Archives: ACA

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House Ways and Means Committee Approves Revenue Provisions Relating to Proposed Repeal and Replacement of the Affordable Care Act

The House Ways and Means Committee approved legislation that would repeal the taxes enacted to fund the Affordable Care Act, and defer for five years the “Cadillac tax” on expensive health insurance policies. It also approved eliminating the penalty tax for not having health insurance, adopting a new refundable credit to help Americans pay for … Continue Reading

DOJ Juggernaut Will Continue To Rack in $$$$

The Department of Justice (DOJ) announced this week that it collected another $4.7 billion during FY 2016 under the False Claims Act (FCA). This was the third largest haul in history, bringing total recoveries since FY 2009 up to $31.3 billion. Although DOJ did not say it directly, there seems no end in sight to … Continue Reading

House Prevails in Challenge to Administration’s Funding of ACA Cost-Sharing Provision

Yesterday, in a blow to the Obama Administration, the United States District Court for the District of Columbia struck down a key ACA provision designed to reduce insurance costs. Specifically, Section 1402 of the ACA requires insurers participating in the Exchanges to reduce deductibles, coinsurance, copayments, and other means of cost-sharing on qualified health plans. … Continue Reading

CMS Creates Standardized Plans for Health Insurance Exchanges

On February 29th, CMS published its final rule regarding the 2017 benefit and payment parameters for the Federally-facilitated health insurance exchanges.  As part of the final rule, CMS creates standardized health care plans that insurers can offer on the exchanges. CMS created the standardized plans in order to simplify health insurance shopping for consumers.  According … Continue Reading

Final Overpayment Rule Clarifies Some, But Not All, Questions

Overview After receiving scores of comments over nearly 4 years, the Centers for Medicare and Medicaid Services (CMS) has released its final rule (the “Final Rule”) addressing the reporting and returning of overpayments made to suppliers and providers who receive funds through Medicare. The Final Rule implements Section 6402(a) of the Affordable Care Act, which … Continue Reading

Life, Liberty and the Pursuit of Conscious Healthcare Spending: The Uncertain Political Future of the “Cadillac Tax” as Effective Deadline Nears

In the months that have followed King v. Burwell, the spotlight on the ACA’s Cadillac tax has grown hotter for groups interested in the reform, and repeal, of the ACA.  The King v. Burwell decision, in large part, moved the debate over the future of ACA from the courtroom to the other governmental branches, as … Continue Reading

Capital Thinking: Health Care Legislative Update

Republicans Consider Obamacare Repeal Through Reconciliation Some GOP lawmakers continue to advocate for an Affordable Care Act repeal via the budget reconciliation process. Others, however, have been questioning whether this budget tactic would be better used for different policy objectives, such as tax reform. The budget resolution provided a July 24 deadline for the committees … Continue Reading

Context is King: Analysis of the US Supreme Court Decision in King v. Burwell

Our public policy and healthcare teams recently published a piece analyzing the King v. Burwell decision and its implications. See Context is King:  Analysis of the US Supreme Court Decision in King v. Burwell.  In this piece, we discuss (1) the highlights of the decision’s rationale; and (2) immediate implications of the decision. There are, … Continue Reading

US Supreme Court Oral Argument on Tax Subsidies for Federal Exchange

This morning, the U.S. Supreme Court heard oral argument in King v. Burwell, which raises the issue of whether the federal government can provide tax subsidies to people who buy insurance on the federal exchange because their state declined to establish its own insurance exchange.  Our earlier post details  the arguments at play.  SCOTUS Blog … Continue Reading

IRS Releases Final Regulations for IRS Code Section 501(r)

On December 29th, the IRS released final regulations regarding Internal Revenue Code Section 501(r).  Section 501(r) was added to the Code as part of the Accountable Care Act and imposes certain requirements on charitable hospitals.   In general, the final regulations provide guidance on hospital obligations under Section 501(r), define the types of entities that must … Continue Reading

