A Brief Overview Of Affordable Care Act Compliance
This A-Z guide briefly overviews the Affordable Care Act (ACA) and discusses cost-sharing reduction subsidies, preventive services, and network adequacy requirements. It also outlines penalties for non-compliance. Employers should review this guide before implementation. Providing employees with the required information is the first step to complying.
Cost-sharing reduction (CSR) subsidies
You’ve probably heard about cost-sharing reductions (CSRs) lately, and you may have attended a Senate HELP Committee hearing about this topic. These subsidies lower your out-of-pocket expenses and are a key part of the Affordable Care Act’s effort to stabilize the individual health insurance market. But what exactly are they, and how are they used? In this article, we’ll go over the basics of CSRs and a recently arisen lawsuit.
CSR is a government-funded program that requires insurers to reduce their out-of-pocket costs. Generally, CSR subsidies apply to silver-level health plans with an actuarial value of 70 percent or more. The difference between these levels and the out-of-pocket limit depends on your income, so check your plan’s actuarial value.
Many Americans are unaware of the links between preventive services and Affordable Care Act compliant health insurance plan. This preventative care helps people stay healthy, delay disease onset, and live productive lives while reducing costs. However, many Americans are going without preventive services due to financial barriers. Even families with insurance may be deterred from getting preventive care because of high co-payments and deductibles. All plans should cover preventative maintenance to ensure compliance with the Affordable Care Act.
Although the new ACA mandates on preventive services have the potential to improve the health of millions of Americans, they do not guarantee universal coverage. However, the ACA requires health insurers to cover preventive services recommended by the USPSTF, the Advisory Committee on Immunization Practices (ACIP), and the Institute of Medicine’s committee on women’s clinical preventive services. The requirements went into effect on August 1, 2012.
Network adequacy requirements
The HHS Notice of Benefit and Payment Parameters for 2019 outlines substantive standards for network adequacy. These include resuming the evaluation of provider networks to ensure they meet adequacy standards. It also defers to state-level network adequacy review processes. Although, the proposed criteria for network adequacy are not yet final; they set clear expectations for updating and filtering.
The new rule also proposes that managed care plans report telehealth availability by 2023 and seek public comments on whether the practice should be incorporated into network adequacy standards. The rule does not propose new standards for cultural competency, but Medicaid-managed care requires providers to provide services for patients with limited English proficiency. Federal rules also require providers to notify patients of their cultural and linguistic capabilities and provide skilled medical interpreters.
Penalties for not complying with the employer mandate
If you’re not offering health insurance to your employees, you may be subject to a penalty under the Employer Mandate. This penalty is based on the number of full-time employees you have and a premium tax credit of up to $406. The amount you pay will be the lesser of the two penalties: $3,860 per full-time employee and $2,570 per employee under 30.
To avoid penalties, employers must offer minimum essential coverage to full-time employees. In addition, the range must be affordable and provide a minimum value equivalent to a bronze plan on the Health Insurance Marketplace. Failure to meet the requirements will result in a $3,750 fine per full-time employee. However, this penalty applies only to full-time employees and does not apply to part-time employees.