News & Analysis as of

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

House v. Burwell: Insurer Cost-Sharing Subsidies Unauthorized

A U.S. District Judge has ruled that HHS unlawfully has spent billions of dollars to reimburse insurers for cost-sharing reductions granted to individuals who bought health insurance through an ACA Exchange such as...more

IREG Update - Key changes for ACA CO-OP boards: a look at new regulations taking effect this week

Key changes for ACA CO-OP boards: a look at new regulations taking effect this week - On May 6, 2016, the US Department of Health and Human Services (HHS) released an interim final rule with comment (IFC) to bolster the...more

House GOP Wins Challenge Against Affordable Care Act

The Affordable Care Act (ACA) has withstood several constitutional challenges. Most well-remembered perhaps, is when, in 2012, the U.S. Supreme Court upheld the individual mandate, which requires individuals to have health...more

CMS Issues Revised Rules for CO-OPs and Special Enrollment Periods

As implementation of the Affordable Care Act (ACA) continues, the federal government continues to make adjustments to its rules to respond to the needs and circumstances arising from this transformational legislation. On...more

IRS Denial of Section 501(c)(3) Status for a Commercial ACO

The IRS recently released a ruling, Private Letter Ruling (“PLR”) 201615022, denying Section 501(c)(3) tax-exempt status to a “commercial” accountable care organization (“ACO”). This is the IRS’ first published guidance...more

DOL Issues Guidance Regarding Interaction Between Affordable Care Act And Fringe Benefit Requirements Under Service Contract,...

The Davis Bacon Act and the Davis Bacon Related Acts (collectively “DBRA”) and the Service Contract Act (“SCA”) impose additional obligations related to fringe benefits and wages on covered contractors. With the passing of...more

L.A. hospital under fire for ‘dumping’ poor patient after emergency treatment

Is this any way to treat the most needy? Los Angeles prosecutors have announced a $450,000 settlement with yet another of the city’s hospitals accused of “patient dumping,” the practice of hustling individuals, particularly...more

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...more

Section 1557 of the ACA: The Legal Side of Health Equity

This week marks the end of National Minority Health Month and its 2016 theme of “Accelerating Health Equity for the Nation.” This month, the HHS Office of Minority Health’s goal was to “raise awareness of the health...more

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

On April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the...more

Health Net Deepens Investigation of Addiction Treatment Centers

As noted in a blog posted earlier this year, addiction treatment providers have been receiving an increased number of requests from payors seeking a range of medical and billing records and other documentation concerning the...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Summary of Benefits and Coverage Templates Finalized

On April 6, 2016, the US Department of Labor posted final versions of the updated summary of benefits and coverage (SBC) template and instructions, updated uniform glossary and other associated materials. In previous...more

Technological and Information Concerns Highlight NAIC Spring 2016 National Meeting

The National Association of Insurance Commissioners (NAIC) Spring 2016 National Meeting, which was held from April 3 – 6 in New Orleans, offered insight into numerous issues being considered by state commissioners nationwide....more

IREG Update - Exemptions of health care sharing ministries from insurance laws and regulations

Exemptions of health care sharing ministries from insurance laws and regulations - Whether because of the cost of the policies, or their religious and political principles, many Americans are looking to avoid enrolling...more

Feds identify security vulnerabilities in state healthcare exchange websites

A Government Accountability Office (GAO) examination of the state-run health insurance exchanges for California, Kentucky and Vermont identified inadequate security measures in place to protect consumers’ personal...more

“A Trap for the Unwary” – Does Your Self-Funded Health Plan Provide Transgender Benefits? It Might Need to Soon.

Assistant Secretary of Labor Phyllis Borzi recently offered informal guidance on the broad scope of nondiscrimination regulations proposed under Section 1557 of the Affordable Care Act. During her remarks at the ABA Labor...more

Health Care Discrimination Litigation Gets a New Set of Teeth under the ACA: 2015 Litigation Review and Preview of 2016

Discrimination in health care was prohibited before the Affordable Care Act, but on a limited basis. Protected classes did not include sex; prohibitions excluded private physicians accepting Medicare Part B; and, most...more

Latest CBO estimates show insurance coverage growth under the ACA due to Medicaid and CHIP enrollment nearly doubling

On March 24, 2016, the Congressional Budget Office (CBO) released a report, Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2016 to 2026, that provides a treasure trove of information about the growth...more

Implementation Date for New Summary of Benefits and Coverage Template

The U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) recently issued new guidance regarding the intended timeframe for the use of the new summary of benefits and coverage (SBC) template and...more

Liberating Data to Enable Healthcare Market Transparency: A Guide for Regulators and Policy Makers

The federal and state Marketplaces established by the Affordable Care Act (ACA) have made it easier for consumers to compare their health insurance options, but data are still not fully available for consumers to understand...more

ACA Reporting: IRS Deadline of March 31 Looms for Applicable Large Employers

Applicable large employers have new reporting requirements under the Affordable Care Act (ACA). Whether an employer is an applicable large employer is determined each calendar year by looking at the employer's workforce...more

Shocking News: Congressional Debate on Obamacare Gets Partisan

In one of the more unexpected developments in recent Congressional history, a House Ways & Means Committee vote relating to the Affordable Care Act (ACA) turned partisan. Astonishingly, all the Republicans voted one way; all...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued voluntary guidelines entitled, “CDC Guidelines for Prescribing Opioids for Chronic Pain — United...more

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