2014 Mid-Term Election Analysis

The results of this year’s mid-term election, while historic,  also raise considerable uncertainty regarding future legislative action.  What legislative initiatives can we expect to see from the Republican controlled Congress? Will President Obama and Congress work together or will Republican control of both houses result in continued gridlock?  What will happen to the ACA? To help answer … Continue Reading

Supreme Court Will Hear Another ACA Case

The Affordable Care Act has once again made its way onto the Supreme Court’s calendar.  On Friday, the Justices voted to accept King v. Burwell for hearing this term.  The issue this time is whether tax subsidies may be given to individuals who purchase insurance through the federal exchange, rather than an insurance exchange run … Continue Reading

CMS Finalizes Medicare Part C and Part D Program Changes for Contract Year 2015: Moderate Deviations from Proposed Rule

On January 8, 2014, we noted several proposed changes to the Medicare Part C and D programs as delineated in CMS’ January 8th proposed rule (hereinafter “Proposed Rule”). On Monday, May 19, 2014, CMS issued the final rule, titled Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare … Continue Reading

Essential Health Benefits Continue to Be Clarified by State Insurance Departments

On February 27, 2014, the D.C. Department of Insurance, Securities, and Banking (DISB) released a bulletin reminding insurers that medically necessary treatment for gender dysphoria, including gender reassignment surgeries, is a mandated benefit in the District of Columbia.  This is not the case in every state and serves as a reminder for health insurance plans … Continue Reading

CMS Adds to the Growing Guidance on Third Party Premium Payments

On February 7, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum that adds to the growing library of federal guidance on the permissibility of and limitations for health care providers and other entities paying the premiums of patients covered by qualified health plans (QHPs) in the health insurance exchanges or marketplaces.  … Continue Reading

CMS Ushers in the New Year with Medicare Part C and Part D Proposed Rules: HHS Hopes to Save $1.3 Billion

On January 10, 2014, CMS will publish the proposed rule titled Medicare Program: Contract Year 2015 and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (the “Proposed Rule”).  The Proposed Rule propositions extensive reforms to the Medicare Advantage (“Part C”) and Medicare Prescription Drug Benefit Program (“Part D”), partly through … Continue Reading

Facing the Medical Device Tax Head On: Strategic Contracting for Hospital Cost-Reduction

With approximately two months having passed since the end of the government shutdown, the fundamental question still remains; what exactly did Congress achieve through the contentious shutdown negotiations?  The shutdown was spurred in part by certain Congressional Members’  opposition to the funding and implementation  of the Affordable Care Act (“ACA”).  A centerpiece of these oppositional … Continue Reading

Tuomey Ordered to Pay $237 Million

Capping a case that has drawn the attention of healthcare lawyers and hospital executives nationwide, the U.S. District Court for the District of South Carolina has ordered Tuomey Healthcare System, Inc. (“Tuomey”) to pay over $237* million for violations of the Stark Law and False Claims Act arising from certain employment agreements between Tuomey and … Continue Reading

Corporate Health Exchanges: The Next Big Thing in the Obamacare Era?

Last Wednesday, September 18, 2013, Walgreen Company (“Walgreen”) announced its plan to move approximately 160,000 employees to Aon Hewitt’s private health exchange (the “Aon Exchange”) in 2014. This move marks a significant decrease in risk for Walgreen as the company will shift to a defined contribution model for funding its employees’ health insurance. Under the … Continue Reading

HHS Releases “Rate Review” Impact Data: Policyholders Save $1.2 Billion Nationwide

Last Thursday, September 12, 2013, the Department of Health and Human Services (“HHS”) reported that the rate review provisions (the “Rate Review Provisions”) of the Affordable Care Act (“ACA”) saved an estimated $1.2 billion on health insurance premiums in 2012 for 6.8 million policyholders.  The Rate Review Provisions are intended to increase transparency behind premium … Continue Reading

Full Medicaid Expansion Required for States to See Full Federal Funding

Yesterday, the federal government announced that the federal government will not provide 100% funding for states that do not participate in the full Medicaid expansion contained in PPACA, as described by the Washington Post.  Partial expansions will be permitted but will only receive matching federal money at the existing rate, at least for 2014-2017. As we … Continue Reading
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