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Health Care Reform: The Latest on PPACA

Patient Protection and Affordable Care Act

Complying with the many complex provisions of the Patient Protections and Affordable Care Act has been challenging, to say the least. We continue to wait for federal regulations to be released providing guidance and clarification on various aspects of the law. Here is a short update on three PPACA provisions.

Section 105(h) Nondiscrimination Testing

Nondiscrimination benefits testing already exists for the self-insured market. What PPACA did was extend this testing to the fully insured market. There is a lot of concern that the lack of clear federal rules would leave many employers subject to fines of $100/per employee per day, the penalty for violation Section 105(h). Thankfully, the IRS issued notice that this new provision of PPACA will not be enforced until new guidance has been issued. The notice did not however outline a time-frame as when to expect this guidance.


Long Term CareThe Community Living Assistance Services and Support Act is a new government long-term care insurance program. Although PPACA authorizes the program to begin in 2011, this program is not yet operational for a few reasons. First, it takes time to set up a program; PPACA delegated nearly all program details, including most program benefits, to an administering entity that was not appointed by law. Once the CLASS benefits are priced, the program premiums must be certified by actuaries as making the program solvent for 75 years. In addition, we still need the basic information on how employers will opt in or out of offering this voluntary program. So at this point in time, due to what was just explained, it appears that the earliest the program will be operating is 2013.

Small Business Wellness Grants

PPACA allocated $200 million in wellness grants for small businesses that did not have a wellness program in existence when PPACA was signed into law on March 23, 2010. PPACA authorized these grants to be available in fiscal year 2011 but currently there is no information available as to when these grants will become available. As we continue to receive more information about the new health care law and how it will affect employers, we will provide you with timely updates. So please stay tuned for more details as they become available!