Compliance Rules are Cumulative 

There are a few milestones that stand out when running a care organization. Hiring your first employee, caring for your first resident, opening a new facility, or celebrating a significant anniversary. While these moments are exciting for any growing organization, with each employee you add, your facility may be subject to a new set of rules that can easily sneak up if you don’t know what to look for. 

Watch out for these 8 rules and regulations as your organization grows: 

10+ Employees 

OSHA Record Keeping 

Once your organization reaches upwards of 10 employees, OSHA record-keeping rules start. Records of serious work-related injuries and illnesses must be kept and maintained at the workplace for at least 5 years. Additionally, each February through April, businesses must post a summary of injuries and illnesses that occurred the previous year (Form 300). 

Learn more about OSHA record keeping here. 

20+ Employees 

COBRA Coverage 

At 20 or more employees* care facilities are required to offer their employees COBRA coverage when a worker quits, is terminated (for reasons other than misconduct), or loses eligibility for healthcare due to a reduction in hours. 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows employees and their families to temporarily keep their employer healthcare coverage when it would otherwise be lost in most circumstances. 

Typically, employees pay 100% of the premium plus a 2% administrative fee. While it’s expensive, COBRA health coverage can be an attractive option if an employee doesn’t want to change providers or has already hit their out-of-pocket maximum for the year and doesn’t want to start over with a new maximum mid-year. 

*Organizations are required to offer COBRA coverage if they have 20 employees (or 20 full-time equivalents) for 50% of the previous calendar year. 

Learn more about COBRA and how it’s administered here. 

Coordination of Medicare Benefits 

Knowing how to answer employees’ questions accurately and knowledgeably is important. If your care organization has employees 65 years or older, you may encounter questions about how their Medicare works with your employer-sponsored healthcare plans. Which coverage pays first? 

Your answer depends on how many employees you have. If you have fewer than 20 employees, Medicare typically pays first, and their employer healthcare pays second. However, once your organization reaches 20 employees or more, the employer-sponsored pays first, followed by Medicare second. If that’s the case, advise employees to tell their doctors to bill Medicare secondary, rather than primary. 

Learn more about Medicare Benefit Coordination here. 

50+ Employees 


If you’ve reached 50 or more employees, following the Family Medical Leave Act (or FMLA) is required. FMLA is a federal law that allows employees to take up to 12 weeks of unpaid, job-protected leave. Why? When the unexpected happens, employees should be protected if they need time to look after their own health, the health of a family member, or time to bond with their newborn (or newly adopted child).  

Learn more about FMLA here. 

Affordable Care Act (ACA) Reporting 

Organizations with 50 or more employees must also follow Affordable Care Act (ACA) laws. This is particularly important when it comes to the ACA’s reporting rules. Under the ACA, employers must report health insurance coverage on an annual basis and share this information with the IRS (Form 1094-C) and employees (Form 1095-C) for their tax purposes. 

Learn more about the Affordable Care Act here. 

Affirmative Action 

If you have 50 or more employees and have over $50,000 in work on government contracts, your organization must have a special plan to provide equal employment opportunities for women, minorities, veterans, people with disabilities, and other protected classes. It’s called an Affirmative Action Program (or AAP). AAP includes your proactive policies and procedure for recruiting, hiring, training, and promoting of all individuals without discrimination. 

Learn more about Affirmative Action Programs here. 

100+ Employees 

EEO-1 Reporting 

Once you reach 100 employees, the US Equal Employment Opportunity Commission (or EEOC) requires that employers fill out and submit an EEO-1 Report. This annual report provides a count of your employees by job category and then by ethnicity, race, and gender. The data is then used for a variety of purposes including enforcement, self-assessment by employers, and research. 

Learn more about EEO-1 Reporting here. 

Form 5500 

If your employer-sponsored insurance plans have over 100 enrolled participants*, you must file Form 5500 annually, according to the Employee Retirement Income Security Act (or ERISA). This form collects data on employees’ benefits, including medical, dental, Section 125, 401(k), and retirement plans. The purpose of Form 5500 is to provide the IRS and DOL with information about your plan’s operation and compliance with regulations. 

*Participants include employees, COBRA enrollees, and retirees, but not dependents. 

Learn more about Form 5500 here. 

Final Thoughts 

Ultimately, growing your organization can be exciting! At the same time, it’s important to work with your human resources, payroll, and legal team to ensure compliance with the various state and federal rules as you grow. These challenges are necessary steps to take your care organization into the next phase of growth. 

If you don’t have a dedicated person for compliance or a specialized team to help you navigate the details of growth, fear not. Procare HR is here to guide you. We’re looking out for you, so you can keep your focus on what matters most – delivering care.Let’s connect! 

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