Hospitals Patient Protection and Affordable Care Act (PPACA)

News & Analysis as of

Antitrust Law - October 2016

Editor’s Note: On September 27, 2016, the Third Circuit handed the Federal Trade Commission (FTC) a significant victory in its campaign against hospital consolidation, reversing a District Court decision that denied a...more

Are you ready for Section 1557’s notice requirements?

This is a reminder that beginning October 16, 2016, Covered Entities (as defined below) are required to comply with certain notice requirements under Section 1557 of the Affordable Care Act (“ACA”). Section 1557 of the ACA...more

Health Law Insights Newsletter - Issue 13

McCarter & English, LLP’s Health Care Group presents Issue 13 of the Health Law Insights, which discusses the latest legal issues in the health care industry. - Failure to Update Business Associate Agreement Results in...more

Manatt on Health Reform: Weekly Highlights - October 2016

Vermont moves closer to launching the country’s first all-payer ACO; CMS approves Arizona’s 1115 waiver extension but rejects the State’s proposed work requirement and premiums for those earning below the FPL; and CMS issues...more

Corridors - October 2016 - News for North Carolina Hospitals

Proposed 2017 Hospital OPPS Rule Would End Medicare Payments to Many Off-Campus Facilities at the Same Levels as Hospital-Based Outpatient Departments - Published on July 14, 2016, CMS’s proposed 2017 Hospital...more

Loaned and Awarded GME Slots: When does the three-year rolling average and the IRB ratio cap apply?

Ever since Congress capped teaching hospitals' Medicare-funded residency positions to the number of "full time equivalent" (FTE) allopathic and osteopathic residents the hospital reported in FY 1996, there have been very...more

Update on First 60-Day Case

A settlement was reached on August 23, 2016, in U.S. ex rel. Kane v. Healthfirst, Inc., et al., No. 11 CIV. 2325 (ER) (SDNY), a little over one year after the judge in that case issued the first judicial interpretation of the...more

CMS Releases 2017 Medicare Hospital Payment Rates, Penalties for Poor Performers

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) modifying the Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

Manatt on Health Reform: Weekly Highlights - August 2016 #5

A federal report finds that Marketplace premiums are lower in expansion states; Massachusetts and Pennsylvania launch prescription drug monitoring systems; and Kentucky submits a slightly modified Medicaid expansion waiver to...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

Hospital and Fixed Indemnity Policies; Excepted Benefits; Supplemental Coverage under Recently Proposed Treasury Regulations; and...

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Manatt on Medicaid: Monthly Expansion Recap - August 2016

California - Medicaid Enrollees Are Largest Share of Newly Insured - A new survey from the Kaiser Family Foundation found that 33% of Californians uninsured in 2013 are now enrolled in Medi-Cal, the State’s Medicaid...more

Anti-Kickback Regs Near Approval, After Only 19 Years

The White House is reviewing proposed regulations to ease restrictions on certain financial arrangements between hospitals and physicians and on certain transactions between providers and patients. The proposed regulations,...more

HHS Issues Final Non-Discrimination Rules for Healthcare Providers

Healthcare providers and others who receive federal financial assistance are now subject to new non-discrimination rules and notice requirements under the Affordable Care Act. The new regulation prohibits discrimination in...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

CMS Issues Final Update to Medicare Hospice Payment Rules for FY 2017

CMS has released a final rule that updates the Medicare hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. CMS estimates that the final rule will increase overall Medicare payments to hospices by...more

New N. Calif. Report Suggests High Cost of Giving Birth Linked to Increased Health System Consolidation

Childbirth is the leading indication for hospital admission in California, with roughly 500,000 deliveries in the state each year. This is particularly challenging for health plans serving Northern California, the most...more

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

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