How the Affordable Care Act affects your ABA agency

Todd A. Ward, PhD, BCBA-D

bSci21Media, LLC

Liliana Salazar, Esq.

Chief Compliance Officer, West Region, HUB International

Jason McVay

Account Executive, HUB international

Jamie Pagliaro & Dawn Mackey

Rethink Behavioral Health

How do recent updates to the Affordable Care Act (ACA) affect your Applied Behavior Analysis (ABA) agency?  That was the question discussed in a recent webinar conducted by Liliana Salazar and Jason McVay of HUB International, a leading insurance brokerage firm in North America.  The event was hosted by Dawn Mackey of Rethink Behavioral Health.

Though recent efforts have tried to repeal and replace the ACA, a second attempt failed last August.  Thus, the ACA is here to stay for the foreseeable future, and can have important implications for your ABA agency.   As an ABA business owner, it is your responsibility to keep up-to-date on policy changes that could affect your company and its employees, both legally and financially.

Is your company an Applicable Large Employer?

If your agency has 50 or more full-time and full-time equivalent, employees, it is deemed to be an Applicable Large Employer (ALE).  ALEs are required to offer affordable minimum value benefits (i.e., benefits that pay at least 60% of costs) to at least 95% of its employees.  According to the ACA, an employee is “full time” if they work 130 hours or more each month or on average 30 hours or more per week.  Moreover, the Employer Shared Responsibility Mandate, or “Pay or Play Mandate”, increases the penalties for noncompliance to ACA guidelines each year to adjust for inflation.  Note that the IRS recently began enforcing the Play or Pay mandate for the 2015 calendar year by issuing letter 226J to employers.

As an ALE, you need to report to the IRS everyone who is a full-time employee, what coverage you offered them, and how much you are paying for coverage.  Moreover, if you receive a notice stating that one of your employees received a subsidy in the health insurance exchange, you have 90 days to file an appeal that says you offered the employee coverage that met all of the requirements, along with supporting documentation.  As an ALE, Liliana strongly recommends documenting every step in the coverage process, including written records of coverage waivers. You may also receive a letter (Letter 226J) from the IRS notifying you of your penalty exposure under the ACA, you will only have 30 days to appeal that determination.

Impact on the Applied Behavior Analysis Industry

According to Liliana, the ACA is helping the ABA industry.  As of 2017, ABA services are now covered as one of the 10 Essential Health Benefits (EHB) offered to recipients.  Moreover, states are now prohibited from imposing restrictive annual dollar limits on EHBs.  EHB status means that more people than ever will have access to much-needed ABA services.  As such, we should expect demand for ABA services to increase during a time when demand for services is already at an all time high.

How has the ACA affected your agency?  Let us know in the comments below!

Also, be sure to join Rethink to watch this and other webinars that support your work as an ABA business owner.

Todd A. Ward, PhD, BCBA-D is the President and Founder of bSci21Media, LLC, which owns the top behavior analytic media outlet in the world, bSci21.org.  bSci21Media aims to disseminate behavior analysis to the world and to support ABA companies around the globe through the Behavioral Science in the 21st Century blog and its subsidiaries, bSciEntrepreneurial, bSciWebDesign, bSciWriting, bSciStudios and the ABA Outside the Box CEU series.  Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno under Dr. Ramona Houmanfar.  He has served as a Guest Associate Editor of the Journal of Organizational Behavior Management, and as an Editorial Board member of Behavior and Social Issues.  Dr. Ward has also provided ABA services to children and adults with various developmental disabilities in day centers, in-home, residential, and school settings, and previously served as Faculty Director of Behavior Analysis Online at the University of North Texas.  Dr. Ward is passionate about disseminating behavior analysis to the world and growing the field through entrepreneurship. Todd can be reached at todd.ward@bsci21.org

Liliana Salazar, Esq. is Chief Compliance Officer for the Western Region for HUB International Limited.  Liliana is responsible for addressing public and private employers’ health and welfare responsibilities under federal and state laws and city ordinances. She works closely with HUB’s service teams and clients to develop short- and long-term strategies that will allow clients to remain in compliance while addressing clients’ financial and human capital needs.

Liliana interacts with regulatory agencies such as the Department of Labor, the Internal Revenue Service, the U.S. Treasury Department, the Centers of Medicare and Medicaid Services, the Department of Health and Human Services, the Equal Employment Opportunity Commission and state insurance departments to discuss the applicability of laws and regulations to group health plans.

Liliana possesses 20 years of experience in addressing the compliance and regulatory needs of employers and their group health plans. She actively worked with carriers and clients in ensuring their compliance with the HIPAA Privacy, Security, and HITECH Act rules, GASB 45 obligations, and more recently the Patient Protection and Affordable Care Act (PPACA or ACA). Prior to joining HUB, Liliana was National Practice Leader for the Employee Benefits Compliance Practice of Wells Fargo Insurance Services, and Vice President of Compliance for ABD Insurance Services.

Liliana is a regular speaker at national and state conferences sponsored by private and public employers, employee benefit chapters and HR associations, including ISCEBS, SHRM, CALPELRA, PELRA, NAFOA and others and is also a regular contributor to national and regional employee benefit publications.

Due to her contributions to employee benefits and the insurance industry in general, Liliana was the recipient of the 2013 Women to Watch Award from Business Insurance.

Rethink Behavioral Health provides the tools every behavioral health provider needs to manage their practice and deliver quality ABA treatment effectively & efficiently. Rethink’s easy to use web-based software streamlines client care with sophisticated yet intuitive tools for both clinicians & administrators. For more information, visit http://www.rethinkbh.com.

Print Friendly, PDF & Email

CE Sale for BCBAs!

About bsci21 628 Articles
President, bSci21 Media, LLC Editor, bSci21.org

2 Comments

  1. I live within the state of Wyoming where BCBS and other insurance companies deny ABA coverage. I’m confused with your article above, because to my knowledge ABA is not covered by insurance in my state. Please let me know if I’m wrong.

Leave a Reply

Your email address will not be published.


*


This site uses Akismet to reduce spam. Learn how your comment data is processed.