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BILLS AMENDING THE AFFORDABLE CARE ACT

This document outlines various proposals in both the House and Senate to address parts of the Affordable Care Act – some of whichmay gain traction in either chamber. This list is by no means exhaustive and there are certainly improvements to be made to the lawthat may not have legislative solutions at this time. Shaded bills are those Senator Heitkamp has cosponsored in the current or previousCongress. If there is no bill number, it has not been reintroduced.

EXPANDING ACCESS

Enhancing Access for Agents and Brokers Act S. 1653 Enhances access toMarketplace enrollment forindependent agents andbrokers.

Senator Bill Cassidy (R-LA)

Public Option Deficit Reduction Act H.R. 265 Requires HHS to offer apublic health insurance optionon the Marketplace.

Rep. Jan Schakowsky (D-IL)

Pregnancy Assistance Fund Expansion Act S. 221 Authorizes additional fundingfor FY2016-FY2019 for thePregnancy Assistance Fundfor grants to states to assistpregnant and parenting teensand women.

Senator Bob Casey (D-PA)

Medicaid Expansion Incentive Act H.R. 778 Redistributes federal fundsthat would otherwise be madeavailable to states notexpanding Medicaid to statesthat do.

Rep. Gerry Connolly (D-VA)

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Expanded Consumer Choice Act Creates a new Copper tier ofcoverage to be offered in theMarketplaces that will berequired to cover the sameessential health benefits, butwith 50% actuarial value.

Senator Mark Warner (D-VA)

Family Coverage Act Addresses the “family glitch”to allow dependent childrenand spouses with an offer ofunaffordable employer-sponsored coverage (coveragethat would cost more than 9.5percent of their familyincome) to be eligible toapply for tax credits on theMarketplace. Currently, thedefinition of “affordablecoverage” only applies tosingle coverage plans.

Senator Al Franken (D-MN)

Small Business Tax Credit Accessibility Act

S. 379

Raises the maximum averagesalary to qualify for thecredits from $50,000 to$100,000, the maximum sizeof the business from 25employees to 50 employees,and allows small businessowner’s families to directlybenefit from the tax credits.Also allows the SmallBusiness Tax Credit to beused for coverage purchasedoutside of the SHOP for 2015.

Senator Chris Coons (D-DE)

H.R. 762 See above Rep. Suzan DelBene (D-WA)

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To permit insurers to offer catastrophiccoverage plans to anyone, and for otherpurposes

H.R. 371 Allows catastrophic plans tobe offered as qualified healthplans to any individual in theindividual or group market.

Rep. Jeff Fortenberry (R-NE)

Commonsense Competition and Access toHealth Insurance Act

Directs the NationalAssociation of InsuranceCommissioners (NAIC) todevelop a model for states tocreate and enter into interstatehealth care choice compactsand identify challenges forStates to allow issuers to sellqualified health plans in otherstates.

Senator Mark Warner (D-VA)

EMPLOYER MANDATE

Small Business Stability Act S. 1415 Permanently increases thethreshold for the employermandate from 50 FTEs to 100FTEs and streamlines thedefinition criteria to clarifyemployers eligible topurchase coverage in thesmall group market areexempt.

Senator Heidi Heitkamp (D-ND)

Forty Hours Is Full Time Act S. 30 Modifies the formula forcalculating the number of full-time employees employed byan applicable large employer

Senator Susan Collins (R-ME)

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subject to the mandate anddefines a "full-timeemployee" as an employeewho is employed on averageat least 40 hours per week(currently, 30 hours).

Save American Workers Act H.R. 30 See above Rep. Todd Young (R-IN)

Small Business Fairness in Health Care Act S. 432 Exempts a small businessconcern, as defined by theSmall Business Act, from theACA employer mandate toprovide employees withminimum essential health carecoverage and redefine "full-time employee," for purposesof such mandate, as anemployee who is employed onaverage at least 40 hours aweek.

Senator Mike Enzi (R-WY)

Hire More Heroes Act S. 12 Exempts any employee withcoverage under a health careprogram administered by theDepartment of Defense,including the TRICAREprogram, or by the VeteransAdministration, fromclassification as an eligibleemployee of an applicablelarge employer for purposesof the employer mandate.

Senator Roy Blunt (R-MO)

H.R. 22 See above Rep. Rodney Davis (R-IL)

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Safeguarding Classrooms Hurt by ObamaCare'sObligatory Levies Act

S. 470 Excludes any elementary orsecondary school, state orlocal educational agency, andinstitution of higher educationfrom the definition of"applicable large employer"for purposes of the employermandate.

