Hospitals Patient Protection and Affordable Care Act (PPACA)

News & Analysis as of

Health Care Update - August 2015

CMS Releases Final Payment Rules (IPPS, IRF, LTCHs, Hospice, and Psych): At the end of last week, the Centers for Medicare and Medicaid Services (CMS) released a set of final 2016 payment rules affecting acute care hospitals...more

CMS Issues FY 2016 IPPS and LTCH Final Rule

On July 31, 2015, CMS issued its final rule to update the fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective...more

After Almost 25 Years--New Long-Term Care Regs: An Impressive and Costly Undertaking

On July 16, 2015, CMS released its long-awaited proposed changes for Medicare/Medicaid participation by long-term care (“LTC”) facilities. The new regulations represent the first comprehensive change to the requirements since...more

New Jersey Tax Court Eliminates Non-Profit Hospital’s Property Tax Exemption

On June 25, 2015, a New Jersey Tax Court issued a significant opinion in the case of AHS Hospital Corp. d/b/a Morristown Memorial Hospital v. Town of Morristown, upholding the Town of Morristown’s denial of Morristown...more

Anthem-Cigna Mega Merger Likely Problematic for Providers

Anthem announced on July 24, 2015 that it would purchase Cigna, just three weeks after Aetna agreed to buy Human for $37 billion. The deal is valued at $54.2 billion, and would create the United States’ largest health insurer...more

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 Implications of CMS' Proposed Stark Law Regulations

On July 8, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations “to reduce burden and to facilitate compliance” under the physician self-referral law known as the Stark Law. See 80 Fed....more

Proposed Rule Aims to Refine Stark Regulations and Clarify “Incident To”

On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2016 Physician Fee Schedule Proposed Rule. In addition to updating several traditional Part B payment policies, the...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

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

CMS Releases CY 2016 Proposed Rule on OPPS and ASC Payment Systems, Including Changes to the Two Midnight Rule

On July 1, 2015, CMS released a Proposed Rule that would revise the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) Payment System payment rates for calendar year (CY) 2016, and would...more

CMS Issues CY 2016 Medicare Physician Fee Schedule Proposed Rule

On July 8, 2015, CMS issued its annual proposed rule outlining payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) for CY 2016. In the proposed rule,...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

IRS Clarifies Financial Assistance Policy Requirements for Charitable Hospital Organizations

The Internal Revenue Service (IRS) has clarified the requirements for charitable hospital organizations required to adopt a financial assistance policy. For large hospitals or hospitals using the services of multiple private...more

Home and Community-Based Services: Seven Things You Need to Know

Few people have a strong understanding of home and community-based services (HCBS), how they work, how they came about and why they are important. There are a number of reasons why HCBS experts are few and far between. Put...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

IRS Says Hospitals Must List Physicians in Financial Assistance Policies

On June 26, 2015, the Internal Revenue Service (IRS) issued guidance to clarify how charitable hospitals may comply with regulations issued by the Department of Treasury under the Patient Protection and Affordable Care Act...more

IRS Clarifies Requirements for Listing Providers in Financial Assistance Policies

On June 26, 2015, the Internal Revenue Service (IRS) released Notice 2015-46, which clarifies the requirement in the Treasury Regulations under Section 501(r)(4) that a hospital's financial assistance policy (FAP) must...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 - July 2015

In This Issue: - Medicare Releases Set of Payment Rules, Physician Fee Schedule on Deck - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Other...more

Health Update - June 2015

Examining Fee Splitting Statutes in the Context of Value-Based Healthcare - Editor’s note: One of the goals of the Affordable Care Act (ACA) is to align incentives among provider communities and their patients and...more

Washington Healthcare Update

This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more

Sixty Days of Gray: Medicare and Medicaid Refund Requirements - Hospital Industry Viewpoint

Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more

Anatomy of a Provider-Merger Antitrust Challenge (Part 6)

This is the concluding installment of a six-part series discussing the Federal Trade Commission's challenges to provider mergers. Following the initial Introduction and Background (Part 1), the series discusses The Need for...more

Manatt on Health Reform: Weekly Highlights - May 2015

This week Montana became the 30th state to expand Medicaid, and the battle over Medicaid expansion and uncompensated care reached a breaking point in Florida. Meanwhile, as the King v Burwell decision looms, Congress and...more

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