Nursing home operators should act decisively to take advantage of employer mandate delay, expert advises

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White House proposes 'accelerated' skilled nursing facility payment cuts
White House proposes 'accelerated' skilled nursing facility payment cuts

Nursing home advocates cheered the Obama administration's recent decision to delay implementing a key part of the Affordable Care Act, and a legal expert said operators must seize this opportunity to prepare for the future.

Under the ACA, businesses that employ 50 or more full-time workers must provide affordable health insurance or face penalties. The American Health Care Association has expressed strong concern that shrinking Medicare and Medicaid reimbursement rates make it impossible for some providers to comply. AHCA President and CEO Mark Parkinson, the leader of the nation's largest long-term care provider group, praised the White House's decision to delay the compliance date for one year, moving it back to Jan. 1, 2015.

“We appreciate the administration hearing our concerns and providing employers this additional time,” Parkinson told McKnight's in a statement on July 3.  “AHCA/NCAL also anxiously awaits additional guidance on the official details of yesterday's announcement.  Finally, we look forward to continuing to work with the Administration on the implementation of the Affordable Care Act.”

Due to the shifting deadlines and uncertainty over details, some providers may continue to delay adapting to ACA guidelines, but this would be “to their detriment,” according to Sharon Stiller, head of the employment law practice at Abrams, Fensterman, a New York law firm that works with many nursing homes. 

Some businesses might take advantage of the delay by reducing their staffs to fewer than 50 full-time workers, but nursing homes lack flexibility in staffing levels, Stiller told McKnight's. Long-term care facilities may benefit from this grace period more than other businesses — but only if operators seize the moment, she said.

She advised operators take certain steps, such as: 

  • Make sure insurance policies match the definition of terms in the Affordable Care Act, such as the definition of a full-time employee (30 or more hours).
  • Reconcile waiting periods for employee insurance coverage with the ACA's 90-day maximum.
  • Calculate to see if the insurance currently on offer meets the criteria for “affordable,” and determine what the choices are in providing insurance.
  • Calculate to see if it makes better economic sense to pay penalties than provide insurance.

“What I would do is prepare just as I would have prepared for the legislation going into effect as of 2014,” Stiller said.

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