News & Analysis as of

Cost-Sharing

Health Care Reform Weekly Roundup – Issue 2

Below are key health care reform developments from the week of May 15th: ACA Repeal Efforts. Efforts to repeal and replace the Affordable Care Act (ACA) continue despite slowing down as the House of Representatives’...more

GOP in D.C. Shaping Up as the Major Problem for Charlie Baker

by PretiFlaherty on

Charlie Baker sent a letter to key members of the U.S. Senate this past Friday, an ominous document concerning matters with the potential to cause enormous harm in Massachusetts: federal cost sharing reduction payments, and...more

Termination of the Affordable Care Act’s Cost Sharing Reduction Subsidies

by K&L Gates LLP on

There is a growing likelihood that the current administration will terminate funding for the Affordable Care Act’s (ACA) cost sharing reduction (CSR) subsidies some time within the next two months. The administration has the...more

Agreement Reached on FY17 Appropriations Package

by Baker Donelson on

Over the past few weeks, it looked increasingly possible that Congress might fail to meet an April 28 deadline for adopting a fiscal year 2017 (FY17) appropriations package, potentially leading to a shutdown of the federal...more

ACA Cost-Sharing Reductions: An Uncertain Future

“Cost-sharing reductions” (CSRs) are one of the primary mechanisms under the Affordable Care Act (ACA) to make health coverage affordable for consumers. CSRs are government payments to insurance companies for the purpose of...more

Manatt on Health Reform: Weekly Highlights - May 2017

Florida, Maine and Ohio consider proposals to impose work requirements in Medicaid, Congress continues to debate the AHCA, and the uncertain future of cost-sharing reductions continues to generate concern....more

Manatt on Medicaid: Maine Releases Draft Waiver Request Proposing New Eligibility Requirements

On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more

Manatt on Health Reform: Weekly Highlights - April 2017 #4

The ACA reduced uninsurance among veterans by 40%; Marketplaces showed signs of stabilizing in 2016; and some states are giving insurers more time to make decisions about offering coverage on the Marketplace next year in...more

The Fate of the ACA’s Cost-Sharing Reduction Subsidies

by Perkins Coie on

As deliberations over a replacement of the Affordable Care Act (ACA) continue in the U.S. House of Representatives, the fate of the ACA’s Cost-Sharing Reduction subsidies (CSRs) may be at stake. Under the ACA, Marketplace...more

HHS Finalizes Health Insurance Market Stabilization Rules

by Ballard Spahr LLP on

The U.S. Department of Health and Human Services (HHS) has finalized regulations designed to help stabilize the individual and small group health insurance markets and, in particular, the health insurance exchanges...more

Manatt on Health Reform: Weekly Highlights - April 2017 #3

The focus is on the Marketplaces this week as CMS publishes a new Marketplace stabilization rule, even as President Trump threatens to withhold cost-sharing reduction payments to insurers. In the states, Florida announces...more

Tax Court Déjà Vu – IRS Tried, and Failed, to Overturn Veritas

by Alston & Bird on

In a recent decision (Amazon Inc. v. Commissioner, March 23, 2017), the Tax Court handed the IRS an unsurprising loss when it attempted to relitigate many of the same issues it unsuccessfully raised before the Tax Court in...more

What’s New in Washington: 10 Things You Need to Know

Congress entered into its spring recess on April 7 having delivered regulatory reforms to President Trump’s desk. In the first 75 days of the Trump administration, legislators approved 13 Congressional Review Act resolutions,...more

Manatt on Health Reform: Weekly Highlights - April 2017 #2

HHS's position on cost-sharing reduction payments remains unclear as insurers seek certainty before Marketplace rate filing deadlines; states continue to finalize Medicaid budgets and seek waiver flexibility; and North...more

Calling for Ideas—CMS Releases Final 2018 Medicare Advantage and Part D Rate Announcement and Call Letter

by Hogan Lovells on

On 3 April 2017, the Centers for Medicare & Medicaid Services (CMS) released its final Medicare Advantage (MA) and Part D Rate Announcement and Call Letter (Call Letter) for calendar year 2018. The Call Letter is part of...more

Amazon v. Commissioner: IRS Cost Sharing Buy-In Challenge Rejected Again

by Jones Day on

On March 23, 2017, the U.S. Tax Court issued its long-awaited opinion in a transfer pricing dispute involving Amazon's cost sharing arrangement ("CSA") with its Luxembourg subsidiary... ...more

ACA Repeal and Replace Plan is Released

by Ballard Spahr LLP on

The House Ways and Means and Energy and Commerce Committees have released, in two parts, budget reconciliation legislation, the first steps of Congress' proposal to "repeal and replace" the Affordable Care Act. Reconciliation...more

Entitlement Reform – Medicaid

by Baker Donelson on

Of particular focus in the coming year will be Medicaid, the federal/state health care program for low-income Americans. The program, which cost the federal government $334 billion in FY15, is a frequent target of...more

Manatt on Health Reform: Weekly Highlights - February 2017 #3

Congress moves forward on key healthcare appointments; the Administration takes steps to shore up the Marketplaces; and Governors prepare to gather in Washington as new reports document the ACA's impacts on states....more

Manatt on Health Reform: Weekly Highlights - January 2017 #4

The National Governors Association and National Association of Insurance Commissioners weigh in on ACA repeal and replace; CBO releases new Medicaid and Marketplace enrollment estimates; and Massachusetts proposes reinstating...more

New Year, New Resolutions, New Safe Harbors

by Akerman LLP on

As we welcome the new year and its endless possibilities, we also welcome some new Anti-Kickback Statute safe harbors and concomitant business possibilities. In December, the U.S. Department of Health and Human Services...more

OIG Rings in the New Year With New Anti-Kickback Statute Safe Harbors

by Foley & Lardner LLP on

Just in time for the New Year, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued final regulations (Final Regulations) that revised two existing Anti-Kickback Statute safe...more

New Year, New Possibilities: OIG Final Rule Amends Beneficiary Inducement Rules

by Davis Wright Tremaine LLP on

The Office of Inspector General (“OIG”) of the Department of Health and Human Services has issued a final rule (“Final Rule”) adding new safe harbors to the federal anti-kickback statute, amending existing safe harbors, and...more

OIG Issues Favorable Advisory Opinion for Cost-Sharing Waiver and Stipend Arrangements in a Government-Funded Clinical Research...

by Robinson & Cole LLP on

The Office of Inspector General (OIG) recently issued a favorable advisory opinion (Advisory Opinion) to a university health system (Requestor) regarding two arrangements: (1) a proposal to waive cost-sharing obligations of...more

2016 eDiscovery Case Law Year in Review, Part 2

by CloudNine on

As we noted yesterday, eDiscovery Daily published 74 posts related to eDiscovery case decisions and activities over the past year, covering 62 unique cases! Yesterday, we looked back at cases related to admissibility and...more

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