ACA regulations rife with unknowns

Approximately 47 minutes into his 75-minute talk on the Affordable Care Act, Mark Nielsen found himself saying something for the third or fourth time – repetitive enough that he felt the need to draw attention to it: “We don’t know how much information the Department of Health and Human Services will want.” Speaking at the International Foundation of Employee Benefit Plans’ Washington legislative update on Monday, Nielsen acknowledged how easy it is get frustrated by the gaps of knowledge in what HHS will require in the future.

“Bottom line is, we don’t know how much information HHS is going to be requesting on [plan participants],” Nielsen said, “but it is going to be new reporting from what happened with the plans previously that you have not had to do, so you want to be aware of that.”

Nielsen, a principal with the Groom Law Group with experience in fiduciary duty, ERISA and other labor law issues, says plan sponsors are still hoping for “more and better guidance” on countless ACA specifics, but that all they can for now is play the field they see.

“I’m not policymaker, I’m not a regulator – I’m not here to give my opinion on the law; I’m here to tell you what it is and what it means,” he said.

And what it means in 2014 amounts to three major components: the health care exchanges, the individual mandate and the employer mandate. The individual mandate is probably the most cut-and-dry, though Nielsen said congressional Democrats may be “willing to tinker” with it in order to up the number of those insured.

“I don’t think anyone anticipated the high number of states that would opt out of the exchanges,” Nielsen said (most have). But the most moving parts may come with plan responsibility: Limit to 90-day waiting periods, increased wellness incentives and even support for clinical trials. And, of course, cost-sharing has a new limit:

“Participants out-of-pocket expense cannot be more than $6,350 for individuals or $12,000 for families. That applies in both the insured market and the self-funded market,” Nielsen said.

That number you can count on.

Keep reading today’s inBrief for more from IFEBP’s Washington event

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