A lot more pa­per­work

Re­form prom­ises sea change for em­ploy­ers

Modern Healthcare - - The Week In Healthcare - Re­becca Ve­sely

Em­ploy­ers large and small face mon­u­men­tal changes to their busi­ness prac­tices as a re­sult of the new health­care re­form law—in­clud­ing added ad­min­is­tra­tive work and re­port­ing chal­lenges. Th­ese changes are com­ing rapidly, too, with the first new re­quire­ments within six months, and won’t let up for the next decade.

“This is the big­gest change in 30 years,” said J.D. Piro, prin­ci­pal in the health law con­sult­ing prac­tice of He­witt As­so­ci­ates. Not since the pas­sage of the Em­ployee Re­tire­ment In­come Se­cu­rity Act, ERISA, in 1974, have em­ploy­ers faced so many new reg­u­la­tions on em­ploy­ment ben­e­fits, he added.

Yet many of the de­tails about th­ese new re­quire­ments are still un­known as HHS must draft detailed reg­u­la­tions on the law’s pro­vi­sions.

“This is big­ger than any­thing we have seen, but it also lacks a lot of de­tail,” said Amy Bergner, prin­ci­pal at Mercer, a con­sult­ing firm.

March 23 was the day Pres­i­dent Barack Obama signed the Pa­tient Pro­tec­tion and Af­ford­able Care Act into law—and it also started the six-month count­down to when the first of the law’s health-plan stan­dards go into ef­fect.

By Sept. 23, em­ploy­ees’ chil­dren up to age 26 who don’t qual­ify for other health cov­er­age will be el­i­gi­ble for de­pen­dent cov­er­age un­der their par­ents’ health plan. Also in six months, health plans can no longer im­pose life­time dol­lar lim­its on med­i­cal spending or re­strict an­nual dol­lar lim­its on care.

Em­ploy­ers will be re­spon­si­ble for check­ing to make sure de­pen­dents up to age 26 don’t qual­ify for other health plans be­fore adding them to their rolls. And em­ploy­ers will be looking to HHS for guid­ance on the an­nual dol­lar lim­its on health spending, as well as the life­time cap elim­i­na­tion. Some small em­ploy­ers may qual­ify for tax cred­its to help cover the cost of em­ployee health ben­e­fits.

Also this year, new health plans face a raft of re­stric­tions on cost-shar­ing re­quire­ments, claims ap­peal pro­cesses and ac­cess to pri­mary care. Un­der the re­form law, “grand­fa­thered” health plans don’t face th­ese new rules this year. But, right now, no one quite knows what plans qual­ify as grand­fa­thered. HHS has 90 days to is­sue th­ese rules.

“The law is pretty clear that you don’t lose your grand­fa­thered sta­tus based on el­i­gi­bil­ity changes,” said Christo­pher Sears, who spe­cial­izes in health and em­ploy­ment law as a part­ner in the Indianapolis of­fice of Ice Miller, a law firm. “But the law doesn’t dis­cuss at all ben­e­fit changes that might af­fect grand­fa­ther sta­tus. It re­ally is kind of si­lent on that is­sue.”

Piro: “This is the big­gest change in 30 years.”

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