Tele-detectives are calling employers now to see whether some public health insurance exchange users lied when they swore they lacked access to a minimum level of employer-sponsored coverage.
The Center for Consumer Information & Insurance Oversight (CCIIO), a unit of the Centers for Medicare & Medicaid Services (CMS), has described the employer coverage verification study in a section on a new employer initiatives Web page.
Investigators working for a CMS contractor started calling employers for the study in April, and will be placing calls at least until June.
The calls take place from 9 a.m. to noon and from 1 a.m. to 5 p.m., local time, and a typical call is expected to last from 10 to 15 minutes, CCIIO officials say. Employer participation in the study is voluntary.
“Employer participation will enable CMS to evaluate for plan year 2016 whether an employee, or a sample of employees, correctly attested that he or she was not offered [employer sponsored coverage] that met affordability and minimum value requirements,” officials say.
The Patient Protection and Affordable Care Act (PPACA) makes premium tax credit subsidies and cost-sharing reduction subsidies available to some exchange plan users who meet subsidy income requirements, buy the right kinds of exchange plans, and lack access to affordable coverage with a minimum value from their employers, or from other sources.
PPACA imposes an “individual shared responsibility” penalty on some individual taxpayers who fail to have what federal agencies have classified as “minimum essential coverage” (MEC).
PPACA also imposes “employer shared responsibility” penalties on some employers that fail to offer affordable coverage with a minimum value to certain employees, if those employees end up qualifying for premium tax credit subsidies through the PPACA exchange system.
CCIIO says it’s conducting the coverage verification study to check what individuals are saying about their coverage on exchange applications, not to determine whether employers should pay employer shared responsibility mandates.
Before a worker can use a PPACA exchange subsidy to pay for exchange coverage, the exchange has to determine that the worker’s employer fails to provide adequate access to MEC. The exchange is supposed to notify the employer about the determination. An employer that believes it does offer a worker MEC can appeal the exchange determination.
“Whether or not an employer chooses to appeal will not have any effect on the IRS’s determination of liability for the employer shared responsibility,” officials say.
“The IRS will independently determine any liability for the employer shared responsibility payment,” CCIIO adds, in boldface type.