Patient Protection and Affordable Care Act (PPACA) Health Insurance Centers for Medicare & Medicaid Services

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

Health Care E-Note - January 2017

On October 4, 2016, The Centers for Medicare and Medicaid Services ("CMS") released the final rules regarding the requirements of participation for skilled nursing facilities. One of the most significant changes to the...more

The New “Price” of U.S. Health Care: The Future of Value-based Reimbursement Under President-elect Trump and Tom Price

The total U.S. health care expenditure was $3.2 trillion in 2015, and is projected to grow to nearly $5.6 trillion by 2025. As our nation’s cost of care rises, both Democrats and Republicans recognize the overwhelming need to...more

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

Congressional Republicans ask states for guidance on new healthcare legislation while insurers and providers urge caution; new reports find ACA repeal would increase uninsurance rates and cut billions of dollars in funding to...more

2016 Health Care Year in Review

Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

Recent Developments in Patient Engagement and Healthcare Cost Initiatives

In the wake of the recent flurry of commentary on the answer to the question of “What will happen to the Affordable Care Act?” the Commonwealth Fund released a new survey addressing how high-needs patients experience health...more

Could Possible Healthcare Repeal Efforts Extend to Physician Payments Under Medicare?

Now that the 2016 presidential election is over, many patients are asking whether Congress will repeal the Affordable Care Act (ACA), or parts of the legislation. Yet, many doctors are asking (or should be asking) whether...more

Health Care Reform 2017: Substance, Process, and Timeline

President-elect Donald J. Trump campaigned on a promise to “repeal and replace” the Affordable Care Act (“ACA”). For several years, the newly reelected Republican majority in Congress has likewise identified ACA repeal as a...more

CMS Continues Efforts to Improve Patient Care, Spending, and Population Health

On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS), released the 2017 Medicare Physician Fee Schedule (MPFS) final rule, which finalized a number of new policies designed to improve Medicare payment for...more

If Obamacare’s Days are Numbered, What’s Next? Trumpcare.

The Affordable Care Act has withstood 62 repeal attempts by the House of Representatives and several challenges brought to the U.S. Supreme Court. Now, with Donald Trump as President and a new Republican-led House and...more

New Presidency Will Compel Action in Key Areas of Health Care in 2017

As we enter the final stretch of the U.S. presidential election, health care remains one of the most contested issues with great potential for change, particularly to existing insurance and patient care systems. Compounding...more

Manatt on Medicaid: Monthly Expansion Recap - October 2016

National News - Medicaid Expansion Is Associated With Improved Hospital Finances, Study Finds - Hospitals in Medicaid expansion states saw “significantly increased” Medicaid revenue, decreased uncompensated care...more

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

Kentucky receives final approval from CMS to transition its Marketplace to the HealthCare.gov platform; Ohio puts a prescription drug price ceiling on its November 2017 ballot; and a new study links Medicaid expansion to...more

Manatt on Health Reform: Weekly Highlights - October 2016

Vermont moves closer to launching the country’s first all-payer ACO; CMS approves Arizona’s 1115 waiver extension but rejects the State’s proposed work requirement and premiums for those earning below the FPL; and CMS issues...more

The Risk Corridors End Game

Since the first cases were filed earlier this year, we have been following nationwide litigation seeking full risk corridors payments to qualified health plans (QHPs) providing coverage on the Affordable Care Act (ACA)...more

Risk Adjustment Update: CMS and the states react to insurer exits

The close of 2016 will mark the end of the third full year that the Affordable Care Act (ACA) has been fully implemented. Data is available for the first two "reporting years," 2014 and 2015, for which health insurers and...more

Manatt on Health Reform: Weekly Highlights - August 2016 #5

A federal report finds that Marketplace premiums are lower in expansion states; Massachusetts and Pennsylvania launch prescription drug monitoring systems; and Kentucky submits a slightly modified Medicaid expansion waiver to...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

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

Transparency's Opaque Beginning: CMS Starts Implementing ACA Transparency Requirements

Based on QHP Certification instructions issued on July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) will collect administrative and performance data from health insurers that participate in the federally-run...more

Manatt on Health Reform: Weekly Highlights - July 2016 #4

CMS’ increase of the “income verification threshold” makes eligibility determinations easier for consumers; Oregon CO-OP policyholders can credit out-of-pocket spending towards new plans; and report finds that 13 million...more

ColoradoCare Stands to Significantly Alter Health Care Services

In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more

Maryland Co-Op Claims Risk Adjustment Formula Discriminates Against Smaller Insurers

Maryland’s Evergreen Health Cooperative has filed for an injunction against the federal government to halt payment by the Consumer Operated and Oriented Plan (co-op) of the $22 million it owes to CareFirst BlueCross...more

Health Law Insights Newsletter - Issue 10 - June 2016

McCarter & English, LLP’s Health Care Group presents Issue 10 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Drug Diversion Case Raises Red Flags for...more

Manatt on Health Reform: Weekly Highlights - May 2016 #4

Uninsurance hit a record-breaking low of 9.1% in 2015; Vermont legislators pass a bill to increase drug formulary and price transparency; and California rolls out its State-funded Medi-Cal expansion to undocumented children....more

New Amendments Grant Failing ACA Co-Op Program Access to Private Capital and Limit Special Enrollment Eligibility

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) passed an interim final rule that amends regulations governing Consumer Operated and Oriented Plans (Co-ops) and tightens restrictions on special...more

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