For the last six years, Republicans have talked about repeal and replacement of the Affordable Care Act. The election outcome now puts Republicans in a position of authority to take action on the Affordable Care Act. As we...more
The Massachusetts Health Policy Commission conducted its fourth annual Cost Trends Hearing on October 17 and 18, 2016, under the requirements of Massachusetts’s 2012 health care reform legislation (“Chapter 224”). The hearing...more
CMS issued a final rule, published in the Federal Register on Friday, June 10, 2016, updating how the performance of ACOs participating in the Medicare Shared Savings Program (MSSP) is measured and compensated. This rule is...more
Price disparities among hospitals pose one of the more intractable issues for policy makers, regulators and the government. That they exist is indisputable. Why they exist is a source of much contention. And the issue...more
Massachusetts Secretary of Health and Human Services, Marylou Sudders, held a public meeting earlier this week to receive feedback on the proposal of the Executive Office of Health and Human Services (EOHHS) to overhaul the...more
In 2012 Massachusetts adopted the most recent in a series of comprehensive legislative approaches to health care reform, Chapter 224 of the Acts of 2012 (Chapter 224), which focused especially on addressing the drivers of...more
The Massachusetts Division of Insurance (DOI) recently held a two-day hearing on rate changes proposed by Massachusetts health insurance plans to be effective for the second quarter of 2016 (Q2). Presentations by carriers, in...more
Building on the momentum of early October hearings on the state’s growing health care expenditures, the Health Policy Commission (HPC), the Joint Committee on Health Care Financing, Governor Charlie Baker, and others spent...more
10/26/2015
/ Alternative Payment Models (APM) ,
Competition ,
Controlled Substances ,
Drug Pricing ,
Governor Baker ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Fraud ,
Hospitals ,
Innovation ,
Licenses ,
Medicaid ,
Nurse Practitioners ,
Pain Management ,
Pending Legislation ,
Performance Improvement Plans ,
Physicians ,
Public Health ,
Rebuttable Presumptions ,
Reimbursements ,
Substance Abuse ,
Telehealth ,
Telemedicine ,
Transparency ,
Value-Based Payments
For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more
7/15/2015
/ Affordable Care Act ,
Alternative Payment Models (APM) ,
Beneficiaries ,
BPCI ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Comment Period ,
Fee-for-Service ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Home Health Agencies ,
Home Health Care ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
OASIS ,
Obama Administration ,
Physicians ,
Value-Based Purchasing
Earlier this month, HHS Secretary Silvia Burwell made a game-changing announcement about the Obama Administration’s most significant alternative payment model (APM). The Pioneer Accountable Care Organization (Pioneer ACO)...more
In an April 22, 2015 letter to the New York State Department of Health (DOH), the Federal Trade Commission (FTC) cautioned that part of the State’s Medicaid reform program may sanction anticompetitive behavior. The FTC’s...more
In this volume, we have collected the 52 weekly blog posts that comprise the series entitled, The Affordable Care Act—Countdown to Compliance for Employers. The series appeared in the Mintz Levin Employment Matters Blog...more
2/25/2015
/ Affordable Care Act ,
Americans with Disabilities Act (ADA) ,
Cafeteria Plans ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Mandates ,
Equal Employment Opportunity Commission (EEOC) ,
Full-Time Employees ,
Health Insurance ,
Honeywell International ,
HSA ,
Minimum Value Plans ,
Pay or Play ,
Self-Insured Health Plans ,
Shared Responsibility Rule ,
Wellness Programs
Important dates for the ACA:
..On November 7, 2014, the Supreme Court took what appears to be an unusual step in accepting review of King v. Burwell without the necessity or the benefit of a clear split on the outcome...more
On September 16, 2014, the Centers for Medicare & Medicaid Services (CMS) announced key shared savings and losses results of Accountable Care Organizations (ACOs) that began participating in the Medicare Shared Savings...more
On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more
7/28/2014
/ Affordable Care Act ,
Chevron Deference ,
Employer Mandates ,
Halbig v Burwell ,
Health Insurance ,
Health Insurance Exchanges ,
Healthcare Reform ,
IRS ,
King v Burwell ,
Subsidies ,
Tax Credits
On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more
Both decisions addressed whether tax credits are available for residents in states that have federally-facilitated health exchanges. The District of Columbia Court of Appeals said “no”; the Fourth Circuit Court of Appeals...more
In a significant development, the House Ways and Means Committee and Senate Finance Committee each advanced its version of Sustainable Growth Rate reform legislation on Thursday, December 12. Thus, early next year, lawmakers...more
What is the SGR?
The Sustainable Growth Rate (SGR) formula was enacted in 1992 as a statutory means of controlling Medicare spending by calculating annual updates to the Medicare physician fee schedule. The fee...more
..Because of the prolonged government shutdown, the Centers for Medicare & Medicaid Services (CMS) may encounter delays in promulgating final payment rules that would otherwise be effective January 1, 2014.
..It is...more
If the federal government is forced to shut down as a result of a budget impasse in Congress, discretionary programs and federal employees would be the most affected, while payments for Medicare services, the Affordable Care...more
The Obama Administration released its proposed Fiscal Year 2014 budget on April 10th. The 244-page document outlines the President’s spending priorities for the coming fiscal year. The FY 2014 Budget for the Department of...more
4/15/2013
As was widely expected over the month of December, the Obama Administration and Congress scrambled in the late hours of 2012 and on New Year’s Day devising a legislative package to prevent the United States from going over...more