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Category: AHCA (American Health Care Act)

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Part II: COVID-19 Supplemental Sick Leave for California Employers (SB 95)

COVID-19 Supplemental Sick Leave

SB 95 Bill

Details of the recent SB 95 Bill that provides supplemental sick leave as a result of Covid-19

 In part I of this blog, we talked about the past Assembly Bill 1867, sick leave hours for the newest SB 95 bill, and eligibility. Today, we’ll be discussing the following points: 

  • How SB 95 interacts with other leave laws

  • Requirements, notices, and pay stubs

  • Compliance recommendations

SB 95 Interaction with Other Leave Laws

An employer may not require an employee to use other paid or unpaid time off before the employee uses SB 95 leave.

California Sick Leave – The Healthy Workplace Healthy Family Act

SB 95’s paid sick leave is in addition to any paid sick leave available pursuant to California’s sick leave law, known as the Healthy Workplace Healthy Family Act of 2014, established in Labor Code section 246.

Cal/OSHA Emergency Temporary Standards Required Paid Leave

Late last year, Cal/OSHA enacted Emergency Temporary Standards (ETS) that required employers, among other things, to prepare and implement a COVID-19 Prevention Program. Employers also had to provide “continued earnings” to employees who were excluded from the workplace because of work-related exposures or positive COVID-19 cases. SB 95 clarifies that employers may require an employee to exhaust supplemental paid sick leave under SB 95 before becoming eligible for “continue earnings” under the ETS.

If an employee took leave for an SB 95 qualifying reason after Jan. 1, 2021 pursuant to any federal, state, or local law, or employer-provided COVID-19 leave, it can be counted as leave provided under SB 95. The employer might be required to provide retroactive payment to the employee for the leave taken if it was unpaid or not paid at the level required by SB 95.

Retroactive Pay Requirement

SB 95 supplemental sick leave became retroactive to Jan. 1, 2021. The new law established these provisions for retroactive payments:

  • The employee took supplemental paid sick leave specific to COVID-19 on or after Jan. 1, 2021 (for example, a city-mandated leave for quarantine).

  • The leave was for one of the reasons covered by SB 95, as defined above.

  • The leave was either unpaid or paid at a lower rate than mandated by SB 95.

If all of these conditions are met and the employee requests retroactive pay either orally or in writing, the employer must comply. Once retroactive payments are made, employers may take credit for the leave hours previously provided.

Retroactive payments must be paid on or before the next full payroll period after the employee requests it. And employers might have to replenish the PTO, vacation, or other leave banks of employees who used them while on an SB 95 leave prior to its enactment.

Requirements and more

Notice Requirements

 Employers must provide employees with notice of the new law. The Labor Commissioner’s Office will release a model notice by the end of March. Employers may provide this notice electronically.

Pay Stub Requirements

  • The COVID-19 supplemental paid sick leave balances must be included on itemized wage statements.

  • The COVID-19 supplemental paid sick leave must be denoted separately from regular paid sick days. 

For employees that have part-time and variable schedules (making their leave entitlements variable), the new law specifies that the employer satisfy the wage statement obligation by doing an initial calculation of leave available and indicating “variable” next to it on the initial and subsequent wage statements. The calculation must be updated when leave is taken.

In-Home Health-Care Providers and Firefighters

A separate section in SB 95 outlines similar leave requirements for providers of in-home health care and supportive services firefighters.

Compliance Recommendations

 Employers are encouraged to take these steps to ensure compliance with the new law.

  • Educate and train human resources and payroll employees about the new supplemental paid sick leave requirements. Employers might want to include in the training the new law’s impact on Cal/OSHA’s emergency temporary standard (ETS) exclusion pay, as well as the requirement that the employer replenish vacation, sick leave, and PTO banks for leave taken since Jan. 1, 2021 for a covered reason.

  • Direct payroll employees to create or reinstate a separate COVID-19 supplemental paid sick leave designation on wage statements.

  • Watch for and post and/or electronically distribute the COVID-19 supplemental sick leave model notice the labor commissioner issues.

Be sure to check out part I of this blog to get all the details on the SB 95 bill.

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Part I: COVID-19 Supplemental Sick Leave for California Employers (SB 95)

COVID-19 Supplemental Sick Leave

COVID-19 Supplemental Sick Leave

COVID-19 Sick LeaveCalifornia Employers Must Provide 80 Hours of Paid COVID-19 Supplemental Sick Leave

The law places new paid leave requirements on most California employers, and it requires their immediate attention. In this first part of this two-part blog, we’ll be addressing the following points for SB 95:

  • The past bill: Assembly Bill 1867 was enacted in California to provide supplemental paid sick leave to employees
  • The new bill: SB 95 provides supplemental sick leave hours (and other requirements)

Gov. Newsom explained the reason for the new law: “Paid sick leave gives workers the time they need to care for themselves and loved ones while keeping their co-workers, families, and community safe.”

