What is the Federally Facilitated Marketplace’s (FFM) 2016 Employer Notice Program that is run by the Centers for Medicare and Medicaid Services (CMS)? It’s important that you know, and we are happy to help you out.
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While the Internal Revenue Service (IRS) thoughtfully extended the filing deadline for Forms 1094-B, 1094-C, and 1095-C to May 31, 2016, if filing nonelectronically (sadly, that date has passed) and to June 30, 2016, if filing electronically, you are hopefully long done with the worst of the process—because you had to get Forms 1095-B and 1095-C to your employees by the end of March.
Now there’s even more fun employers can look forward to: FFM’s 2016 Employer Notice Program, run by the CMS.
What’s that, you may ask? It’s a program in which you may find yourself a less-than-enthusiastic participant if you fail to meet your obligations under the play-or-pay rules, or worse, if the government simply believes you failed to do so. Read more on this below.
APTCs for Employees = Penalties for Employers
As you probably know, the Affordable Care Act (ACA) requires the various health insurance marketplaces (Marketplace) to notify any employer whose employee was determined eligible for advanced premium tax credits (APTCs) and cost-sharing reductions (CSRs) because the employee attested that he or she was neither enrolled in employer-sponsored coverage nor eligible for employer coverage that is affordable and meets the minimum value standard.
Starting in 2016, the FFM will notify certain employers whose employees enrolled in Marketplace coverage with APTCs. The FFM will send notices to employers if the employee received APTCs for at least 1 month in 2016 and if the FFM has an address for the employer. The program will expand to additional employers in 2017 and beyond.
What Will the Notice Say?
The notice will identify the specific employee and will include a statement that the employee is enrolled in Marketplace coverage with APTCs; it will not contain the employee’s personal health information or federal tax information. Note that, for 2016, the FFM will not notify employers when an employee who was benefiting from APTCs or CSRs terminates Marketplace coverage.
We’re in a State with a State-Based Marketplace (SBM)—What Happens Here?
CMS reports that SBMs have the same flexibility to phase in their employer notices process in an effort to enhance operational efficiency and improve stakeholder engagement. SBMs will continue to have the option to refer employer appeals to the U.S. Department of Health and Human Services appeals entity. (So you’re not off the hook, in other words.)
When Are These Notices Going Out?
The FFM is sending notices in batches, with CMS reporting that the first batch will go out sometime in Spring 2016 … So, anytime now. This will likely be the largest batch of notices, says CMS, as it will include employers whose employees enrolled in Marketplace coverage with APTCs during open enrollment, which ended on January 31, 2016. The FFM will send additional batches of notices throughout 2016.
If you think you may be receiving a notice, be on the lookout so you don’t accidentally toss it as junk mail. For 2016, all notifications will be coming through postal mail rather than via e-mail, though the process may change in future years.
Tomorrow, more on this topic, including how to appeal.