The Department of Health and Human Services (HHS) oversees the Affordable Care Act (ACA), including any Affordable Care Act implementation processes. In summary, the ACA is a 2010 comprehensive health care reform law designed to extend health coverage to Americans. Accordingly, the ACA includes premium tax credits and cost-sharing reductions to help lower expenses for lower-income individuals and families. Since 2010, the HHS and other government agencies have issued Frequently Asked Questions (FAQs) documents to address specific concerns. Given that, on October 4th, 2021, the HHS issued Part 50 of its Affordable Care Act Implementation Frequently Asked Questions. Earlier, in October 2020, the IRS announced an extension for ACA reporting requirements due to the COVID-19 pandemic.
Summary of Affordable Care Act Implementation, Part 50
By and large, Part 50 of the FAQs addresses coverage of preventive services for COVID-19, HIPAA nondiscrimination, and wellness programs. Indeed, the FAQs discuss the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Markedly, under the CARES Act, non-grandfathered group health plans and health insurance issuers have to cover qualifying coronavirus preventive services. Chiefly, a “qualifying coronavirus preventive service” means an item, service, or immunization that prevents or mitigates COVID-19.
Part 50 also discussed the connection between the ACA and the Employee Retirement Income Security Act (ERISA). Basically, under ERISA, plans and issuers cannot discriminate against participants, beneficiaries, and enrollees based on health factors. For that reason, interested stakeholders have asked if health plans can provide incentives to encourage individuals to receive COVID-19 vaccines. For example, may group health plans offer participants a premium discount for receiving a COVID-19 vaccination? In a word, the answer is “yes.” The premium discount, however, must comply with final wellness program regulations. Overall, a premium discount that requires someone to perform a health factor-related activity is a wellness program.
In conclusion, critical stakeholders can find more information on the Affordable Care Act Implementation Frequently Asked Questions webpage.