ACA Compliance / Health Care Reform – Are You in Compliance With the Latest Nondiscrimination Rules?

Young businesswoman shaking hands with male partner in office

Young businesswoman shaking hands with male partner in office

You think you’re ready for to comply with the Affordable Care Act? You sent out Form 1095-C before the March 31 deadline. You filed Form 1094-C before June 30. You’ve applied for certification so you can handle this electronically. You’ve calculated how many full-time equivalent employees your business employs. You’ve offered the Minimum Essential Coverage to at least 95% of your employees. The plan offers at least 60% minimum value.

You’re covered, right? You’re in compliance.

But what about the nondiscrimination rules the Health and Human Services Office of Civil Rights published May 18, 2016? Are you sure you comply with them? It covers all health care programs or entities under Title I of the Affordable Care Act.

What is a Covered Entity?

Every health care provider or insurance program receiving federal financial assistance, including Medicare and Medicaid.

Covered for the Insured

It’s illegal to deny, cancel, limit or refuse health insurance coverage, or use discriminatory marketing or benefit designs.

What if You are Not a Covered Entity, but are an Applicable Large Employer under the Affordable Care Act?

You are responsible to offer your employees medical insurance coverage that does not discriminate against them. This includes all hospitals, clinics, Medicaid providers, wellness programs, home health care agencies, health insurance issuers and long-term care providers.

Nondiscrimination Based on Gender and Gender Identity

The new regulations apply to Section 1557 of the Patient Protection and Affordable Care Act, and are effective July 18, 2016. If they require changes to your benefit design, they begin with the first day of the first year under the new plan starting on or after January 1, 2017. Employers are liable for discrimination in their healthcare plans. Healthcare insurance plans cannot charge women higher premiums.

Basically, the rules prohibit discrimination or denying health care on the basis of race, disability, national origin, age, sex and gender identity. Healthcare providers and insurers cannot withhold treatment based on sex-specific medical conditions.

Make certain the healthcare plan you’re offering covers pregnancy, false pregnancies, related medical conditions and terminating pregnancy. Providers must treat everybody on the basis of their gender identity, including providing rest room facilities. Providers must treat them even when the condition relates to the transition process.

However, a covered entity may also not deny services based on their gender at birth. For example, if a person identifies as female but a doctor diagnoses with prostate cancer, the provider must treat their case if they cover any cases of prostate cancer.

OCR prohibits providers from excluding gender transitioning services on a broad basis. However, it does not require covered entities to pay for all transition medical services. OCR says medical care in this area will continue to progress, and does not want to limit coverage with specifics that may become out-of-date.

Discrimination Against People With Limited English

OCR requires all ACA entities to take reasonable steps to make certain all their employees understand what is going. OCR  encourages them to develop language access plans. They must post notices of nondiscrimination and translation services. OCR has samples in 64 languages.

Discrimination Against the Disabled

OCR requires ACA entities to newly constructed facilities and electronic services accessible to people with disabilities. Plan sponsors need to make certain all information about the plan is accessible to all.

All Employers Providing Healthcare Plans Under the ACA

Although these new rules specifically apply to healthcare providers as employers, they also apply to Third Party Administrators. TPAs providing services to self-funded group health plans do not design the plans, but this ruling means OCR can review the plans to make certain they comply with the nondiscrimination provisions. If not, the plan could be referred to the Equal Employment Opportunity Commission for possible action against the employer.

Clearly, these provisions illustrate how the government views discrimination based on gender, gender identity, lack of skill in English and disability accessibility. Make sure your healthcare plan and other employment practices comply.

SurmountHRM are experts at helping businesses meet the challenges Human Resources and Payroll management by using cloud-based human resource solutions. Contact us today to make certain you comply with the latest rules of Health Care Reform.


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