Hospitals Patient Protection and Affordable Care Act (PPACA)

News & Analysis as of

IRS Denial of Accountable Care Organizations Raises More Questions Than It Answers

In a recent ruling, PLR 201615022, the IRS denied tax exemption to an accountable care organization on the basis that the organization was conferring private benefit on its participating physicians by negotiating shared...more

IRS Denies Exempt Status for Non-MSSP Accountable Care Organizations

In April, the IRS released a private letter ruling denying section 501(c)(3) status to an accountable care organization (“ACO”) that contracted with third-party payers outside of the Medicare Shared Savings Program (“MSSP”)....more

Medicare Board of Trustees Releases 2016 Annual Report: Hospital Trust Fund Insolvency Projected by 2028

The Medicare Board of Trustees is calling for urgent legislative action to address the impending financial insolvency of the Medicare hospital benefit program. The Board’s 2016 report reveals the trust fund that pays for...more

Clinically Integrated Networks - The New Way for Healthcare Providers to Play Together in the Sandbox

The implementation of the Affordable Care Act has shifted the attention of the healthcare industry away from fee-for-service payment toward performance-based reimbursement. This reform of the healthcare system focuses on...more

October 1 Compliance Deadline for Section 501(R) Regulations

Is your hospital one of the hundreds of charitable hospitals with fiscal years ending Sept. 30? If so, your hospital has only a short amount of time to put in place policies and procedures to comply with the regulations under...more

Hospital Mergers: Is the FTC’s Winning Streak Over?

Following a winning streak dating back to its 2007 win in Evanston, the Federal Trade Commission (FTC) has suffered two losses over the last month in two of its three pending hospital merger challenges. On June 14, 2016, a...more

Manatt on Health Reform: Weekly Highlights - June 2016#3

CMS targets short-term insurance plans in efforts to stabilize the individual market risk pool; Illinois mandates Medicaid coverage for opioid addiction treatment; and Michigan seeks to restructure State Medicaid financing....more

Health Law Insights Newsletter - Issue 10 - June 2016

McCarter & English, LLP’s Health Care Group presents Issue 10 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Drug Diversion Case Raises Red Flags for...more

Tackling the Dragon of Hospital Price Disparity: Massachusetts's On-Going Efforts to Address Price Equity

Price disparities among hospitals pose one of the more intractable issues for policy makers, regulators and the government. That they exist is indisputable. Why they exist is a source of much contention. And the issue...more

Manatt on Health Reform: Weekly Highlights - June 2016#2

Arkansas’ Governor requests to transition to a “State-based Marketplace on the Federal Platform;” Louisiana launches Medicaid expansion with SNAP fast-track enrollment; and study shows 2016 premium increases are lower for...more

FTC Suffers Setback in Campaign to Slow the Rising Tide of Healthcare Consolidations

The FTC just suffered a major setback in its concerted efforts to challenge the ever growing number of consolidations in the healthcare industry, failing to secure a preliminary injunction to block a hospital merger in...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

Health Update - April 2016 #2

How to Prepare for "Phase Two" HIPAA Compliance Audits: Tips on Getting Ready for Scrutiny - Editor's Note: Now that the Department of Health and Human Services (HHS) has announced that it is beginning the next round of...more

Reminder to Charitable Hospitals: Final Section 501(r) Regulations Effective

Section 501(r) of the Internal Revenue Code was added by the Affordable Care Act (ACA) and imposes significant new requirements on charitable hospitals. At a very summary level, this section requires charitable hospitals...more

Health Update - March 2016

Liberating Data to Enable Healthcare Market Transparency: A Guide for Regulators and Policymakers - Editor's Note: We are on the cusp of a transparency revolution in which consumers will have the data and tools to make...more

Health Law Insights Newsletter - Issue 7 - March 2016

McCarter & English, LLP’s Health Care Group presents Issue 7 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Providers’ Obligation to Report Medicare...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled, “Medicare Program; Part B Drug Payment Model.” The proposed rule seeks...more

New Stark Law Exception for Non-Physician Practitioner Subsidies: A Gift or Pandora's Box for Hospitals?

As of January 1, 2016, a new Stark Law exception allows hospitals to give subsidies to physician practices for the recruitment of non-physician practitioners (“NPPs”). In the Phase III Stark Law regulations, the Centers for...more

Health Care Update - February 2016 #4

What to Expect from Congress this Work Period - The next Hill work period basically runs from February 22nd to March 23rd. As Congress returns, here’s a brief look at the pending health care issues on the radar for this...more

Private Equity Market Intelligence: Physician/Hospital Quarterly Report - Q4

Key Findings - ..ACA enrollment reached 11.3 million by the end of the third open enrollment period, surpassing HHS expectations. Three-quarters of the enrollees were from the 38 states that use the healthcare.gov...more

Manatt on Medicaid: CMS Approves California's Delivery System Reform Incentive Payment (DSRIP) Waiver Renewal

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved California's request to renew its waiver under Section 1115 of the Social Security Act. A significant component of the waiver is the Delivery...more

Washington Healthcare Update

This Week: The House is not in session this week... The Senate returns today... Committees in the Senate will hold hearings on co-ops and mental health... Vice President Biden will attend the World Economic Forum in...more

A&B Healthcare Week in Review - January 2016

On January 5, 2016, the Office of Management and Budget (OMB) received for review a final rule from the Centers for Medicare & Medicaid Services (CMS) entitled Covered Outpatient Drugs (CMS-2345-F). The rule had previously...more

Manatt on Health Reform: Weekly Highlights - December 2015 #4

HealthCare.gov enrolls 8.2 million; Manatt and RWJF release an open access dataset on Marketplace plans nationwide; Montana names administrator for its Medicaid expansion; and Michigan gets the green light in the nick of time...more

Also In The News - Health Headlines - December 2015 #2

CMS Releases HAC Data for FY 2016, Showing More Payment Reductions – On December 10, 2015, CMS published quality measure scores related to hospital-acquired conditions (HACs) for hospitals participating in the HAC Reduction...more

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