to all employees to avoid issues with employee expectations and claims of unfairness or discrimination.

  • Keep in mind that military leaves cannot negatively impact tenure because taking such leaves cannot cause “harm” to the employees. Consider whether adjusting tenure for any leaves (family and medical leave, disability, pregnancy, etc.) could create discriminatory issues related to the reward policy.

As always, we recommend reviewing new or modified policies with counsel prior to implementation.

Work Weight Loss Competition

Question: We are considering an employee weight loss competition and an in-office scale per the suggestion of our employees and to encourage workplace health awareness. The competition would not be an office-sponsored event and we do not have a wellness plan. Do you have any best practice suggestions? Answer: Weight loss is a sensitive topic and a weight loss challenge in the workplace may be problematic. If you establish the challenge, then notify your empl

oyees that it is a personal challenge and is not employer mandated. Although this program could be sponsored by you or the employees, an employer cannot mandate participation or penalize for nonparticipation. Here are some best practices for implementation:

  • Ensure that the program is fair and objective; consider whether an outside provider may be best suited to monitor and run the program.

  • Ensure participants understand the sensitive nature of such a competition and the need to keep it professional, supportive, and measurable in a way that does not disclose personal or private details (weight, medical condition, etc.).

  • Encourage healthy eating and an easy to follow exercise regime. Provide educational materials on weight loss with an emphasis on health.

  • Encourage participating employees to seek the advice of a health care advisor or medical professional before participating in the program.

  • Do not publicize any individual’s actual weight.

  • Discourage any unhealthy methods of weight loss (starvation, use of water pills, etc.).

  • Require the organizer to draft a statement detailing that the program is voluntary, and require all participants to read, sign, and date the statement. The statement should outline the following:

  • The program is employee sponsored and voluntary.

  • The amount each participant is contributing toward the biggest weight loss between X and Y date (if a monetary prize is involved).

  • How the weight loss will be confirmed, validated, and who will determine the winner. Best practice is to only use percentage of weight lost rather than actual weight.

  • How the prize money will be allocated/returned/distributed in case of termination, employees leaving the program, injury, etc.

  • How a tie (equal weight loss between participants) will be handled.

OSHA Compliance for Optometry

Question: We are an optometry office. What should we have on file in case of an OSHA audit?

Answer: Based on the Occupational Safety and Health Administration’s (OSHA) healthcare and general industry rules, medical offices should have a compliant general industry safety plan. OSHA offers a compliance tool for the healthcare industry that will help ensure you have the right documents on file for general recordkeeping requirements as well as for any audit situation. OSHA also provides specific guidance for medical and dental offices.

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