PPACA Updates
Our health reform updates are provided to help members understand how the Patient Protection and Affordable Care Act (PPACA) impacts their plans. We will also post fact sheets and regulations here from federal agencies as they are released. We encourage you to work with your attorney and other business partners to comply with these changes. These health reform pieces will continue to be updated as we receive new information, so please check back here regularly.
Items Related to Timeline of PPACA
You'll find many of the PPACA Administrative Requirements in this document. It is meant as a starting point for discussion between TPAs and employers to determine where action has been or needs to be taken. This Excel spreadsheet (.xls) can be used to keep track of what has been done. (updated December 5, 2011)
Provisions Impacting Self-Funded Employer Plans with Grandfathered Status from 2011-2013 (.pdf, updated November 23, 2010)
Effective Dates for Key Provisions of Patient Protection and Affordable Care Act (Courtesy, Groom Law Group, Chartered)
Health Plan Assessment to Fund Comparative Effectiveness Research (.pdf, added January 12, 2012)
Implications for Employers Related to PPACA
State Innovation and Implications for Employers (.pdf, added April 28, 2011). Self-funded employers may be impacted by the issue of state innovation – the ability of states to opt out of certain health reform requirements and instead implement their own state-based health reform programs.
Preventive Care Mandates for Non-Grandfathered Plans (.pdf, updated December 2011)
- Read the letter The Alliance sent in response to DOL and HHS request for comments.
Internal Appeals and External Grievance Review Requirements for Non-Grandfathered Plans (.pdf, updated July 2011)
Federal regulators have made revised model notices available regarding adverse benefit determinations and final external review decisions in the "Internal Claims and Appeals and External Review" section of the Employee Benefits Security Administration (EBSA) website.
Grandfathered Plans: What Changes Can You Make? (.pdf, updated November, 2010)
- Read the letter The Alliance sent in response to DOL and HHS request for comments.
Employer Responsibility Provisions: A Primer on "Pay or Play" Penalties (.pdf, updated January 11, 2012)
More Specific Concepts Related to PPACA
PPACA Cost Containment Concepts: Quality, Transparency, Wellness, Prevention and Provider Payment Reforms (.pdf, updated July 15, 2010)
Exchange and Subsidies under Federal Reform (.pdf, updated June 3, 2010)
Additional Tools for Employers
PPACA Section-by-Section Analysis from the National Association of Insurance Commissioners
Info from the U.S. Department of Labor
More information on PPACA from the U.S. Department of Labor includes regulations, guidance, and model notices.
- The Department of Labor has provided guidance on the requirement to providing a 4-page summary of benefits. You can find information about the requirement and sample templates here. (Updated August 2011)
- Part VI of the FAQ has been added regarding implementation of the market reform provisions of the Affordable Care Act, as well as the Mental Health Parity and Addiction Equity Act. (Updated April 8, 2011)
Info from the EEOC
The Equal Employment Opportunity Commission (EEOC) recently released a guidance letter that clarifies the use of genetic information in wellness programs. Employers may collect genetic information, such as family medical history, and use it to improve it to help employees improve their health, but it must be done on a voluntary basis. Employers must obtain written authorization from a plan participant before requesting the individual's genetic information. You can find the guidance letter here.
Alliance Online Excise Tax Calculator (updated March 30, 2010)
The Alliance has developed this calculator to help organizations understand the possible implications of the excise tax.
Health Reform Subsidy Calculator (Kaiser Family Foundation)
This tool illustrates premiums and government assistance for individuals and families under PPACA in 2014. We are providing this link as a convenience. This is not an endorsement of this organization.
Health Care Mandate Cost Calculator (National Retail Federation)
This tool helps organizations determine what penalties they might face under the recently enacted federal health care reform law if they do not provide health benefits to all full-time workers. We are providing this link as a convenience. This is not an endorsement of this organization.