To most of us, the word compliance conjures up thoughts of rules, conformity and agreement. In organized endeavors, participants often are presented with a set of rules they agree to abide by in order to establish consistency, fairness and organization for all involved. The Affordable Care Act (ACA) brought with it a requirement that every single American now must have health insurance. Because most people get this coverage through their place of work, employers must be more attentive than ever in order to ensure they are familiar with the ACA guidelines and are compliant to the extensive list of requirements commensurate to this law. The challenge for most groups is that compliance to the ACA has become a moving target.

 

ACA compliance brings with it requirements that are often difficult to pin down. Regardless of one’s personal politics, reality has proven the implementation of the ACA to be less than smooth. Legislative wrangling has delayed implementation, technologies have failed and rules have been changed on the fly. Employers are left with compliance questions that are hard to answer with certainty.

 

A good example of this happened in late 2014, when the deadline requiring self-funded employer groups to obtain a Health Plan Identifier Number (HPID) was looming for November 5th. Some groups planned ahead and had their HPID’s well in advance of the deadline. Most others had not planned ahead and the Center for Medicare and Medicaid Services (CMS) was flooded with applications. With the eminent date approaching and more paperwork than they could process, CMS issued a statement on October 31st stating the HPID requirement was put on hold until further notice. To this date, there still hasn’t been any update on the status of that particular requirement.

 

Many other examples exist of the moving target that plan compliance has become for every employer sponsored health plan across the country. Forms are often revised, deadlines have no actual terminal end to them and some fees have sliding scales from one year to the next. There are some anticipated ACA demands that will require groups to plan for years in advance, yet they may not even come to fruition (ex. Cadillac Tax with its approaching deadline in 2018.) They require attention nonetheless.

Guiding groups through this maze of compliance confusion has placed increased responsibility directly on the shoulders of capable benefit advisors more than ever before. Gone are the days of soft recommendations and educational seminars with vaguely applicable suggestions. Advisors must have specifically applicable solutions and resources tailored for each individual client in order to help them avoid the eminent pitfalls that exist. To ensure adherence to the ACA, governmental audits on health plans are anticipated to increase in frequency moving forward. Every employer must ask themselves if they are prepared with the tools they need to hit the moving target of compliance when the time comes.