Patient Protection and Affordable Care Act (PPACA)

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
News & Analysis as of

North Carolina’s Medicaid RAC Program - Don't Let Your Guard Down

With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program,...more

How to Structure an Employee Severance Package Regarding COBRA and the ACA

Often, when parting ways with an employee, an employer may offer to pay for some months of COBRA continuation coverage so that the employee can remain covered without having to pay the substantial premiums associated with...more

Fatal Blow to Healthcare Reform? Courts split on federal tax credit

On July 22, 2014, two federal courts came down on opposite sides of an issue that may have far-reaching consequences about the future of the Patient Protection and Affordance Care Act ("PPACA"). At stake is whether the PPACA...more

Circuit Courts’ Split over Major ACA Issue Will Impact Employers

Two U.S. Courts of Appeals recently issued conflicting rulings on a major provision of the Affordable Care Act (ACA), and the U.S. Supreme Court is being asked to weigh in. The concern is over the Internal Revenue Service’s...more

CMS Issues Final Rule on Marketplace Auto-Enrollment

On September 5, 2014, the Centers for Medicare and Medicaid Services (CMS) published a final rule, effective October 6, 2014, that, among other things, specifies the auto-enrollment process for consumers who receive health...more

Health Care Update - September 2014

In This Issue: - HealthCare.gov Hacking Breach - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health...more

California Repeals 60-Day Limit on Waiting Periods

On August 15, 2014, California passed Senate Bill 1034, which repealed an insurance law (Assembly Bill 1083) that prohibited insurance companies from including waiting periods in excess of 60 days in their group health...more

U.S. Court of Appeals for the District of Columbia Circuit to Rehear ACA Subsidy Challenge

On September 4, 2014, the D.C. Circuit vacated a panel decision in Halbig v. Burwell (Civ. No. 14-5018) striking down the federal government’s provision of premium subsidies to individuals purchasing coverage through the...more

Independent Hospitals Innovating, Finding New Partnerships in Response to Market Pressures

Standard & Poor’s (S&P) Rating Services recently warned the health care sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” S&P noted...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 16: So What, Exactly, is an “Offer of Coverage”?

Whether an employer makes the requisite offer of group health plan coverage is critical to the application of the Affordable Care Act’s employer shared responsibility rules as reflected in final implementing regulations...more

CMS Approves Pennsylvania’s Medical Assistance (Medicaid) Waiver

CMS approved Pennsylvania’s Medical Assistance (“Medicaid”) waiver request entitled Healthy Pennsylvania (“Waiver” or “Healthy Pennsylvania”) by letter dated August 28, 2014. Governor Tom Corbett and the Pennsylvania...more

Health Care Reform Implementation Update

As summer rolls to a close, the agencies continue to make announcements and roll out additional regulations. The Department of Health and Human Services (HHS) introduced the new CEO of Healthcare.gov, awarded grants to 147...more

D.C. Circuit Court of Appeals Agrees to Hear Halbig ACA Case Before Full Court

Following up on our Week 22 ACA Countdown to Compliance post, the D.C. Court of Appeals granted the government’s petition for en banc review in Halbig v. Burwell, which held low income subsidies to purchase coverage through...more

Advocacy Organizations’ Complaint Puts a Spotlight on Potential Noncompliance by Nonprofit Hospitals

On August 25, two advocacy organizations filed a complaint with the Internal Revenue Service (IRS) alleging noncompliance by a hospital system with respect to certain community benefit requirements imposed by the Patient...more

Full D.C. Circuit to Rehear ACA Premium Tax Credit Case

The full U.S. Court of Appeals for the D.C. Circuit has vacated the 2-1 panel decision issued July 22, 2014, in Halbig v. Burwell, which struck down the Internal Revenue Service (IRS) Rule providing for Affordable Care Act...more

Government Issues New Rules for Religious Employers, But Health Plans, TPAs, and PBMs are still on the Hook to Provide...

The Affordable Care Act (“ACA”) requires that non-grandfathered health plans make preventive care and screenings available to their members at no cost (i.e. no deductibles, coinsurance, or co-payments). The Department of...more

Getting the Best Medical Care: a Newsletter from Patrick Malone - August 2014

In This Issue: - One Consumer's Story - Why Were You Denied? - Preparing for a Successful Appeal - Getting Help - Persistent Consumer Wins Big - Excerpt from Introduction: When Your Health Insurer...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 17: Cherry Bomb in the Gold Fish Pond, or Third-Party Staffing...

With two seemingly simple and straightforward definitions in the final regulations implementing the Affordable Care Act’s pay-or-play rules—i.e., definitions of “employer” and “employee”— the Treasury Department and IRS have...more

IRS Issues More Guidance on Affordable Care Act Reporting Requirements

Following up on regulations and forms published earlier this year, the IRS has issued instructions and other guidance on the shared responsibility reporting requirements under the Affordable Care Act....more

What’s Ahead for 2015: Preparing Your Nonprofit’s Group Health Plan for the Employer Mandate

In this presentation: - Introduction to the Play-or-Pay Rules - Identifying Full-Time Employees - New Reporting Requirements - Excerpt from Introduction to the Play-or-Pay Rules: Employer...more

Manatt on Medicaid: Pennsylvania Receives Federal Approval to Implement Medicaid Expansion

On August 28, 2014, the Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s application under Section 1115 of the Social Security Act to implement a Medicaid expansion effective January 1, 2015, through a...more

IRS Guidance on the Application of the Affordable Care Act’s Market Reform Provisions to HRAs and FSAs

The Internal Revenue Service (IRS) recently published guidance in Notice 2013-54 (the “Notice”) on the application of certain market reform provisions of the Affordable Care Act to Health Reimbursement Accounts (“HRAs”),...more

DOL Issues Post-Hobby Lobby Guidance for Closely Held For-Profits Making Changes in Contraception Coverage

The Department of Labor (DOL) issued guidance for closely held for-profit corporations that wish to exclude coverage of any contraceptives under their health plans in the wake of the Burwell v. Hobby Lobby Supreme Court...more

Federal Appeals Courts Issue Contradictory Rulings on Federal Marketplace Subsidies under Affordable Care Act

Two federal appeals courts issued contradictory rulings on the validity of subsidies for the purchase of health insurance under the federal marketplace established pursuant to the Affordable Care Act (ACA). On July 22, a...more

IRS Issues Draft Forms for Coverage Reporting Requirements under the Affordable Care Act

The Internal Revenue Service (IRS) has released draft versions of forms that will be used by employers to report health coverage information required under the ACA’s employer shared responsibility rules. As we have written in...more

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