Healthcare Reform: Requirements for Workplace Compliance
By: Robert J. McBride
Breaks for Nursing Mothers
Effective immediately
1. Section 4207 of the Fair Labor Standards Act amended to require unpaid breaks for nursing mothers.
2. The amendment requires the company provide a place "shielded from view and free from intrusion from co-workers and the public" to express breast milk.
3. "A reasonable break time for an employee to express breast milk for her nursing child for one year after the child's birth each time such employee has a need to express the milk."
4. Must provide a room excluding bathrooms.
May Apply to MOST Employers
1. Although the section provides that businesses with less than 50 employees may be excluded from coverage, THIS IS ONLY TRUE IF the requirements would "impose an undue hardship by causing the employer significant difficultly or expense when considered in relation to the size, financial resources, nature, or structure of the employer's business."
Amend Employee Handbook
1. Recommend that employee handbooks be amended to include nursing policy clearly stating whether break time is paid or unpaid.
Expanded Causes of Action Against Employers.
Effective Immediately
False claims Act Amendments
1. The bills strengthen the False Claims Act by seriously limiting the public disclosure bar.
2. In the past a claim was barred if based on publicly disclosed information unless the whistleblower was the "original source" of the publicly disclosed information.
3. Prior to amendment an "original source" had to have direct and "independent" knowledge of the information reported.
4. Now, an "original source" may have secondhand knowledge that could lead to much more litigation.
Whistleblower Protections
Do not retaliate against an employee who:
1. Provides the employer, the federal government, or a state the information the employee reasonably believes to be a violation of the act;
2. Testifies or participates in a proceeding under the act; or
3. Objects to or refuses to participate in any activity that the employee reasonably believes to be a violation of the act.
Lifetime Benefits Limits
Effective: After September 23, 2010 or January 1, 2011
1. Prohibits lifetime limits on the dollar value of essential benefits for any participant or beneficiary.
2. Waiting for regulations to define essential benefits.
3. Lifetime benefit limits may continue to be imposed on non-essential benefits.
4. Applies to both fully-insured and self-insured group health plans.
5. Reconciliation Bill eliminates grandfathering.
Annual Benefit Limits
Effective: After September 23, 2010 or January 1, 2011
1. Annual benefit limits on coverage would be limited to HHS defined non-essential benefits for plan years beginning prior to January 1, 2014.
2. Annual limits would be prohibited entirely after January 1, 2014
3. Applies to fully-insured and self-insured plans.
4. Reconciliation Bill eliminates grandfathering.
Increased Dependent Coverage
Effective: After September 23, 2010 or January 1, 2011
1. Increased age of a dependent regardless of marital status to age 26.
2. Applies to both fully-insured and self-insured plans.
3. Reconciliation Bill eliminates grandfathering.
Prohibition Against Rescission of Health Care Coverage
Effective: After September 23, 2010 or January 1, 2011
1. Prohibits the rescission of health care coverage except in cases of fraud or intentional misrepresentation.
2. Applies to fully-insured and self-insured plans.
3. Reconciliation Bill eliminates grandfathering.
Preventive Care Coverage
Effective: After September 23, 2010 or January 1, 2011
1. Mandates coverage of specific preventive services with no cost sharing.
2. Applies to fully-insured and self-insured plans.
3. The services that must be covered at minimum include:
a. Evidence based items or services with a rating of ‘a' or ‘b' in the current recommendations of the U.S. Preventive Services Task Force;
b. Immunizations recommended by the advisory committee on immunization practices of the centers for disease control and prevention;
c. For infants, children, and adolescents, evidenced informed preventive care and screenings provided for in the comprehensive guidelines supported by the health resources and services administration;
d. For women, additional preventive care and screenings provided for in the comprehensive guidelines supported by the health resources and services administration; and
e. For women, additional recommendations regarding breast cancer screening and mammograms.
4. Grandfathered plans are excluded.
Coverage of Emergency Services & Designating Primary Care Physician
Effective: After September 23, 2010 or January 1, 2011
1. Mandates coverage of emergency services at in-network level regardless of provider.
2. Allows enrollees to designate any in-network doctor as their primary care physician (including OB/GYN and pediatrician), if the plan requires the designation of a primary care physician.
3. Grandfathered plans are excluded.
Preexisting Condition Coverage for Children
Effective: After September 23, 2010 or January 1, 2011
1. Fully-insured and self-insured plans will have to cover preexisting conditions for children 19 and under for plan years beginning on or after September 23, 2010.
2. Grandfathered plans are excluded.
Preexisting Conditions for Adults
Effective: January 1, 2014
1. Exclusions based on preexisting conditions would be prohibited.
2. Reconciliation Bill eliminates grandfathering.
Employer Wellness Programs
Effective: January 1, 2014
1. Increases the value of workplace wellness program incentives to 30% of premiums with HHS discretion to increase the cap on incentives to 50%.
Employer Waiting Period for Coverage
Effective: January 1, 2014
1. Prohibits waiting periods in excess of 90 days.
2. Reconciliation Bill eliminates grandfathering.
For more information on how healthcare reform will impact your business please attend the Healthcare Seminar this June 2010 or contact Robert J. McBride.