The law takes effect immediately but includes a 10-day grace period for employers to start providing sick leave. Employers must begin providing the leave on March 29, 2021.

The new law applied retroactively to Jan. 1, 2021, and will remain in effect until Sept. 30, 2021. It’s enforced by the California Labor Commissioner.

Prior Supplemental Sick Leave Laws Applicable to California Employers

Last year, Assembly Bill 1867 was enacted in California to provide supplemental paid sick leave to employees at businesses with 500 or more workers. It was intended to fill the gaps for employees not covered by the federal Families First Coronavirus Response Act (FFCRA), which applied to all employers with a workforce up to 500 employees.

AB 1867 and the FFCRA expired on Dec. 31, 2020. Note: SB 95 does not extend either piece of legislation, but creates an entirely new mandate with a new required “bank” of available paid sick leave. So even if California employers paid out supplemental paid sick leave in 2020, they must create new leave banks for eligible employees in 2021.

  • Covered Employers — The new law applies to all California employers with more than 25 employees.

  • Eligible Employees — Employees who are not able to work or telework for any of the reasons detailed in the legislation qualify for the paid leave. No length of service is required to be eligible for leave. Employees may request the leave orally or in writing.

  • Qualifying for Leave — The first two qualifying reasons for leave (below) were included in the original California and FFCRA paid sick leave laws. SB 95 adds five more. Qualifying reasons for SB 95 leave are:

    • The employee is subject to a quarantine or isolation period related to COVID-19 as defined by an order or guideline of the state Department of Public Health, the federal Centers for Disease Control and Prevention (CDC), or a local health officer with jurisdiction over the workplace.

    • The employee has been advised by a health-care provider to self-quarantine due to concerns related to COVID-19.

    • The employee is attending an appointment to receive a vaccine for protection against COVID-19.

    • The employee is experiencing symptoms related to a COVID-19 vaccine that prevents him or her from being able to work or telework.

    • The employee is experiencing symptoms related to COVID-19 and is seeking medical diagnosis.

    • The employee is caring for a family member who is subject to a quarantine for isolation order or has been advised to self-quarantine.
    • The employee is caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID-19.

Employees Are Eligible for Up to 80 Hours of Leave for Full-Time Employees

Full-time is defined as an employee classified as full-time by the employer, or who was scheduled to work, on average, 40 hours or more per week in the two weeks preceding the date on which leave is taken.

Full-time employees are entitled to 80 hours of COVID-19 supplemental paid sick leave. If an employee is not considered full time, his or her schedule and length of employment will determine the amount of leave entitlement as follows:

  • An employee with a regular schedule is entitled to the total number of hours he or she normally is scheduled to work for the employer over two weeks.

  • An employee with a variable schedule is entitled to 14 times the average number of hours he or she worked each day for the employer in the six months preceding the leave.

  • An employee with a variable schedule who has worked for the employer for 14 days or fewer is entitled to the total number of hours he or she has worked for the employer.

  • Nonexempt employees’ pay is calculated as the highest of:

    • the employee’s regular rate of pay for the work week in which he or she uses the leave;

    • a formula dividing the covered employee’s total wages not including overtime by his or her total hours worked in the full pay period of the previous 90 days of employment;

    • the state minimum wage;

    • the local minimum wage to which the employee is entitled.

Exempt employees should be paid at the rate the employer calculates wages for other forms of paid leave time.

Currently, the amount paid for supplemental paid sick leave is capped at $511 per day, and an aggregate $5,110.

Employees who reach the maximum supplemental leave payout may use other available paid leave including vacation, paid time off (PTO), or other sick leave to supplement their salary so that they earn up to 100% of their regular salary.

Stay tuned for part II of this blog, where we continue this discussion and address other aspects of SB 95.

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A peek inside the 2021 healthcare reform plan

Healthcare Reform

Health insurance in coloradoTaking a look at the nation’s healthcare agenda for 2021 

New healthcare plans are underway as we inch into completing the first quarter of 2021. An executive order was recently signed that will direct the federal government to open a special enrollment period from February 15 to May 15 for Affordable Care Act (ACA) exchanges that serve 36 states.

 According to Forbes, this measure is designed to boost coverage for people who are uninsured. The goal of the upcoming healthcare agenda is to improve people’s access to health insurance.

 The key pillars of the 2021 healthcare agenda include:

  • Fortifying the ACA, which includes augmenting the law with a public option;

  • Expanding ACA for lower-income Americans in non-Medicaid expansion states;

  • Introducing legislation on Medicare for More;

  • Revitalizing public health.

