Maintaining Compliance Under The Patient Protection And Affordable Care Act

2181 words - 9 pages

Maintaining Compliance under the Patient Protection and Affordable Care Act
The passage of the Patient Protection and Affordable Care Act and its recent implementation into the market is transforming not only the health insurance industry, but also employers that offer health insurance. Businesses across the United States now find themselves being legally compelled to offer a larger portion of their workforce health insurance. The effects of this change leave these businesses attempting maintaining compliance under the new law and at times limit the increased costs.
One of the most aspects of the Patient Protection and Affordability Care Act is what is being referred to as the Employer ...view middle of the document...

17).
The first step is to determine how many additional employees a business must now offer health insurance. The law established that all full time employees are eligible and defined a full time worker as an employee whose average hours of service was at least 30 hours or more. Clements (2013) explains how this time is calculated best:
“Logan” starts work with your company on week five of your fiscal year (March 3, 2013). He is not expected to average more than 30 hours of service per week. So, he is not eligible for health coverage and is not given initial measurement and stability periods of 52 weeks. After his initial measurement period, it is determined that he has average 31.5 hours of service per week, which makes him a full-time employee and eligible for health insurance. Therefore, he is eligible for health coverage from March 31, 2014 until March 29, 2015 (the end of his initial stability period).
Thus, compliance has become the name of the game for the majority of businesses, as failure to do so would cause the business to incur $2,000 per employee per year for whom they are failing to provide compliant health insurance plans. In order for businesses to ensure their compliance, employers have begun instituting compliance departments or officers. These departments utilize statistical concepts to monitor and audit their endeavors including data analysis; data mining; and statistical or probability sampling (Dorfschmid, 2012).
Data analysis covers a wide range of areas in regards to Patient Protection and Affordable Care Act compliance. Data analysis is the application of statistical concepts to interpret and evaluate a given data set. Business must now analyze the average number of hours an employee works, the number of employees that do work over the threshold for the Employer Mandate and provide those employees the opportunity to enroll in coverage through the organization. But the organization would not enter this new climate without proper research in determining the number of additional employees the organization must now provide coverage for and the probability of other employees will become eligible for employer coverage based on their schedule.
Calculating the probability of these scenarios requires the organization calculate a projected estimate of employees who will become eligible. This estimate is calculated “from a random sample that was based on the correct interpretation and application of the various… requirements” (Dorfschmid, 2014, Para.3). In this instance a random sample of current employees is taken, the data is separated based on those who would be eligible for health insurance from the employer based on the new rules under the Patient Protection and Affordability Care Act and those who would not. The number of elements, or employees, who would be eligible would be divided by those who would not be eligible, to determine the probability that an employee will be eligible for employer health insurance under the...

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