Final Rule Outlines Procedures for Affordable Care Act Whistleblower Complaints

Final Rule Outlines Procedures for ACA-Related Whistleblower Complaints

A new final rule establishes the final procedures and time frames the Occupational Safety and Health Administration (OSHA) will use when handling complaints from employees who may have been subject to retaliation for reporting potential violations of certain Affordable Care Act (ACA) requirements or for receiving a premium tax credit or cost-sharing reduction as a result of participating in the Health Insurance Marketplace.

Because the relationship between an employee’s receipt of the premium tax credit and an applicable large employer’s (ALE’s) potential Pay-or-Play penalty liability could create an incentive for the employer to retaliate against the employee, the federal Fair Labor Standards Act prohibits an employer from retaliating against an employee for receiving a premium tax credit or cost-sharing reduction under the ACA.

The law also prohibits retaliation against employees who provide or are about to provide to their employer, the federal government, or the attorney general of a state information relating to any potential violation of several key provisions of the ACA, including but not limited to:

  • The prohibition on lifetime and annual dollar limits on essential health benefits;
  • The requirement for non-grandfathered plans to cover certain recommended preventive services with no cost-sharing; and
  • The prohibition on pre-existing condition exclusions.

To review OSHA’s final procedures, click here.