Affordable Care Act Compliance | FTI Consulting

Affordable Care Act Compliance and Operational Services

Health Solutions

October 16, 2015

While the future impact of health care reform is still unknown, it is widely understood that significant compliance and operational risks and challenges currently exist for health care issuers and their stakeholders.

The Patient Protection and Affordable Care Act (“ACA”) was signed into law on March 23, 2010, bringing with it sweeping reforms that have since altered the health care landscape. Although the majority of the provisions brought forth by the ACA have been already been implemented, several regulations are still forthcoming. As a result, health care issuers and their stakeholders are still measuring both the compliance and operational impacts of the provisions implemented to date and continue to prepare for future changes.

A key question will be how do issuers and their stakeholder continue to develop and update Compliance Programs and operational policies and procedures to keep pace with the transforming environment produced by the ACA? The answer lies in proactively identifying potential areas of risk and readying personnel, processes, and systems to be nimble enough to address all ACA-related issues as they are implemented or updated. FTI Consulting’s Health Solutions practice is an advisor with broad and deep regulatory compliance, operations, and system expertise that can help your organization in this endeavor.

The ACA necessitates a Compliance Program and operational structure that serves many masters (the Department of Labor (“DOL”), the Internal Revenue Service (“IRS”), The Centers for Medicare and Medicaid Services (“CMS”), the Center for Consumer Information and Insurance Oversight (“CCIIO”), and state Departments of Insurance (“DOIs”)). This is true for all issuers not just those that offer qualified health plans (“QHPs”) through the Federal or a state Marketplace. The Government’s joint oversight approach for ACA-based products has brought Federal regulation to commercial business that has not previously existed. Further, ACA provisions related to maintenance and access to financial records for inspection by multiple agencies coupled with the programmatic goal of increased transparency have opened health plans to increased risk.


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