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3 Ways That 3 Letters Can Affect ACA Compliance

3 Ways That 3 Letters Can Affect ACA Compliance
Posted on Thursday, January 25, 2018 by Bruce Gillis
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In December, my colleague Angel noted that keeping up with the Affordable Care Act in 2017 had been a bit of a rollercoaster ride. Well, 2018 is here and it seems we’re still riding that rollercoaster as we watch a divided government go back and forth on healthcare law.

The open comment period for the 2019 HHS Notice of Benefit and Payment Parameters (aka, proposed changes to the rules that govern ACA) recently concluded, which means formal rule changes could be introduced within just a few weeks.

Before you go sifting through the nearly 100-page proposal, I wanted to let you know that we already did! (All in a day’s work for us policy wonks.) There is one key proposed change – concerning ACA’s essential health benefits (EHBs) – that may affect employers’ health benefit strategies when new rules go into effect.

Here are three ways those three letters could impact how your organization administers health benefits and complies with ACA.

  1. Patchwork provisions. The new rule would allow states to bypass ACA’s EHBs and decide their own. A state’s decision to change its EHBs could impact the protection of the ACA’s ban on annual and lifetime limits, and the requirement that insurance plans cap enrollee’s annual out-of-pocket spending for employer coverage.
  1. Drops the baseline. EHBs ensure everyone with qualified health plans has at least a base level of health benefits for services like emergency, preventive, and maternity care. Under the proposed rules, states could choose a benchmark from another state for care that may be less generous than its current offering. This would essentially be a reversion back to pre-ACA for states, even as other provisions around what constitutes “affordable” and “minimum essential coverage” remain intact – which clearly can create a confusing environment for employers.
  1. One state, two state, red state, blue state. Obviously, there are political implications with allowing states to make their own determination on whether to maintain EHBs as outlined under ACA, do away with EHBs altogether, or create their own. Never mind, the varying state laws that already exist around required healthcare and/or healthcare coverage. Multistate employers, or ones considering relocating headquarters to another state, will want to fully evaluate the ramifications of this rule – everything from your benefits approach, plan design, to segmented enrollments to employee communications

And all of that could happen before 2018 reporting deadlines! Like I said, the rollercoaster ride continues – hang on tight, and let our experts help you stay up to date on reporting requirements.


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Bruce Gillis Head of Compliance Lorem ipsum dolor sit amet. View All Posts