 More details about efforts to support the ACA can be found here.

Why the ACA is still significant to us, and why it’s still under attack today.

On March 23, 2010, the Affordable Care Act was signed into law, allowing over 100 million people to not have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition – whether cancer or diabetes or heart disease or a mental health challenge.

 While over the last decade, the Affordable Care Act has been under relentless attack for various reasons, efforts are being made to protect the Affordable Care Act from these continued attacks in the following ways:

  • Fortifying the ACA, which includes augmenting the law with a public option.

 Instead of starting from scratch and getting rid of private insurance, the plan is to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate

  • Expanding ACA for lower-income Americans in non-Medicaid expansion states.

 The prospect that health protections could extend to millions of uninsured Americans is being raised. As the Covid-19 pandemic saps state budgets and strains safety nets, the opportunity arises. The goal is to break the Medicaid deadlock in the 12 states that have rejected federal funding made available by the Affordable Care Act.

 While this is not an overnight procedure, there are significant opportunities for the remaining states to embrace the Medicaid expansion.

 Key to these potential compromises will likely be federal sign off on conservative versions of Medicaid expansion, such as limits on who qualifies for the program or more federal funding.

 Read more about the efforts that are being made to expand Medicaid here.

  • Introducing legislation on Medicare for More.

 Unlike the Medicare for All approach that would abolish private health insurance and provide universal access to all Americans, regardless of age, Medicare for More builds incrementally on the existing framework of both Medicare and the Affordable Care Act (ACA), and aims to close current gaps in access to healthcare insurance.

 This version of Medicare for More is narrower, as it would permit people aged 60 to 64 to enroll in Medicare. Premium and cost-sharing subsidies would be offered to lower-income beneficiaries. As a result, approximately 20 million more Americans would be eligible for Medicare. Enrolling in Medicare would be voluntary. Employers would be prohibited from dropping newly Medicare-eligible persons from their plans.

 There is an increased likelihood for a pragmatic approach that combines Medicare for More, introduction of a public option, and reinforcement of the Affordable Care Act (ACA).

Learn more about the Medicare approach here.

  • Revitalizing public health.

 In January, the National Strategy for the COVID-19 Response and Pandemic Preparedness was released. The plan builds on the previously announced vaccine distribution plan and the American Rescue Plan, and is organized across seven goals, namely, efforts to get the pandemic under control so Americans can inch into a safer future moving forward.

 Some of those goals are listed below:

  1. Mount a safe, effective, and comprehensive vaccination campaign;

  2. Mitigate spread through expanding masking, testing, treatments, data, healthcare workforce, and clear public health standards;

  3. Safely reopen schools, businesses, and travel while protecting workers;

 For a more comprehensive list on the plan to revitalize public health, read here.

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What Happens to AHCA Now?

What is the future of the AHCA

Shortly after the American Health Care Act vote was pulled from the House Floor, Speaker Paul Ryan said that the American public would be “living with Obamacare for the foreseeable future.” Then, just three days later, he makes the statement that “If Obamacare just stays as is, that’s not acceptable to the American people.” So what does that mean for us today? It’s a little hard to say. It appears that this issue of health care reform is not closed, but at this current time, we do not hear any definitive timelines on when we can expect to see a new bill being formulated. At this period, President Trump is calling on the American public to be on the watch as he predicts that Obamacare will implode. But while we are watching and while there are no timelines, what do we do?

Where is may seem as though America is between the proverbial rock and hard place, however, we will most likely see very little change during 2017? Most insurance companies are currently reviewing their options about what plans they will offer and what they will charge for premiums in 2018. With large companies like Aetna giving themselves a deadline of April 1st to make decisions about what they will offer in 2018, most insurance companies will make their decisions closer to June. There is still a trend of insurance companies pulling out of areas where they have found financial hardships. Aetna is now only offering their services in 4 states where they previously were offered in 15 states.

One this is for certain, that at Bernardini & Donovan we will continue to offer you the best customer service and we will always work to find the best health insurance options available for you, your family or your business during this time of transition.

Keep up with our blog for the latest news on the American Health Care System!

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The ACHA is Pulled (For Now)

American Health Care Act Pulled for Now

One of the biggest news stories recently has been the pull the healthcare reform bill on March 24th. If you’ve had your head in the sand here is a timeline of what went down:

-On Thursday afternoon the House vote was delayed. Members of the House Freedom Caucus met with President Trump but left feeling that their compromised could not be reached.

-Thursday evening the vote is back on. The White House communicated to the Republican party that no further negotiations were to be held and the vote was scheduled for the next day.

