by Phil Larson
The Affordable Care Act (ACA) will add to the growing list of possible discrimination claims or requirements to treat some health plan participants the same (or similar). Many of these rules are not published yet but plan design including eligibility, coverage levels, and administration may be impacted.
A sampling of just some of these rules includes:
1. ACA HIPAA Nondiscrimination. Most people consider these rules with wellness programs and incentives but these rules broadly prohibit discrimination based on a medical condition. New ACA rules will make it much easier for individuals to request alternatives for wellness programs and incentives.
2. ACA MHPAEA. The Mental Health Parity and Addiction Equity Act will require similar benefits for mental health and substance abuse when compared to other medical coverage including pharmacy. ACA will also ensure qualified health plans meet these rules.
3. ADA. The Americans with Disabilities Act prevents discrimination based on a disability, which is broadly defined.
4. ACA Civil Rights. Section 1557 of the ACA (42 U.S.C. 18116) prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Government regulators asked how this may impact certain health activities.
5. ACA Whistleblower. Section 1558 of the ACA also creates a new whistleblower right. A new form of discrimination, this prevents employers from treating employees differently because of subsidy or participation in government investigations for ACA.
6. ACA 105h Tax Discrimination Rules. A new requirement for insured plans that is expected in 2014, it remains to be seen how the new rules will impact self-insured plans under the old (and currently applicable) 105h tax rules.
7. ACA Provider Discrimination. PHSA 2706 has not had any guidance issued but some states are referring to this rule to prevent plans from denying some providers payment. Chiropractors also commonly refer to this rule.
8. ERISA 510 Retaliation. This prevents discrimination for the purpose of interfering with the attainment of any right under the plan.
9. ACA Employer Fair Share Rules. These rules often require individuals to be treated the same for measurement, stability and administrative periods unless it is based on an approved category.
10. ACA Pre-existing Condition Exclusions. Plans are not allowed to treat participants differently based on prior medical conditions or history.
11. ACA Premium Rating. Plans cannot rate differently for categories like male or female.
12. GINA. Genetic Information Nondiscrimination Act will also apply to health plans as well as employer activities. Among other things, this will prevent questions about employees family medical history.
If you need help navigating these rules, please contact Kinney and Larson.
The Affordable Care Act (ACA) will add to the growing list of possible discrimination claims or requirements to treat some health plan participants the same (or similar). Many of these rules are not published yet but plan design including eligibility, coverage levels, and administration may be impacted.
A sampling of just some of these rules includes:
1. ACA HIPAA Nondiscrimination. Most people consider these rules with wellness programs and incentives but these rules broadly prohibit discrimination based on a medical condition. New ACA rules will make it much easier for individuals to request alternatives for wellness programs and incentives.
2. ACA MHPAEA. The Mental Health Parity and Addiction Equity Act will require similar benefits for mental health and substance abuse when compared to other medical coverage including pharmacy. ACA will also ensure qualified health plans meet these rules.
3. ADA. The Americans with Disabilities Act prevents discrimination based on a disability, which is broadly defined.
4. ACA Civil Rights. Section 1557 of the ACA (42 U.S.C. 18116) prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. Government regulators asked how this may impact certain health activities.
5. ACA Whistleblower. Section 1558 of the ACA also creates a new whistleblower right. A new form of discrimination, this prevents employers from treating employees differently because of subsidy or participation in government investigations for ACA.
6. ACA 105h Tax Discrimination Rules. A new requirement for insured plans that is expected in 2014, it remains to be seen how the new rules will impact self-insured plans under the old (and currently applicable) 105h tax rules.
7. ACA Provider Discrimination. PHSA 2706 has not had any guidance issued but some states are referring to this rule to prevent plans from denying some providers payment. Chiropractors also commonly refer to this rule.
8. ERISA 510 Retaliation. This prevents discrimination for the purpose of interfering with the attainment of any right under the plan.
9. ACA Employer Fair Share Rules. These rules often require individuals to be treated the same for measurement, stability and administrative periods unless it is based on an approved category.
10. ACA Pre-existing Condition Exclusions. Plans are not allowed to treat participants differently based on prior medical conditions or history.
11. ACA Premium Rating. Plans cannot rate differently for categories like male or female.
12. GINA. Genetic Information Nondiscrimination Act will also apply to health plans as well as employer activities. Among other things, this will prevent questions about employees family medical history.
If you need help navigating these rules, please contact Kinney and Larson.