The Tangled Web of ACA Compliance
I’d like to start with a famous quote from Walter Scott:
“O, what a tangled web we weave when first we practice to deceive!”
Sound words to live by to be sure, but in true compliance guru fashion, I think we can tweak this into a more pragmatic statement – just change the last word from “deceive” to “regulate” and, well, it takes on a whole new meaning, doesn’t it?
When Congress passed the Affordable Care Act into law back in 2009, that’s precisely what happened. By establishing the requirement to purchase health insurance, Congress guaranteed that thousands of pages of new regulations would have to be implemented in order to make sure all the contingencies were accounted for and that the system would work efficiently and fairly.
I’m not going to go into whether it succeeded or failed – the fact is that the ACA is here to stay (don’t let the repeal of the individual mandate penalty in 2019 fool you).
What I do want to do, however (over the course of 2018), is examine the web of regulations that you as an employer must be aware of, and navigate through, as you work with employees in the real day-to-day world of benefits and employment administration.
Let’s begin that journey from the 50,000 foot level in order to assess just what we’re talking about.
Private employer health plans are generally subject to what I call “the big three” sets of rules – the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code, and Medicare (specifically, Medicare’s coordination of benefit and secondary payer rules). By and large, the ACA’s rules modified these core rulesets, and when you’re evaluating a question regarding an employee’s eligibility or coverage under a plan, these are the go-to regulations for the answers.
But not the only ones. Not by a long shot. Here’s where we start to see the regulatory web emerge.
On the federal side, there are non-discrimination provisions in the ADA and GINA rules. On the state side, in addition to regulations on insurance carriers, you can run into wage withholding rules, state-based rules on child medical support orders, and benefit continuation rules different from COBRA. Is your employee out on workers’ comp leave? We can welcome that set of rules to the party as well.
The point is this: getting from Point A to Point B isn’t always straightforward. Sure, some questions will have a relatively easy solution, but most will have aspects that bear examining from many different perspectives.
There’s always an element of frustration, as all these different sets of rules were written at different times by different governing bodies for different purposes. And as you would expect, they conflict with each other in all kinds of ways. One solution may prompt another issue to be dealt with.
That’s why managing your employee benefit risk is about much more than just your plan design. Designing your employee benefit package is more than picking an insurance carrier or settling on a certain deductible.
You need to take a holistic approach to the entire exercise, and make sure your employment practices, handbooks, policies etc. are synced up with the benefits you provide, the entity doing your claim processing and more. Failure to do so can leave you stuck paying your employee’s medical bills, answering to the Department of Labor and Internal Revenue Service, and spending more time dealing with benefits than generating revenue for your company.
The good news is that we’re here to help! Over the course of 2018, we’ll be blogging about different aspects of the compliance web and how you can successfully navigate it. Importantly, we have new consulting services available to our clients to assess their compliance risk and make plans to best mitigate that risk.
We’re ready to help. Are you ready to go?
- Compliance Support Page
- ACA Playbook Overview
- What a Wild Ride It's Been
- Keep Calm and Don't Panic
- Buyer Beware: ACA Compliance Plans
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