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

Led by Texas, Several States Challenge Section 1557’s Gender Identity Protections in HHS’s Final Rule

On August 23, 2016, several States and three faith-based healthcare providers filed suit in the Northern District of Texas against the U.S. Department of Health and Human Services (“HHS”) over HHS’s interpretation of “sex” in...more

Anti-Kickback Regs Near Approval, After Only 19 Years

The White House is reviewing proposed regulations to ease restrictions on certain financial arrangements between hospitals and physicians and on certain transactions between providers and patients. The proposed regulations,...more

HHS Proposes 340B Dispute Resolution Process

From its inception the 340B program has been the subject of disputes between drug manufacturers and their safety-net hospital customers. On August 12 HHS proposed an administrative process for resolving those...more

2016 Draft Instructions For 1094-B and 1095-B

Last week, the IRS released draft 2016 instructions for the 1094-B and 1095-B (the “B” Forms). The release of the draft instructions is just weeks after the IRS released the draft instructions for the 1094-C and 1095-C...more

HRSA Proposes Administrative Process to Resolve Disputes Between 340B Program Covered Entities and Drug Manufacturers

Taking a step toward completing a requirement imposed by the Affordable Care Act, the federal government has proposed regulations that would create an administrative dispute resolution (“ADR”) process to resolve disputes...more

HHS Issues Final Non-Discrimination Rules for Healthcare Providers

Healthcare providers and others who receive federal financial assistance are now subject to new non-discrimination rules and notice requirements under the Affordable Care Act. The new regulation prohibits discrimination in...more

CMS Flags Potential Provider “Steering” of Medicare/Medicaid Beneficiaries to Favorable ACA Marketplace Plans to Obtain Higher...

CMS is putting health care providers on notice that it considers it “inappropriate” for providers to offer premium or cost-sharing assistance to Medicare or Medicaid beneficiaries in order to “steer” the patient to an...more

Affordable Care Act Compliance: IRS Releases Draft 2016 Employer Reporting Forms and Instructions

The Internal Revenue Service recently issued revised draft Forms 1094-C and 1095-C and related instructions for use for the 2016 reporting year. ...more

Manatt on Medicaid: Medicaid: States’ Powerful Tool to Combat the Opioid Crisis

Editor’s Note: The United States is in the throes of a rapidly worsening opioid epidemic. The crisis is far-reaching: As of 2014, 1.9 million Americans had an opioid use disorder involving prescription medication, and an...more

You Received a Health Insurance Marketplace Notice from HHS – Now What?

Take a deep breath. The HHS Health Insurance Marketplace Notice (the “Notice”) may seem to be a nuisance, but it does not necessarily mean that you will be subject to employer shared responsibility penalties....more

Are You Down With O.O.P.s?: Opt-Out Payments Under the Affordable Care Act

In Notice 2015-87, the IRS addressed the impact of employer opt-out payments — payments made to employees who decline enrollment in an employer’s group health plan — on affordability for ACA purposes. Employers who do not...more

What Should You Do With a Marketplace Notice?

Employers of all sizes are receiving notices from Health Insurance Marketplaces (“Notice” or “Marketplace Notice”) alerting them that an employee or employees have obtained Exchange coverage and are eligible for and receiving...more

IRS Issues Drafts of Forms 1094-C, 1095-B and 1095-C for 2016

Last month, the IRS issued proposed changes to the ACA reporting and disclosure forms for 2016. As a reminder, Forms 1094-B and 1095-B are used by insurance providers to report on the number of individuals enrolled in health...more

Section 1557 of the Affordable Care Act Requires Healthcare Providers to Take Certain Steps in 2016 to Promote Equity

Section 1557 of the Affordable Care Act aims to advance healthcare equity. This statutory provision provides that current non-discrimination laws, such as the Civil Rights Act of 1964, will now apply to individuals and...more

HHS Proposes Administrative Dispute Resolution Process for 340B-Related Claims

On August 12, 2016, the US Department of Health and Human Services (HHS) Health Resources and Services Administration issued a notice of proposed rulemaking that establishes an administrative dispute resolution process for...more

Manatt on Health Reform: Weekly Highlights - August 2016 #3

CMS’s risk adjustment program data signals an improving risk pool while the agency announces plans to modify the program; California enrolls 134,000 undocumented immigrant children into Medicaid; and Oregon approves increases...more

CMS Reports Marketplace Successes and Considers Improvements

On August 12, 2016, the federal Centers for Medicare and Medicaid Services (CMS) issued both a report delivering a message of optimism regarding the healthcare Marketplaces (or exchanges) and posted a blog written by the...more

Client Alert: The Physics of Wellness at Work

Newton’s Third Law of Motion states that for every action, there is an equal and opposite reaction, and that Law is evident in the workplace wellness environment. Employers believe they are doing right by their employees by...more

New IRS Guidance on Collection of TINs for ACA Information Reporting

Recently proposed IRS regulations aim to clarify lingering questions about steps employers with self-insured health plans must take to collect and report the taxpayer identification number (TIN) of covered individuals in...more

Departments Finally Publish Updated SBC Template and Instructions

On April 6, 2016, the Departments of Health and Human Services, Labor and Treasury (the “Departments”) issued an updated Summary of Benefits and Coverage (“SBC”) template. The latest template represents an effort by the...more

Under the Dome: Inside the Maine State House

Under the Dome: Inside the Maine State House provides a high-level overview of recent activity at the Maine State House. Maine’s Health Exchange Co-op Sues Federal Government & Files for Rate Increase - Community...more

Manatt on Health Reform: Weekly Highlights - August 2016 #2

CMS targets Medicaid managed care pass-through payments; California proposes “California Qualified Health Plans” for the undocumented; and a new study finds out-of-pocket costs were reduced by nearly a third for Medicaid...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

Seattle Ballot Initiative Targets Hotel Industry

According to Ballotpedia, 140 state ballot initiatives in 35 states have already been certified for the November 8, 2016 election. This number does not include the many city-wide measures that will be before voters on...more

Traps for the Unwary: Does Your Employee Handbook Comply with the Affordable Care Act?

Do you think you’ve complied with the Affordable Care Act mandates? Before you answer yes, you’d best take a close look at your Employee Handbook – a minefield for mistakes....more

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