-Friday Morning comes, and the House proceeded with morning roll call. Where the vote was still planning on being held it was unclear if it would pass.

-On Friday Afternoon Speaker Paul Ryan urges the President to cancel the vote because they did not have the votes to pass the bill and at 3:30 pm the President agrees. At 4 pm, it is announced to the press that they vote has been canceled.

President Trump placed the blame of the bill not being able to be passed squarely at the feet of the Democrats saying that because they had not one Democrat vote, there was just a wide enough margin to ensure that the bill couldn’t pass and therefore did not go to vote. He also said that he is hopeful for the next version of the bill.

So what does that mean for us now? Speaker Paul Ryan says that he is not giving up on healthcare reform and that he believes that the American Health Care Act could still end up being passed. “About 90 percent of our members are for this bill, and we’re not going to give up after seven years of dealing with this, after running on a plan all of last year and translating that plan into legislation,” he said.

At this time we will just have to wait and see what the future holds for our health care reforms.

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The American Health Care Act: Part 2

In our last post, we started to discuss the American Health Care Act as it was presented to us by Speaker of the House Paul Ryan. If you have not read that yet, please find it here. After going over some of the failures of ObamaCare, Speaker Ryan started to explain what we will find in the legislation that is going up for a vote on March 24th.

Within the American Health Care Act, you will find the lowering costs of insurance premiums, creating more choices for citizens on their insurance options, giving patients control over their health care coverage and creating universal access to care.  But how will they do that? First, they would repeal the taxes in ObamaCare. They would, secondly, stop the massive spending that is going on. They would end the federal mandates that are telling private citizens what to do. They will be protecting citizens with preexisting conditions by encouraging states to set up risk pools so that people with PEC could still get insurance. These state-based and federally contributed risk pools directly support any people with PEC so that the rest of the population has cheaper and more predictably priced health insurance. They also want to create more transparency within the health care systems so that patients know what they are paying for up front. Currently, you receive care and are then sent a bill. What you are billed for can come as a complete surprise. Instead, they would like to create a free market system that allows hospitals, insurance companies, and health providers to compete against each other for the business of the American citizens. This makes our health care system like every other market that we have in our country and gives the citizens the control they need to make good decisions. They want to move Medicaid to be state run systems. The states know better what the needs of their residents are and how to better care for them than a federally based system. They would allow young adults up to the age of 26 to stay on their parent’s insurance and would transition in their changes so that people’s current health care is not being immediate disrupted or not available to them.

What do we think of these changes? If the law passes, we could see rates drop by 20-30% with more plan choices and power to negotiate better contracts with doctors. But we want to wait and see how things play out. There are a lot of favorable items in the law that will favor lower premiums, but we will be taking a wait and see approach to see what ends up in the new law.  Follow Bernardini & Donovan to stay up on the latest changes regarding your health care and how the new incoming legislation may affect you.

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The American Health Care Act: Part 1

Information about the American Health Care Act

On March 9th, Speaker of the House Paul Ryan did a powerpoint presentation about what was in the American Health Care Act. What he laid out was that this piece of law is essential the first piece of a three-pronged attack. The three-pronged attack being:

Reconciliation – this is the American Health Care Act. They are not able to put in every piece of legislation that they would like in this legislation due to certain Senate floor rules. They don’t want the whole thing to be thrown out before it can be voted on. But that is why this is a three-pronged attack.

Administration Action – Much of the current law has legislation written into it that gives the Secretary of Health and Human Services the right to deregulate the market and create more choices in the marketplace.

Additional Legislation – These would be all of the other laws that they are not able to pass in the American Health Care Act because if they did the Senate floor would throw it out. However, if they take these on a case by case basis, he believes that we will see a truly competitive market which could include interstate shopping as well we association health plans.

Speaker Paul Ryan also spent a good portion of his talk exposing the flaws of the ObamaCare. Since the passing of ObamaCare, he pointed out that citizens are seeing their health care options and choices of coverage disappearing. As many as 2,000 counties within the US that initially had 3 or more insurance options in 2016. In 2017 that number has plummeted. In 2016, 200 counties only had only one insurer choice. That is 1 in 3 counties in the US with only one insurance option. Humana has stated that it is planning on pulling out some of those counties which will leave those counties with zero options. While options for insurance coverage are going down, premiums are going up. People are receiving fewer choices, and the price they pay on their premiums continues to rise. In Minnesota, they saw a 59% increase in their premiums. In Tennessee, they saw a 63% increase. And in Arizona, they saw a 116% increase in their premiums. According to Aetna’s CEO, “Obamacare is in a death spiral. It is not getting any better, it’s getting worse”

Look for our next post to cover what is in the American Health Care Act and how we are viewing it.

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