In March 2010 the hotly contested Affordable Care Act (Public Law 111-148) (ACA or the Act) was signed into law by President Obama. Since its enactment, some health care providers have struggled to meet the Act’s current deadlines, while others have questioned if they should test new care delivery methods in anticipation of the apparent movement away from a pure fee-for-service system. When it was clear that the constitutionality of the ACA would be decided before the United States Supreme Court this summer, some health care providers forged ahead and others took a wait-and-see approach. On June 28, 2012, the Supreme Court made its decision on health care reform, keeping the law for the most part intact, and leaving health care providers to now wonder, “What’s next?” Below is a summary of the Court’s decision as well as some key areas under the ACA that will now need to be implemented by the Centers for Medicare and Medicaid Services (CMS) and other Department of Health and Human Services.