Affordable Care Act Update for Hospital Employers

Affordable Care Act Update for Hospital Employers
Senior Director of Marketing

As the end of the year approaches, healthcare human resources leaders need to be looking closely at the Affordable Care Act (also known as the ACA or “Obamacare”) requirements and what they need to do to remain compliant in 2015. There have been many changes to deadlines and requirements in recent months, and the new Republican-controlled Congress may make additional changes early in the new year.

Here’s what healthcare HR leaders need to know about the ACA as they move into 2015.

Does It Apply to Your Organization?

Smaller providers should know whether they’re required to provide employees with health insurance under the ACA, says Erik Gunderson, an attorney at Charlton Weeks LLP. “If they are not large enough to be required to provide insurance coverage, and do not elect to do so anyway, they should guide their employees to the online health exchanges and set aside some time during the workday for the employee to use computers at work to enroll.”

If your organization has fewer than 50 full-time equivalent employees (FTEs), the ACA doesn’t require you to provide your employees with health insurance. If you have 50 to 99 FTEs, you won’t be required to provide coverage until 2016.

What’s Required Under the Employer Mandate

If your organization has 100 or more full-time employees, the employer mandate will apply to your organization in 2015, and you’ll need to ensure that all full-time employees and their dependents are offered coverage, says Barbara J. Zabawa, attorney and founder of the Center for Health Law Equity. “This will likely mean working closely with the employer’s insurance broker or self-insured plan administrator to confirm that plan offerings meet these requirements so that the employer can avoid paying a penalty in 2016 for the 2015 plan year.”

How to Support the New Rules With New Processes

The new rules and regulations will require new HR processes. “Keep exchange subsidy certification notices confidential,” says Pepper Crutcher, leader of the Affordable Care Act practice group for Balch and Bingham. “Create a documented process now, before those certifications start to arrive, so that you can prove that managers who made those discharge and discipline decisions lacked access to subsidy certification information.”

You should also read up on what information you’re required to provide to employees about their rights under the ACA, Zabawa says, and provide notice of any plan changes within 60 days of those changes taking effect.

The Risk of Retaliation Claims

The ACA’s retaliation protections prohibit employers from discharging or otherwise discriminating against any employee in the compensation, terms, conditions or other privileges of employment because the employee, or an individual acting at the employee’s request (such as a union steward), has engaged in protected activity under the act, says Daniel Finerty, of Lindner & Marsack, S.C.

“Employers can avoid litigation and, specifically, ACA retaliation claims by first and foremost ensuring their genuine compliance efforts are designed to reduce confusion over the health insurance benefits being offered and to provide a mechanism for employees to request more information or clarification from the employer regarding these issues,” Finerty says. Less confusion over offered benefits and a mechanism for employees to seek clarification will mean less room for an employee to argue there was retaliation.

While employers’ short-term efforts should be focused on compliance, Finerty says, longer-term efforts can be planned to weave the ACA retaliation protection into existing nondiscrimination policies to recognize that employees have the right to speak out in disputes about health insurance-related issues to designated individuals. “Similarly, anti-retaliation policies should be revised to reflect that any employee that chooses to reasonably speak out will be protected from retaliation for having done so. After making these changes, employers should train supervisors regarding what is expected of them if a complaint regarding, for example, the affordability of the employer’s health insurance policy is received.”

Changes That Could Come in 2015

The new Republican-controlled Congress may eliminate some ACA provisions regarding the employer mandate, Zabawa says, so HR leaders will need to pay attention to any action taken. “Also, HR leaders should follow the U.S. Supreme Court’s decision in the King v. Burwell case, which is likely to be decided before July 2015,” she says. “That decision could impact whether employer penalties may occur in states with a federally facilitated exchange.”

The ACA has changed a lot of the HR landscape since it has gone into effect, and changes will continue throughout 2015. Healthcare employers and HR leaders should work carefully with their vendors and lawyers to ensure they’re doing what’s required under the law.

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