Healthcare Reform

News & Analysis as of

Healthcare Reform in the U.S. Territories; Prepayment of Taxes for Puerto Rico Retirement Plans

The summer of 2014 has brought further guidance for health plan coverage in the U.S. territories and for retirement plan coverage in Puerto Rico. Issuers and employer sponsors of Puerto Rico group health plans and employer...more

Health Care Reform Implementation Update August 2014

The Centers for Medicare and Medicaid Services (CMS) made announcements this week regarding the Open Payments system and the availability of Affordable Care Act (ACA) Consumer Assistance Program grant funds, issued a request...more

Health Update - August 2014 #5

The Five Megatrends Shaping Pharma’s Next Decade: Sustaining Success in a New Market Landscape - Disruptive trends in the healthcare system will force companies to change their strategies. With new care models...more

Resistance WAS Futile—California Conforms to ACA Waiting Period Requirement

After wandering in the wilderness for a year, California has now come in from the cold and conformed its requirements for eligibility waiting periods to the federal standard adopted in the Affordable Care Act (ACA). Effective...more

GAO Concludes CMS Should Increase Oversight of Post-Payment Claims Review Process

The Government Accountability Office (GAO) has released the findings of its study of the steps taken by CMS to prevent Medicare contractors from conducting certain duplicative post-payment claims reviews. Based on its audit,...more

CMS Care Coordination Payments – A Boon to Doctors and Patients but Patient Participation Will be Essential

As the Affordable Care Act continues to mature, we are seeing new efforts by the Obama administration to incentivize care coordination across a spectrum of services provided to Medicare Fee-for-Service (FFS) patients. A New...more

Federal Health Insurance Marketplace Sends Notices Regarding Citizenship and Immigration Data Inconsistencies

The Centers for Medicare & Medicaid Services (“CMS”) announced that the Federal Health Insurance Marketplace (“Marketplace”) began sending follow-up notices to consumers with citizenship or immigration data inconsistencies...more

Health Care Reform 2.0 Part 1

In this issue: - Health Care Reform – Overview - 2014 Federal Poverty Level Guidelines – 48 Contiguous States* - Health Care Reform – Affected Benefits - Health Care Reform – Excepted...more

Health Care: CMS Issue Inpatient Rehabilitation Final Payment Rule For 2015 (8/14)

On July 31, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule, published in the Federal Register on August 6, 2014, updating fiscal year (FY) 2015 Medicare payment policies and rates for the...more

Health Care Update - August 2014 #2

In This Issue: - Brady Unveils Medicare/Medicaid Fraud Bill - Possible Litigation Threat Adds to Considerations in Containing Drug Costs - Implementation of the Affordable Care Act - Other Federal...more

Academic Medical Centers: Clinical Care, Research and Teaching (or Maybe Not?)—Graduate Medical Education and the Future

In the world of healthcare policy and law, we usually discuss issues impacting providers, but don’t often report about the training and infrastructure behind what allows our healthcare system to treat patients in our...more

CMS Temporarily Closes the Open Payments System

Open Payments is the website through which pharmaceutical and medical device manufacturers (“Manufacturers”) report payments and transfers of value to physicians and teaching hospitals, as required by the Sunshine Act. ...more

Health Care Reform Implementation Update August 2014

August recess has begun on Capitol Hill. Congressmen and women and senators are home in their districts and states, and Capitol Hill staffers are catching up on piled up work. Nonetheless, last week Congressman Kevin Brady...more

Business News Digest – August 2014

In this issue: - Draft Forms Released for the Affordable Care Act's Health Coverage Reporting Requirements - FINRA Targets Broker-Dealer Order Routing and Execution Quality of Customer Orders - Potential...more

Dark Clouds Over Sunshine Act

Once again the Obama administration has been tripped up in launching a healthcare-related online system. This time the problem concerns the Physician Payments Sunshine Act—the act that is supposed to enable the public to see...more

The Sliding Scale of Health Coverage: Finding the Intersection of Cost, Access and Quality

While not a new concept, the use of narrow networks has become a lightning rod for the controversy surrounding qualified health plans (QHPs) offered on the insurance exchanges created under the Affordable Care Act (ACA) and...more

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

August and September 2014 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties and excise taxes. To...more

Evolving Healthcare Trends & Patents: Charting a Safe Course for Personalized Medicine

Rapid changes resulting from personalized medicine, including the ability to use individual patient biomarker data to generate a tailored treatment, are transforming healthcare. New business structures are evolving in the...more

Don't Delay: Deadline for ICD-10 Compliance for October 1, 2015 Still Underway

In a final rule released on July 31, the U.S. Department of Health and Human Services (HHS) confirmed October 1, 2015 as the compliance date for health care providers, health plans, and health care clearinghouses to...more

ICD-10 Compliance Deadline Is Now October 1, 2015

Health care providers, health plans, and health care clearinghouses (“Health Care Entities”) are required to comply with ICD-10 (which stands for the International Classification for Diseases, 10th Edition) on October 1,...more

Health Care Update - August 2014

In This Issue: - Sovaldi Pricing Lower in Canada - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health...more

Health Care Reform Implementation Update

Congress begins its summer recess this week, but last week legislators were busy holding hearings on management issues regarding HealthCare.gov, introducing legislation to increase payments to primary care doctors under...more

Affordable Care Act Update: Courts Divided on who is Eligible for Subsidies on the Exchange

On July 22, 2014, within 2 hours of each other, two U.S. Courts of Appeal issued conflicting rulings on whether subsidies may be offered in states that use the federal insurance exchange. Background. The...more

CMS Proposes Regulations: Changes to Physician Fee Schedule, Hospital Outpatient, and Ambulatory Surgical Center Policy and...

On July 3, 2014, The former revises payment policies under the Medicare Physician Fee ScheCenters for Medicare and Medicaid Services (CMS) proposed two regulations, CMS-1612-P and CMS-1613-P. dule, while the latter makes...more

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