SECTION 1: Summary
Chapter 58 of the Acts of 2006, An Act Providing Access to Affordable, Quality, Accountable Health Care, is hereby amended to improve access to affordable health insurance for self-employed
people, independent contractors, working artists, part-time workers, and workers who work part-time jobs and engage in a self-employed enterprise, also known as combined income individuals. This Act will increase eligibility for the Insurance Partnership for both employers and individuals; and provide the self-employed more support in accessing the most affordable insurance option. This Act will also protect and aid small businesses and small nonprofit organizations.
SECTION 2: Definition of "Eligible Employee"
Section 9C of chapter 118E, subsection 1 (as amended by 2006, 58, Sec. 19) under the definition of
"Eligible Employee", is hereby amended by striking subsection (iv) in its entirety.
SECTION 3: Definition of combination income individual
Section 9C of said chapter 118E is hereby amended by inserting the following definition: "Combination Income Individual," Individuals with incomes deriving from more than one income source including 1) part-time employment 2) full-time employment 3) independent contract work 3) seasonal work 4) self-employment 5) or any other types of income sources not mentioned.
SECTION 4: Determining "Income" for combination income individuals and the self-employed
Combination Income Individuals and self-employed individuals may incur expenses associated with
the creation of art, learning new skills associated with professional work, inventing new products or processes for commercial purposes, or other professional pursuits from which the individual does not derive a majority or any of their overall income.
Section 9C of chapter 118 is amended by adding the following language: “(5) One of the methods of income determinations for Combination Income Individuals and self-employed individuals may be taxable income as defined by the Internal Revenue Code as TOTAL INCOME as defined TITLE 26, Subtitle A, CHAPTER 1, Subchapter B, PART I, Sec. 63., as appears on line 22 of the 1040 individual income tax return form and as found in other IRS tax forms that may be filed by tax payers but is identified by other line numbers on those IRS forms"
SECTION 5: Eliminating the Self-employment Penalty
Amend Section 9C of chapter 118E, subsection 1, by adding the following language after the words
"eligible employer": - nothing in this section shall exclude a self-employed single individual or self-employed husband and wife from eligibility for programs under Chapter 118H, provided that all other eligibility criteria have been met in accordance with the definitions in Chapter 118E as amended.
SECTION 6 Calculating Fair Share Employees
(a) Section 188 of Chapter 149, “Fair Share Employer Contribution,” is amended by inserting under subsection (c) the following paragraphs:
(11) For the purpose of the Fair Share Contribution compliance test, an employer may count employees that have qualifying medical insurance coverage from a spouse, a parent, a veteran’s plan, Medicare, Medicaid, MassHealth or a plan or plans due to a disability or retirement towards their qualifying take-up rate as a “Contributing Employer,” as defined by the Division of Health Care Finance and Policy. Medical insurance coverage from the Commonwealth Care program may not be counted as qualifying medical insurance coverage towards the FSC contribution compliance test. The employer is still required to offer insurance and must keep and maintain proof of their employees’ insurance status.
SECTION 7: Mitigation and Waiver of Employer’s Fair Share Contribution and Related Liabilities
Chapter 149 : Section 188 Fair Share Employer Contribution is amended by inserting
(f) The Division of Unemployment Assistance and the Division of Health Care Finance and Policy may waive or mitigate an employer’s Fair Share Contributions, Free Rider Surcharges, fines, interest, and related fees when collection would bankrupt a business owner or business, or force the business to close.
(g) The Division of Health Care Finance and Policy shall create and implement a hardship appeal and waiver process for employers for the Fair Share Contribution (“FSC”) requirement and will direct the Division of Unemployment Assistance to waive or reduce an employer’s fair share contributions, fines, interest, or related fees if the collection of such moneys will cause business closure, bankruptcy of the employer’s business or of the employer’s personal finances. Pending an appeal decision, the Division of Unemployment Assistance shall not continue to accrue or collect interest, penalties or fees on the Fair Share Contribution once a business has entered into a payment agreement. DUA shall notify all businesses at least thirty days in advance of an audit both verbally and by certified mail of the FSC hardship appeal and waiver process.
(h) The Division of Health Care Finance and Policy shall create and implement a hardship appeal and waiver process for employers for the Free Rider Surcharge. The Commonwealth Health Insurance Connector Authority, DUA and DHCFP will post downloadable versions of the FSC and Free Rider Surcharge hardship and waiver processes and relevant forms on their websites in an easy to find place and shall make available hardcopies of the instructions and forms. These forms shall be sent by DUA and DHCFP to all employers that are past due on payments regarding the Fair Share Contributions or Free Rider Surcharge.
(i) The FSC and Free Rider Surcharge appeals and waiver processes shall also take the following into consideration when determining when to waive or mitigate any fair share contribution or Free Rider Surcharge moneys owed by employers:
(1) If the employer is experiencing hardship such as but not limited to eviction, utility shut off, a medical emergency, death in their immediate family, a sickness or a short term disability that prevents the employer from working or running their business.
(2) If the employer’s business has experienced a major disaster either natural or manmade such as but not limited to a fire, flooding, major wind damage, major theft, or the long term loss of electricity, water, or heat due to storms or other such causes.
(3) If the employer’s business is a nonprofit organization that has a valid IRS letter of determination, the Division of Unemployment Assistance and the Division of Health Care Finance and Policy shall determine and acknowledge if any of moneys held by the business are bound by legal contractual obligations and therefore prohibits the employer from using said moneys to pay their assessed fines, interest, and related fees for the FSC and the Free Rider Surcharge.
(4) If the employer made a good faith effort to comply with Chapter 149: Section 188 during the first year of the implementation of Chapter 58 or during their first year of business, whichever occurred last.
(j) If an employer is found liable for the Fair Share Contribution and/or the Free Rider Surcharge and if the employer relied on a paid/contracted outside third party’s error, the third party will be entirely responsible for the said financial obligations.
(k) DUA or any entity of the Commonwealth shall not take any funds out of an employer’s bank account if the employer has filed a FSC appeal, hardship appeal/waiver or is in the process of mediation and is awaiting a decision.
(l) The Division of Unemployment Assistance shall not allow their audit department staff to answer the Division of Unemployment Assistance helpline or to staff the Division of Unemployment Assistance help centers. Nor shall the Division of Unemployment Assistance’s help center staff share customer information with the audit department staff. No information recorded by the helpline may be used in an audit proceeding or be used to initiate an audit.
(m) For the purposes of Chapter 149: Section 188, an offer of insurance shall mean that the company has a group health insurance plan that is active or has made an offer of a group health insurance plan that can be put in place on the first day of the month that an eligible employee requests it. The offer of health insurance must be from an insurance carrier that is licensed by DOI to conduct business in the Commonwealth. All offers of group health insurance must have the date of the when request was made and the date or dates the plan can be activated.
(n) The Division of Health Care Finance and Policy, the Commonwealth Health Insurance Connector Authority, and the Division of Unemployment Assistance shall hold joint quarterly meetings with the small businesses and small nonprofit advocates. The meetings times and places must be posted on their websites at least two weeks prior to the meeting.
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