News & Analysis as of

ACA’s Deductible Limits for Small Groups Repealed

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The primary purpose of the law is to provide a one-year delay of a 24% reduction in payment rates for physicians who participate...more

It’s Not Too Late: You May Still Qualify for ACA Coverage

March 31 was the last day to enroll in a health insurance plan through the federally-facilitated health care exchange. However, like many other Affordable Care Act (“ACA”) deadlines, the March deadline was a soft deadline, as...more

Monthly Benefits Update

As expected, the Department of the Treasury and the IRS (the “Agencies”) finalized the employer information reporting requirements under the Affordable Care Act (the “ACA”) earlier this month. The final rules, which are...more

Five Key Decisions for ACOs Looking to Participate in the 2015 MSSP

The Centers for Medicare & Medicaid Services (CMS) has announced the upcoming deadlines for the third round of new applications to the Medicare Shared Savings Program (MSSP). Accountable Care Organizations (ACOs) that...more

Health Care E-Note - March 26, 2014

In This Issue: - Hospital CEO Turnover Rate Reached Record 20 Percent in 2013 - States Take on Authority of Doctors vs. Advanced Practice Nurses - HHS Urges Hospitals to be More Prepared for Emergencies -...more

Health Care Reform Implementation Update - March 2014

On Sunday, the Affordable Care Act (ACA) turned four. Unsurprisingly, Democrats celebrated the law’s birthday by touting its many successes and Republicans used it to highlight the problems the law has faced, as well as...more

Health Update

Ten Years In: Charting the Progress of Health Information Exchange in the U.S. - HITECH: Federal Dollars Spur Adoption and Use: The modern era of HIE-related public policy began in May 2004 with the appointment...more

Chance to Comment on Future of DMEPOS Payments

CMS recently took the unusual step of issuing an Advance Notice of Proposed Rulemaking (ANPR) regarding changes to Medicare payment methodologies for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)...more

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Upcoming Hearings and Markups. Excerpt from...more

2015 Notice of Benefit and Payment Parameters

The Centers for Medicare & Medicaid Services (CMS or the agency) kicked off a flurry of springtime regulatory activity for health insurance issuers with publication of the final Notice of Benefit and Payment Parameters for...more

Health Care Update

In This Issue: Implementation of the Affordable Care Act; Other Congressional and State Initiatives; Other Health Care News; and Upcoming Hearings and Markups. Excerpt from Implementation of the Affordable Care...more

Program Integrity Priorities Revealed in FY 2015 HHS Budget

On March 14, 2014, President Obama unveiled his Administration’s proposed fiscal year 2015 budget for the Department of Health and Human Services (HHS). In total, the Administration is seeking $77.1 billion to fund HHS in FY...more

Health Care Reform Implementation Update - March 13, 2014

This week President Obama released his Fiscal Year 2015 Budget Proposal, which provides useful information on his priorities for the year but, as is normally the case, is not likely to gain much traction; the administration...more

Health Care Update - March 10, 2014

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Healthcare News; and Hearings and Mark-Ups Scheduled. Excerpt from...more

Health Care Reform Update - March 3, 2014

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; and Hearings and Mark-Ups Scheduled. Excerpt from Implementation of the...more

Health Care Reform Implementation Update - February 26, 2014

Though Congress was in recess this past week, congressional staff was hard at work continuing to consider ways to prevent a cut to Medicare providers’ payment rates that will be triggered by the sustainable growth rate...more

CMS Announces 2015 Rate Cut for Medicare Advantage Plans

On February 21, 2014, CMS released an Advance Notice estimating a decline of 1.9% in 2015 payments for Medicare Advantage (MA) plans. The preliminary estimate of the decline is based on the per capita MA growth percentage,...more

Health Update - Feb 24, 2014: Manatt on Medicaid: Pennsylvania Submits Waiver Application for Approval to Implement ACA Medicaid...

On February 19, 2014, Pennsylvania submitted to CMS an application requesting approval under Section 1115 of the Social Security Act to implement the Affordable Care Act (ACA) Medicaid expansion effective January 1, 2015....more

The Physician Payment Sunshine Act – The Top Five Steps for Physicians: The law defines “payment” to include almost any imaginable...

The Physician Payment Sunshine Act is a minor part of the Affordable Care Act, but it could result in major headaches for physicians. The chief purpose of the Sunshine Act is to make any payments made by medical manufacturers...more

CMS Proposes Significant Rate Cuts and Other Changes to Medicare Advantage and Prescription Drug Plans

The Advance Notice ("Advance Notice") of Methodological Changes for Calendar Year ("CY") 2015 for Medicare Advantage ("MA") Capitation Rates, Part C and Part D Payment Policies and 2015 Call Letter was released by the Centers...more

Polsinelli Podcast - Health Care Payment Changes: From Service to Value [Video]

Healthcare is changing for consumers and providers under the Affordable Care Act. Less publicized is the way providers are now being paid and the way they will work together. In this week's Polsinelli "Inside Law," podcast,...more

CMS Releases Long-Awaited Details for Sunshine Act Compliance

The Physician Payment Sunshine Act (the "Act") was enacted as part of the Patient Protection and Affordable Care Act for the purpose of promoting transparency between the medical industry and health care providers. It...more

CMS Issues Draft Letter with 2015 Affordable Care Act Plan Certification Requirements

On February 4, 2014, CMS released a Draft Letter containing guidance for issuers seeking to offer Qualified Health Plans (QHPs) in Federally-Facilitated Marketplaces (FFMs). The Draft Letter offers operational and technical...more

Health Care Reform Update -- February 10, 2014

In This Issue: Implementation of the Affordable Care Act; Other Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health News; and Hearings and Mark-Ups Scheduled. Excerpt from...more

Health Care Reform Implementation Update - February 10, 2014

Last week the Congressional Budget Office (CBO) released a report on the Affordable Care Act (ACA), in which it projected a decline in the number of full-time-equivalent hours worked; the Senate Finance, House Ways and Means,...more

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