News & Analysis as of

Cost-Sharing

Congress Returns to Washington with a Packed Health Care Calendar

by Baker Donelson on

September is traditionally one of the busiest months in Washington, and this year is no exception. While much of the attention is focused on the debt ceiling debate, appropriations and the federal response to Hurricane...more

Health Care Reform Roundup – Issue 9

After health care reform efforts failed in late-Spring/early-Summer, things have been quiet. However, Congress returned to DC this week. Although legislative focus now appears to be on general tax reform, we expect some...more

26 Days: Congress and Health Care as FY 2017 Comes to a Close

by Epstein Becker & Green on

Congress returns from August recess today, facing a daunting workload to complete before the end of the current fiscal year (FY) on September 30. Big picture issues include raising the national debt ceiling and passing a...more

Qualified Medicare Beneficiary Program Billing Rules Call

by Reed Smith on

On September 19, 2017, CMS is hosting a call to explain Qualified Medicare Beneficiary (QMB) billing rules, including upcoming changes to the HIPAA Eligibility Transaction System (HETS) and remittance advice to identify...more

Window on Washington - This Week in the Nation's Capital - Vol. 1, Issue 23

by Clark Hill PLC on

CBO Confirms Size of Breach of Defense Cap for FY18 Bills: The House FY18 Omnibus Appropriations Bill scheduled to be taken up in September would bust the Defense cap by $72 billion. This would cause the Office of Management...more

ACA Cost-Sharing Reductions– A Momentary Reprieve and Ongoing Doubts

The Future of CSRs – A Tale Told in Tweets. In follow-up to our May 5, 2017 blog post, “ACA Cost-Sharing Reductions: An Uncertain Future,” on August 16, 2017, the Trump Administration made an announcement (Announcement) that...more

Update on Cost-Sharing Reduction (CSR) Payments and Graham-Cassidy-Heller Proposal

by King & Spalding on

According to multiple media reports, the Trump administration will make CSR payments for August. President Trump has previously called these expenditures, which help insurers fund coverage for low income individuals,...more

K&L Gates Triage: 340B Regulatory Update: CMS Proposal and Draft Executive Order Could Have Big Impact on 340B Program

by K&L Gates LLP on

cmsThis episode outlines the basics of the 340B Drug Pricing Program and discusses potential changes affecting the program, including CMS’s recent proposal to cut reimbursement for Part B drugs purchased under the 340B...more

ACA Legislative Path and Cost–Sharing Reduction Payments Both Uncertain

by King & Spalding on

Congress is on recess until September 5, and the outlook for Affordable Care Act (ACA) repeal and replace legislation remains unclear. Moderate Democrats and Republicans want to work together to shore up the ACA insurance...more

Manatt on Health: August 2017

Next Steps on Healthcare Reform - Though President Trump has continued to call for action on repeal and replace in the wake of the Senate’s failed vote at the end of July, congressional Republicans have been fairly muted...more

Senate Rejects Proposals to Repeal and Replace Affordable Care Act

by McDermott Will & Emery on

Senate Republicans failed to pass legislation to repeal and replace the Affordable Care Act last week. After voting to proceed with debate on the American Health Care Act, which was passed by the House in May, the Senate...more

Healthcare Legislation Outlook and Update

by Holland & Knight LLP on

Below is a summary of recent U.S. Senate action on healthcare legislation and our outlook regarding coming issues and possible actions. Holland & Knight's Healthcare & Life Sciences Team will follow up as developments...more

Health Care Weekly Preview from ML Strategies – July 2017 #4

Following the dramatic conclusion of the failed vote on the repeal of the Affordable Care Act (ACA), it appears the Senate will pivot to other issues, namely the National Defense Authorization Act (NDAA). However, the...more

What Can Health Plans Do if the Trump Administration Stops Making CSR Payments?

by Faegre Baker Daniels on

Amid assertions that the Affordable Care Act (ACA) should be allowed to fail, the Trump administration has indicated that it may stop paying subsidies that are central to ACA markets. At the core of these subsidies are...more

OIG Approves Cost-Sharing Arrangement Involving Clinical Research Study

by Baker Ober Health Law on

The U.S. Department of Health and Human Services, Office of the Inspector General (OIG), issued a favorable advisory opinion, No. 17-02, regarding a proposed arrangement under which the cost-sharing amounts owed by...more

Health Care Weekly Preview from ML Strategies – July 2017 #3

We head into the last week of July with the Findings of the Senate Parliamentarian in hand, who ruled late Friday that several provisions in the Better Care Reconciliation Act (BCRA) released on June 26th would be subject to...more

Significant Cuts Proposed to Medicare Payments for 340B Drugs

by McDermott Will & Emery on

As part of the CY 2018 proposed updates to the Medicare Hospital OPPS, the US Department of Health and Human Services has proposed to decrease Medicare Part B payments to hospitals for 340B drugs by almost 30 percent. The cut...more

Updated Health Care Reform Legislation Comparison Chart

The chart below compares key provisions of the Affordable Care Act (ACA), the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). This chart is current as of July 13, 2017, and as of that date,...more

New OIG Advisory Opinion Allows Waiver of Cost Sharing in Research Studies

The Office of Inspector General (OIG) recently issued Advisory Opinion 17-02, allowing waivers or reductions of cost-sharing amounts owed by financially needy Medicare beneficiaries in connection with certain clinical...more

Better Care Reconciliation Act – Key Takeaways for Employers and Plan Sponsors

On June 22, 2017, the Senate released its much anticipated health care reform legislation – the Better Care Reconciliation Act (“BCRA”) (linked to amended version released June 26, 2017). In many respects the BCRA is similar...more

The Better Care Reconciliation Act of 2017

On June 22, Senate leadership released their proposed substitute for the House-passed American Health Care Act (AHCA), the Better Care Reconciliation Act of 2017 (BCRA), as a discussion draft. The BCRA was updated on June 26,...more

Senate Releases Repeal and Replace Legislation on ACA: The Better Care Reconciliation Act of 2017

by Foley & Lardner LLP on

After weeks of secrecy, the Senate has released a discussion draft of legislation that is the counterpart of the American Health Care Act (AHCA) previously passed by the House. The Senate legislation, entitled the Better Care...more

Health Update - June 2017

HIPAA and Emerging Technologies - Editor’s Note: According to a HIMSS Mobile Technology Survey of healthcare provider employees, about 90% say they are using mobile devices to engage patients in their healthcare—and 36%...more

Are You Ready for AB 72?

by Buchalter on

To protect patients from receiving an unexpected surprise bill when they seek care at in-network facilities from out-of-network providers, Governor Brown signed AB 72: California’s surprise out-of-network law. The new law...more

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

Senate health reform bill to be made public Thursday; CMS Actuary releases its AHCA coverage and cost projections; and new analysis finds Marketplace rate increases are being driven by the Trump Administration’s lack of...more

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