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| “You are soon to be faced with a tsunami of things to comply with” when it comes to health care regulation, said Marcia S. Wagner, principal of Boston-based Wagner Law Group. |
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HOUSTON—Hotels’ checklist of to-dos in preparing for new health care regulations in the United States can cast an intimidating shadow. But if hotels tackle the items one by one, compliance can be had.
Marcia S. Wagner, principal of the Wagner Law Group in Boston, said during the Hospitality Law Conference Thursday the No. 1 thing employers should cross off that list is employee communication. Employers have to distribute notices, such as whether the current plan will be grandfathered into the new system, special enrollment for adult children, and the new limit on flexible spending accounts to US$2,500 (most FSA limits were set at US$5,000 previously.)
“Even if no one reads them, you have to distribute them,” she said.
Employers also need to communicate that premium assistance is available, Wagner said during a presentation titled “What You Need to Know About Health Care Reform Compliance” this week at the Omni Houston. Employees are eligible if their income is between 100% and 400% of the federal poverty level. There also is a cost-sharing subsidy for those with income below 200%.
Prepare for enrollment
The list of action items regarding health-care compliance doesn’t end with communication.
“You are soon to be faced with a tsunami of things to comply with,” she said.
Wagner said employers should prepare for open and automatic enrollments. There are five different health-care options. Into which will you automatically place your employees? That’s one question companies will have to investigate.
“You don’t want this to hit and not be ready for your 400 employees,” she said.
Grandfather status
Companies also will need to decide whether they will keep their grandfather status. One consideration to take into account: The cost to provide coverage is likely to increase as health care provider costs go up. That means employers should perform a cost/benefit analysis to decide what’s best.
Grandfather status also can be lost if:
- a new contract or policy is entered;
- there is an increase in cost-sharing;
- there is a decrease in employer contribution; and
- new annual limits are enacted.
Meanwhile, provisions available to non-grandfathered plans include:
- free preventive care services;
- emergency care services without prior authorization; and
- participants are able to select primary care providers, including pediatric care providers and women’s health providers.
Furthermore, provisions available to all plans include:
- coverage for adult children;
- restrictions on annual and lifetime benefit limits; and
- elimination of pre-existing condition exclusions.
Stay organized
While the checklist can be daunting, employers will be OK if they stay organized, Wagner said.
The federal reform is based on Massachusetts’ health care regulations. Working in Boston, Wagner is familiar with the state’s system.
“It can work, but there will be a lot of transition,” she said.
Wagner said there likely will be some “tweaks” to the law, but the foundation and general structure of the reform will remain intact.
That two federal judges have declared the new law unconstitutional doesn’t mean employers should slack off on their preparation.
“Regardless of whether you like this law or don’t like it … It is the law of the land and will be with us for awhile,” she said.