Senator John Thune (R-SD)

H.R. 769 See above Rep. Luke Messer (R-IN)

STARS Act Exempts seasonal employeesfrom the definition of "full-time employee" for purposesof the employer mandate.

Senator Kelly Ayotte (R-NH)

H.R. 863 See above Rep. James Renaci (R-OH)

Fairness for Farmers Act H.R. 1387 Excludes nonimmigrantagricultural seasonal workersfrom the definition of "full-time employee" for purposesof the employer mandate.

Rep. Renee Ellmers (R-NC)

Protecting Volunteer Firefighters andEmergency Responders Act

S. 420 The final rule released by theAdministration in January2014 exempted volunteer firstresponders from beingcounted in determining thenumber of full-timeemployees at a givenemployer for the purposes ofthe employer sharedresponsibility provisionscounted. This codifies thepolicy by amending the

Senator Mark Warner (D-VA)

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definition of “full-timeemployee” to ensure thatqualified emergency servicesvolunteers are not counted.

H.R. 2658 See above Rep. Lou Barletta (R-PA)

Treating Families Fairly Act Exempts dependentsemployed by the same firmand covered under theemployer-sponsored planfrom counting towards thefull-time employeecalculation.

Senator Joe Manchin (D-WV)

PACE Act S. 1099 Allows states to maintain thecurrent small group marketdefinition, which applies tobusinesses with up to 50employees, in order to preventpremium increases anddisruption for small and mid-sized businesses

Senator Tim Scott (R-SC)Senator Jean Shaheen (D-NH)

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FSAs/HSAs/HRAs

Small Business Healthcare Relief Act S. 1697 Restores ability for smallemployers, not required tootherwise offer healthinsurance under the law, tooffer tax-preferred HRAswithout also providingaccompanying qualifyinghealth insurance coverage.Employees can only use thesefunds to purchase qualifiedinsurance and/or pay for costsassociated with healthcoverage (including coverageunder a spouse’s plan). Thosetaking advantage of this tax-preferred product are then noteligible for Marketplacesubsidies.

Senator Chuck Grassley (R-IA)Senator Heidi Heitkamp (D-ND)

H.R. 2911 See above Rep. Charles Boustany (R-LA)Rep. Mike Thompson (D-CA)

Family Health Care Flexibility Act S. 836 Repeals ACA provisions thatrestrict payments from healthsavings accounts, Archermedical savings accounts, andhealth flexible spending andreimbursement arrangementsfor medications toprescription drugs and insulinonly (thus allowing paymentsfor over-the-counter

Senator Mike Johanns (R-NE)

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medications) and imposes a$2,500 limitation on salaryreduction contributions to ahealth flexible spendingarrangement under a cafeteriaplan

H.R. 15478 See above Rep. Erik Paulsen (R-MN)

Helping Save Americans' Health CareChoices Act

H.R. 3006 Increases the maximumcontribution limit to an HSAand delinks the connectionbetween high deductiblehealth plans and HSAs, andallows an HSA to be used topurchase health insurancepremiums; over-the-countermedications; and pre-paidphysician fees.

Rep. John Fleming (R-LA)

Restoring Access to Medication Act S. 709 Repeals the requirement of aprescription to use FlexibleSavings Accounts (FSAs),Health Savings Accounts(HSAs) and Medical SavingsAccounts (MSA) to purchaseover-the-counter drugs.

Senator Pat Roberts (R-KS)Senator Heidi Heitkamp (D-ND)

H.R. 1270 See above Rep. Lynn Jenkins (R-KS)

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TAXES

Medical Device Access and InnovationProtection Act

S. 149 Repeals the excise tax onmedical device manufacturersand importers

Senator Orrin Hatch (R-UT)

Protect Medical Innovation Act H.R. 160 Rep. Erik Paulsen (R-MN)

Medical Device Tax Elimination Act H.R. 1533 Rep. Dan Maffei (D-NY)

Jobs and Premium Protection Act S. 183 Repeals the annual fee on ahealth insurer based on netpremium income

Senator John Barrasso (R-WY)

To repeal the annual fee on health insuranceproviders enacted by the Affordable Care Act

H.R. 928 Rep. Charles Boustany (R-LA)

Ax the Tax on Middle Class Americans’Health Plans Act

H.R. 879 Repeals the excise tax on theexcess benefit portion of high-cost employer-sponsoredhealth care plans (referred toas “Cadillac” plans)

Rep. Frank Guinta (R-NH)

Middle Class Health Benefits Tax Act H.R. 2050 Rep. Joe Courtney (D-CT)

Page 40 • 40 Under 40 2015

Since becoming CEO, Theo Stoller has brought a whole new energy to Jacobson Memorial Hospital Care Center in Elgin. He is not afraid to wear multiple hats, whether it’s helping the maintenance department or fi xing computers. Age: 29

Position and company: CEO of Jacobson Memorial Hospital Care Center

Family: I am married to Crystal Stoller and have two children: Brooklyn, who is 5 years old, and Easton, who is 18 months old.

