News & Analysis as of

Washington Healthcare Update

This Week: CMS Releases Guidance on Fast Track Process for 1115 Waivers for Medicaid and CHIP... Healthcare.gov CEO Sends Letter to State Insurance Commissioners Concerning 2016 Premium Decisions... Medicare Board of Trustees...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 2 of 24): Yikes! The Costs of Failing to Comply...

The Affordable Care Act (ACA) imposes information reporting rules on providers of minimum essential coverage, e.g., insurance carriers and self-funded plans, and on applicable large employers, i.e., those employers that are...more

Regulators Likely To Heavily Scrutinize Proposed Humana-Aetna Merger

At the beginning of the month, insurance companies Aetna Inc. and Humana Inc. announced they would be pursuing a merger, with the former company acquiring the latter. Aetna, sources say, will be purchasing Humana for roughly...more

Also In The News - Health Headlines - July 2015

CMS Reopens Attestation Period For First-Time Hospitals Until August – CMS recently announced that eligible hospitals participating in the Medicare Electronic Health Record Incentive Program for the first time in 2015 may...more

Changes and Challenges for Mental and Behavioral Health Providers

As Kentucky’s Senate Bill 192 highlights, coverage and treatment of substance abuse problems is dramatically changing as the current penal model is slowly being replaced with a treatment model. Even terminology for what has...more

Health Update - July 2015

Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace - Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...more

Manatt on Health Reform: Weekly Highlights - July 2015 #3

In quick succession, governors in Alaska and Utah announce Medicaid expansions this week; Iowa is transitioning its expansion away from the Marketplace to Medicaid managed care, for now; and, HHS extends its exception to...more

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

King v. Burwell Aftermath: Where Does the Health Care Industry Go From Here?

What was at stake in King v. Burwell? DH: Perhaps more than initially meets the eye. If the U.S. Supreme Court had sided with the King v. Burwell plaintiffs, federal tax subsidies to reduce the cost of insurance premiums...more

Health Care Update - July 2015 #1

In This Issue: - Recent Mandatory APMs Signal Evolution in Delivery Reform Efforts - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Upcoming...more

Employer Health Plans: Taking Responsibility for Your Business Associates

The Anthem and Premera Blue Cross data breaches caused widespread panic throughout the employer health plan community earlier this year. For many, these data breach announcements served as a wakeup call for employer health...more

Health Alert (Australia) - July 6, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgments: Victoria. 26 June 2015 - Northern Health v Kuipers [2015] VSCA 172 - The Victorian Supreme Court has allowed an appeal...more

Health Care Update - June 2015 #4

In This Issue: - Pathway for Bipartisanship following King v. Burwell - Federal Regulatory Initiatives - Congressional Initiatives - Other Health Care News - Upcoming Congressional...more

King v. Burwell – Supreme Court Upholds Premium Subsidies under Federally-Run Marketplaces; ACA Remains (Mostly) Unfazed

On June 25, 2015, the United States Supreme Court released its much anticipated King v. Burwell decision regarding the validity of premium assistance issued by Federally-run Marketplaces. Chief Justice Roberts, writing for...more

How Does the King v. Burwell Decision Affect the Affordable Care Act?

The Supreme Court handed the Obama administration a key victory this morning, upholding the tax credits that allow many low-income Americans to purchase health care insurance in states where the federal government is running...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. Legislature Plans Long Day - Early this past Wednesday morning, the Maine House and Senate...more

King v. Burwell: No “Death Spirals”

"Death spirals" were avoided today when the U.S. Supreme Court released its long awaited opinion in King v. Burwell, holding that tax credits are available to subsidize coverage for qualified individuals in all states,...more

King v. Burwell: The Supreme Court Rules in Favor of the Administration and the Affordable Care Act Survives

The U.S. Supreme Court has once again ruled in favor of the Affordable Care Act (ACA). At issue in King. v. Burwell was whether the landmark legislation allows federal subsidies to be given to low-income consumers residing...more

U.S. Supreme Court Upholds Affordable Care Act Subsidies

Today, in King v. Burwell, the United States Supreme Court held that subsidies for coverage under all marketplace health exchanges pursuant to the Patient Protection and Affordable Care Act (the “ACA”) remain available. ...more

How Does King v. Burwell Decision Affect the Affordable Care Act? [Video]

At the core of King v. Burwell is the concern of whether patients will have access to affordable medical care across the country, regardless of how a state chose to implement health care exchanges. In this video, Foley...more

The skinny on narrow networks

The insurance exchanges created under Affordable Care Act have facilitated increased competition. Old version managed care models implemented cost-savings measures like pre-authorizations for medical care, hospital length of...more

May Companies Reduce Employee Hours to Avoid ACA Requirements?

The Affordable Care Act (the “ACA”) generally requires that large employers offer health coverage that meets certain requirements to their full-time employees (i.e., employees working 30 hours or more per week) and their...more

Washington Healthcare Update

This Week: Leading Up to the SCOTUS King v. Burwell Decision... House Votes to Repeal the Medical Device Tax... CMS Announces It Will Bolster Transitional Reinsurance Payments... MedPAC Releases June Report to Congress....more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

Providers Await Result on Affordable Care Act Challenge

Challenging a holding by the Fourth Circuit Court of Appeals before the U.S. Supreme Court in King v. Burwell, counsel Michael Carvin argued that the Affordable Care Act does not allow the federal government to issue tax...more

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