The Department of Labor (DOL) has released two compliance checklists that address the health care reform law as well as other mandates for both insured and self-insured group health plans. The checklists may be useful given the reported increase in DOL compliance audits of these mandates.
The checklists focus on parts of the Patient Protection and Affordable Care Act (PPACA), the non-privacy security provisions of the Health Insurance Portability and Accountability Act (HIPAA) and certain provisions of the Employee Retirement Income Security Act.
The PPACA checklist is a 29-page document with questions that can help group health plans and group health insurers verify their compliance with many of the PPACA's provisions, such as grandfathered status, prohibition on rescissions, lifetime and annual dollar maximums on essential health benefits, internal claims and appeals standards, and external reviews.
The other checklist covers HIPAA preexisting condition exclusions, HIPAA certificates of creditable coverage, special enrollment rights/notice, health status nondiscrimination and wellness programs, the Mental Health Parity Act, the Women's Health and Cancer Rights Act and others.
According to the DOL and the Employee Benefits Security Administration (EBSA), the tools provide "an informal explanation of the statutes and the most recent regulations and interpretations and include citations to the underlying legal provisions. The information is presented as general guidance, however, and should not be considered legal advice or a substitute for any regulations or interpretive guidance issued by EBSA. In addition, some of the provisions discussed involve issues for which the rules have not yet been finalized."
In recent months, the DOL appears to have stepped up the incidence and complexity of compliance audits. The two checklists suggest the focus of these audits, which is particularly relevant for self-insured health plans as the plan sponsor is generally solely responsible for compliance.