Top 10 Compliance Priorities That Will Keep You Up Long After the Late Show 

 US elections United States Capitol (c) Dwight Nadig
Jul 12 2018

I’d love to say that this top-10 list will make you laugh like a Late Show audience – not likely. But if you want to at least keep smiling as you make important decisions about your health and welfare plans for 2019, you’ll need to be familiar with these ten compliance issues and prepared to deal with them.

1. Ongoing ACA concerns for large employers

6. Wellness programs

2. State responses to weakening of ACA

7. Paid leave

3. 2017 tax act considerations

8. Prescription drug costs and coverage.

4. Health savings account (HSA) developments

9. DOL fiduciary investment advice rule

5. Mental health parity

10. Preventive services.


Some highlights from “home offices” like the Department of Labor, the IRS and a state near you are below:

ACA. We have seen a good number of letters issued in 2018 to employers proposing payments to the IRS for past offer of coverage failures. Many of these are in the millions of dollars – and that’s no laughing matter. In fact, over 30,000 letters have been issued, with proposed penalties of more than 4.3 billion. This is a wake-up call for employers that may have been lax in the past regarding (a) awareness of their employees’ full-time (30 hours/week) status, (b) offering affordable, minimum value coverage to those employees, and (c) accuracy of ACA reporting on forms 1094/1095.

Wellness program design. All employers desire a healthy, happy workforce and many have implemented (or at least contemplated) wellness programs to help reach that goal. With the incentive provisions of the ADA/GINA wellness rules set to be vacated effective January 1, 2019 (AARP v. EEOC), employers face uncertainty regarding whether their programs would still be considered “voluntary” as currently designed. Employers should consider their options (including status quo) and weigh risks in consultation with their “band” of advisors and legal counsel.

Mental health parity. With so many other areas grabbing their attention, it is no wonder that many employers have been caught sleeping on mental health and substance use disorder parity. The Department of Labor recently released statistics showing 92 citations for MHP violations in 2017 alone. It is worth the time and effort to review benefit plans for compliance with recent parity guidance and best practices, while preparing to respond to disclosure requests.

State law issues. States are increasingly attempting to fill perceived gaps in federal mandates and protections. We are seeing this take shape in the form of state-based individual coverage mandates, health plan assessments to fund reforms; family leave, sick leave and disability leave mandates; and prescription drug transparency laws. Syncing up leave programs has already caused sleepless nights, but employers should also be mindful of additional reporting requirements – including on the health care side -- that may arise under these newly enacted provisions.

As you reshape and refresh your health and welfare programming for 2019, be sure you add a segment that includes compliance. That will go a long way in making sure the joke is not on you at the end of the day.

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