By MATT CHANDLER
mchandler@bizjournals.com | 716-541-1654

Last year, as what was described by some as "bloated" national health-care legislation was being signed into law, there was a sense of uncertainty, frustration and even fear among business owners.

Law firms scrambled to verse themselves on the intricacies of thousands of pages of legislation and phones were ringing off the hook with clients demanding answers. Threats of lawsuits were rampant, there was talk of loopholes and a flat-out refusal to comply, as well as a general sense of chaos.

What a difference a year makes.

Many aspects of the legislation took effect Jan. 1, and area attorneys say things have been generally quiet on the health-care front. While there are still questions to be answered and issues to be resolved in the courts, they see a better understanding of what is expected of employers and health-care providers.

As one attorney said, it is the "calm after the storm."

Jack Brill is an associate with Harter Secrest & Emery LLP. It would not be an exaggeration to say that he has been eating and breathing health-care legislation for the past year. And according to Brill, clients seem to understand what needs to be done and are doing what it takes to be in full compliance as legislation continues to roll out.

"We had a very busy summer last (year) sort of digesting that onslaught of new guidance for the legislation," he says. "In our experience, the larger employers - say the 5,000 to 10,000 range - will self-insure their benefits.

"And for them, the compliance burden is a lot more hefty."

Though it may have added cost, time and stress to larger employers, Brill says the little guys were at an advantage.

"If you are a smaller employer and you have insurance through an insured product, it's not as onerous as it maybe is made out to be because, again, the burden falls on the insurer," he says. "For the most part, having to comply with making plan-design changes, offering eligibility rules and things like that falls to the providers. So that is where the larger companies struggled and, as a firm, it is where we spent most of our time."

Brill says the complex legislation has basically sorted itself out and clients haven't raised many questions regarding compliance - something that was a major concern in the early stages of the legislation.

"For the plans with an effective date of Jan. 1, that's really where a lot of the new rules took effect," he says. "You had to extend coverage to dependent children up to age 26, remove annual and lifetime limits on essential health benefits from your plan - things like that."

He sees confusion in other areas, however.

"For example, the law says you can't have a lifetime limit on essential health benefits. But the law doesn't define what essential health benefits are. It just lists a bunch of categories and you have to decide, for example, is a fertility treatment - because it has a prescription-drug element to it - an essential health benefit? There are some tough calls to be made," he says.

Kate Ulrich Saracene, meanwhile, is an attorney with Nixon Peabody and a member of its health-care reform team. She, too, sees some gray areas in the legislation as trouble spots as firms work with clients to help them understand for the next wave of regulations.

"The big issue that I spent a ton of time on to make sure our clients were prepared was the non-discrimination testing," she says.

Under that provision, it would be illegal to have a health plan that favors management over other employees.

"We were finding that a lot of employers did have plans like that, with management having more generous plans with greater company funding than the rest of the company," Ulrich Saracene says. "So everybody was jumping through hoops to get ready for that."

Like several other areas of the legislation, the implementation date for the non-discrimination testing was pushed back, she adds.

"Now everybody is just in limbo waiting. It was a sort of a deep sigh of relief for everyone, knowing that was one less area they had to worry about."

She says there were similar pullbacks, including the claims-and-appeals procedures regulations. And for lawyers looking to advise clients, she says it is a matter of waiting for additional guidance from the top.

"A lot of the clients have gone ahead and put some of the new requirements into place because, in a lot of cases, it is the health insurance companies, the third party administrators that are administering them for the clients," she says.

As for the other big elephant in the room, there was much ado about suing to block health-care legislation and have it tossed out by a court. So far, most of it has been upheld, but Brill says he doesn't think the fight is anywhere near over.

"I believe that the health-care legislation is ultimately going to be decided by the Supreme Court," he says.