Hobbies: I enjoy spending time on our family farm ranching and hunting.

Community involvement: I serve on the Elgin Lion’s Club, New Leipzig City Council, EMT on New Leipzig Ambulance Service, vice president of Elgin Economic Betterment Club and Mule Deer Foundation member.

Career path: I graduated from Dickinson State with my bachelors of science, majoring in human resource management, and I accepted a position at Jacobson Memorial Hospital Care Center as the human resources director in 2008. Around two years ago, I was asked to serve as the CEO, and I graciously accepted.

Mentors: My professional mentors would include Jim Opdahl, Brandon Vaughan and Gary Miller. My personal mentors would include both sets of my parents: Bruce and Genia Kasper and Myles and Wanda Stoller. In addition, my ambulance squad leader, Carrie Roth.

Briefl y, tell us about yourself: I feel that I am a hard working, dedicated professional who is always willing to learn new things. If I have stopped learning, then I have stopped

growing. In my career thus far, I have learned many things, but some of the principles that I have used are to always do the right thing the right way and remember why we are all here. Basic common courtesy and ethics can get us all a long way. In my case, being in health care, we always need to do what is best for the patient.

What motivates you? Patient satisfaction

Challenges in your career path: Everyday is a new challenge; it is how we grow from those challenges and make those opportunities into strengths.

What’s the biggest risk you’ve ever taken? Serving as the CEO at Jacobson Memorial Hospital Care Center

Anything of which you’re particularly proud? I am sincerely proud to be a part of Jacobson Memorial Hospital Care Center. It brings a smile/tear to my eye when I know the organization that I lead saves a life or does something wonderful for the communities we serve.

What advice would you offer other young professionals? With change comes opportunity, and always be ethical and honest.

For what are you thankful? I am very thankful for my supportive wife who has allowed me to take the career path I have chosen and supported me throughout. In addition, the rest of my family, and I could not be doing what I do without the leadership team at Jacobson Memorial Hospital Care Center and the very supportive board of directors.

What do you see yourself doing in 10 years? I would hope that I am still serving my mission in health care to be serving patients.

Theo Stoller

601 East St. N.Elgin, ND 58533(701) 584-2792

THEO STOLLERCongratulations on yourselection to the Bismarck

Tribune’s Forty Under 40 classof 2015!

Your dedication, enthusiasmand insight are inspiring.

Thank you for all you do forour hospital and communities.

Submitted photo

For questions, contact Angie Lockwood, Center for Rural Health701.777.5381 | angela.lockwood@med.und.edu

The North Dakota Flex Program Presents:North Dakota Critical Access Hospital Revenue Cycle WebinarThursday, August 27, 2015 • 11:00 am - 12:30 pm CSTPresenters: Mark Hollan & Phil Schmid, Independent Healthcare ConsultantsThis webinar will provide an overview of those revenue cycle, billing, and compliance issues that have been consistently noted during the last and current cycles of IHC’s North Dakota CAH Revenue Cycle Management Analysis reviews. IHC will highlight key findings and recommendations as well as provide thoughts on methods for implementing needed changes. The target audience for this educational webinar is CAH CEOs and CFOs, as well as hospital board members.

Topics that will be covered include:Chargemaster • Billing of Observation services / OP Services (time elements needed in the chart) • Charging and billing for Drug Administration services • Capturing appropriate ER charges • Supply Department charging • Issues with pricing Compliance • Chart documentation for wasted drugs • RHC regulations (2014/2015 updates) • 96 Hour Certification • 24/7 physician coverage notice requirements • ABN processes Revenue Cycle • Always new billing staff & managers (Train, Train, Train…continued education) • Clinic upfront collections • Pre authorization for high cost imaging services • Electronic payment posting • Financial Assistance Policy (FAP) requirements • Medicare Bad Debt tracking

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