Proskauer Rose: Feds Are Auditing PPACA Compliance

From grandfathered plans, the Labor Department is asking for copies of grandfathered status disclosure documents and documents showing that the plans qualify for grandfathered status, the compliance specialists say.

From non-grandfathered plans, the department is asking for documents such as emergency services benefits documents, preventive services documents, and descriptions of internal claims and appeals procedures.

Plans must show, for example, that they they are covering out-of-network emergency services without requiring more cost sharing than they would require of enrollees using in-network emergency services.

The Labor Department also is auditing plans’ compliance with provisions that affect both grandfathered and non-grandfathered plans, such as the requirement that plans offering dependent coverage make dependent coverage available to adult children up to age 26.

The Proskauer Rose compliance specialists are recommending that employers and plans keep written records of any steps taken to comply with PPACA since Sept. 23, 2010.

“For example, plans should keep and be able to produce notices of coverage for children up to 26 years of age, and evidence of distribution,” the compliance specialists say.

Anyone who gets a PPACA compliance audit request should talk to lawyers immeidately, because the parties involved may need to act quickly to protect their interests, the compliance specialists say.