Healthcare Reform

News & Analysis as of

ACA Outlook: What Will 2015 Hold for the Affordable Care Act and Employers?

For many employers, the effective date of the Affordable Care Act's "play-or-pay" mandate is only weeks away. The impending deadline comes amid questions about the future—and perhaps viability—of the law itself. Entering...more

Manatt on Health Reform: Weekly Highlights: December 2014 #3

Enrollment numbers and Medicaid reform top the news this week. Federal officials report 1.4 million consumers have selected plans on healthcare.gov. And in the states, Michigan and New Hampshire announce Medicaid expansion...more

Health Care Reform Implementation Update

We are now more than two weeks into the Affordable Care Act (ACA’s) second open enrollment period, and 765,000 individuals have obtained coverage through HealthCare.gov. On Capitol Hill, House lawmakers filed a lawsuit...more

HHS Broadens Federal Controls Over Private Health Insurance Benefits and Operations

On November 21, 2014, the Obama administration released two proposed rules affecting health insurance issuers’ offering of private health insurance products both inside and outside of the public insurance exchanges...more

Monthly Benefits Update - November 2014

U.S. Supreme Court Grants Review of ACA Case Involving Premium Subsidies Offered Through Federally Facilitated Exchanges - The Supreme Court granted review in King v. Burwell, a Fourth Circuit case that upheld an IRS...more

Detailing Provisions of “Obamacare” Affecting Individuals

In Fact Sheet 2014-09, November, 2014, the IRS provides details on “Obamacare”, technically known as the Affordable Care Act (the “ACA”). However, the Fact Sheet does not discuss a case currently before the U.S. Supreme...more

Fundamentals of Hospital/Medical Staff Issues: Minimizing Risk and Maximizing Collaboration

In this presentation: - Health System Structure and Governance - Medical Staff Structure and Governance - Committee Structure - Medical Staff Categories - Medical Staff Governance...more

Impact of Health Care Reform on Provider Liability

In this presentation: - The Changing Healthcare Landscape - Key Features of an ACO/CIN - ACO Standards and Quality Metrics - Examples of Quality Standards - Impact on Board and Corporate...more

The Affordable Care Act Part Two – Preparing for 2015

This is the second of a three part series on the Affordable Care Act (“ACA” or “Act”), commonly known as “ObamaCare.” This post discusses the Employer Mandate, which takes effect January 1, 2015, and certain reporting...more

Manatt on Health Reform: Weekly Highlights: November 2014 #3

With the 2015 Open Enrollment Period (OEP) officially launched as of November 15, this week’s news highlights Marketplaces’ preparation for and tracking of outreach and enrollment – including 100,000 applications submitted on...more

Health Care Reform Implementation Update

Over the past several days, the second open enrollment period through the Affordable Care Act’s (ACA’s) health insurance exchanges began; Republican lawmakers, now with majorities in both the House and the Senate, explored...more

Supreme Court Will Hear Case on ACA Health Insurance Tax Credits

On Nov. 7, 2014, the U.S. Supreme Court announced that it will hear the case of King v. Burwell, one of multiple challenges to the validity of the premium tax credits provided under the Affordable Care Act (ACA) to...more

Why Providers Should Think About the Impact of ICD-10 on Managed Care Reimbursement Now

ICD-10 implementation has been delayed by Medicare until October 2015. Many believe it may be delayed again and are putting off thinking about its impact until it is clear that the updated code set will be implemented by...more

Agencies Come Down Hard on Various Employer Health Plans and Arrangements

As we move into 2015, employers continue to grapple with numerous Health Care Reform concepts. Employers should be cautious regarding arrangements promoted to avoid health care penalties because the agencies are cracking...more

Impact of Midterm Elections on Health Care

The November 4 elections saw the Republican party win control of the U.S. Senate, increase its majority in the House of Representatives, and increase its majority of governorships....more

SCOTUS to Review Subsidy Issue

On November 7, the U.S. Supreme Court announced it was going to review King v. Burwell. At issue in the case is whether Fourth Circuit correctly determined that the IRS did not exceed its authority when it released a rule in...more

U.S. Supreme Court Takes Up Major Challenge to Federal Health Reform

Are Employers in the 34 States Without Exchanges Subject to Penalties? - Despite the fact that there is no longer any disagreement in the lower courts, the Supreme Court on Friday, November 7, 2014, made the unusual...more

Post-Election Washington Outlook

In this issue: - Post-Election Analysis, the Lame Duck, and 114th Congress - Senate Election Results at a Glance - House Election Results at a Glance - Lame-Duck Session Outlook - Issues...more

The Affordable Care Act – Where Are We Now?

The ACA was signed into law in March of 2010 with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the...more

Rules for CME, Revises List of Data Elements to be Reported

Last Friday, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period addressing, among other issues, changes to the reporting and data collection requirements imposed upon “applicable...more

In-Patient Hospitalization and "Minimum Value" Under the ACA - Regulators Issue Guidance to Fix Minimum Value Calculator

The Patient Protection and Affordable Care Act – more commonly known as the Affordable Care Act (ACA) – imposes many requirements on group health plans, including, among others, that plans must provide "minimum value" (MV) in...more

CMS Releases CY 2015 Outpatient PPS/Ambulatory Surgical Center Final Rule

On October 31, 2014, CMS issued its CY 2015 outpatient and ambulatory surgical center (ASC) PPS final rule. CMS finalized a net payment rate increase of 2.2 percent under the OPPS. This figure includes a 2.9 percent market...more

CME Payments Exposed to Sunshine, But Not Too Much

Sometimes there’s less to life than meets the eye. Take the final rule issued last Friday by CMS on reporting CME (for continuing medical education) payments under the Physician Payments Sunshine Act....more

Health Care Update - November 2014

In This Issue: - CMS Releases Final Medicare Payment Rules - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional Initiatives - Other Health...more

Key Takeaways from OIG’s 2015 Work Plan

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Fiscal Year 2015 Work Plan on October 31. The Work Plan provides the OIG’s planned reviews and activities with respect to...more

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