ACA like Disability Claim Rules Proposed Senate

ACA like Disability Claim Rules Proposed Senate

Our Thinking / Healthcare /

ACA like Disability Claim Rules Proposed Senate GOP Plans Attack on ACA
Calendar01 December 2015

Proposed Department of Labor rules would require ERISA plans processing disability claims to provide certain procedural protections similar to ACA standards for non-grandfathered group health plans. The new rules would treat coverage rescissions like benefit denials, require more detailed denial notices written in a "culturally and linguistically appropriate manner," and expand claimants' response rights. Unlike the ACA, however, the proposal does not call for external reviews. The changes would affect employers, insurers, and third-party administrators handling claims that call for a disability determination under ERISA welfare (and pension) plans.

On Capitol Hill, the Senate could vote as early as this week on a Republican budget reconciliation bill to repeal or gut major portions of the ACA, including employer play-or-pay requirements, the individual mandate, Medicaid expansion, exchange subsidies, and the “Cadillac” tax. The House has passed a similar, though narrower measure. While a Senate bill could not be filibustered and may pass with just 51 votes, the President has vowed to veto any attempt to harm the law. Still, Republicans view the reconciliation exercise as a powerful campaign messaging tool and a dry run for what they might be able to accomplish if a Republican is elected president next year.

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