Regulatory Guidance

ACA – Applicable Large Employer Mandate

 

Click below to play the Webinar on the Affordable Care Act Compliance

2015-12-17 03.14.13 pm

Download Slideshow:  ACA Reporting Webinar for BPA

 

Exchange (Marketplace) Notices

 

The Affordable Care Act (ACA) requires employers subject to the Fair Labor Standards Act (FLSA) to provide a written notice to new hires informing them about the Marketplace (also known as the Exchange) and some of the consequences of purchasing coverage through a Marketplace instead of enrolling in available employer-sponsored coverage. The Department of Labor (DOL) recently updated the expiration date on the notices from October 1, 2013 to January 31, 2017.

Providing This Information to Employees

The DOL has confirmed these notices must be automatically provided to new hires within 14 days of their start date and they must receive a notice a) regardless of their full- or part-time status and b) regardless of whether they are enrolled in your employer sponsored plan. Separate notices for dependents or other individuals who are or may become eligible for coverage are not required.

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Model Notice for employers who offer a health plan to some or all employees:  

Model Notice for employers who do not offer a health plan:   

COBRA Model Election Notice:   

Notice 2013-54:    pdf_logo

Notice 2013-17:    pdf_logo

 

 

 

Medicare Part D Creditable Coverage Notice

 

As required by the Prescription Drug, Improvement, and Modernization Act (MMA) provisions, you must disclose to the Centers for Medicare & Medicaid Services (CMS) whether your health plan coverage is “creditable prescription drug coverage” regardless of whether the coverage is primary or secondary to Medicare.

The Disclosure Notice and policy guidance were posted on the Medicare website and require that the Disclosure Notice be made to CMS on an annual basis and upon any change that affects whether the drug coverage is creditable. Disclosure of creditable coverage status must be provided within 60 days after the beginning date of the plan year for which the entity is providing the disclosure to CMS. Disclosure must also be made within 40 days after the termination of the prescription drug plan and within 30 days after any change in the creditable coverage status of the prescription drug plan.

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Creditable Coverage Disclosure Guidance:                                              

Creditable Coverage Disclosure Instructions User Manual:                 

Creditable Coverage Disclosure Technical Help/Policy Assistance:  

 

Click here for more information about Creditable Coverage

 

 

Medicare Part D Forms

 

Forms provided as a courtesy to BPA clients:

The following model documents are for disclosure of Creditable and Non-Creditable coverage under Medicare Part D.

Important Notes About These Model Documents:                                 

Creditable Coverage Disclosure Notice:                                                    

Creditable Coverage Disclosure Notice (Spanish):                                 word-icon

Non-Creditable Coverage Disclosure Notice:                                          

Non-Creditable Coverage Disclosure Notice (Spanish):                        word-icon

Personalized Disclosure Notice:                                                                  

 

 

Notice of Privacy Practices

 

Notice of Privacy Practices (NPPs) is a HIPAA-mandated document that tells patients of their rights with regard to protected health information (PHI) and limits on how and when this information can be shared by a covered entity.  By September 23, 2013, NPPs must be updated to include certain statements in order for them to be compliant with the Omnibus Final Rule. These include:

 

Instances when required authorization is needed from participants before disclosing PHI such as:

  • Most uses and disclosure of psychotherapy notes if the Plan maintains them;
  • Uses and disclosure for marketing;
  • Sale of PHI; and
  • Other uses and disclosures not described in the NPP.

 

Additional Participant’s rights such as:

  • Opting out of fundraising contacts;
  • Being notified by the Plan of any breach of his or her unsecured PHI; and
  • The prohibition of disclosing genetic information of an individual for underwriting purposes.

If you post your NPP to your website, you now must also prominently post the material change or the revised notice on the website by the time of the effective date of the material change. Additionally, you must provide the revised notice, or information about the change and how to obtain the revised NPP, in the next annual mailing to all participants covered by the plan. If you do NOT have a website, then the revised NPP, or information about the updates and how to obtain the revised NPP, must be provided to individuals covered by the plan within 60 days of the material revision.

 

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Notice of Privacy Practices Instructions:        pdf_logo

Notice of Privacy Practices Layered Template:        pdf_logo

Notice of Privacy Practices Full-Page Template:        pdf_logo

Notice of Privacy Practices Booklet Template:        pdf_logo