Hospitals Patient Protection and Affordable Care Act (PPACA)

News & Analysis as of

CMS Issues Final Rule for CY 2016 OPPS and Changes to the Two-Midnight Rule

On October 30, 2015, CMS issued its final rule with comment period (Final Rule) for the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for...more

Health Care Update - November 2015

Ways & Means Leadership Changes – Health Policy Implications Looming: As Congress pushes forward with a two-year budget deal, and new Speaker Paul Ryan begins his tenure as the top Republican in the House of...more

Congressional Health Policy Hearings and Markups Scheduled this Week

Today, November 3, 2015, the House Energy and Commerce Health Subcommittee has scheduled hearings and votes on a variety of health policy bills. First, the Subcommittee will discuss the following five bills intended to...more

Pending Budget Deal Includes Medicare Sequestration Extension, Other Medicare/Medicaid Cuts

Outgoing House Speaker John Boehner and the Obama Administration have reached agreement on a two-year, $80 billion budget/debt-ceiling deal that includes Medicare and Medicaid “offsets” to finance other spending. For...more

OIG Alert Shows Increased Concern over Data Blocking

In a report to Congress last April, the Office of the National Coordinator for Health Technology addressed the growing issue of data blocking. Data blocking occurs when some person or entity knowingly and unreasonably...more

Mississippi CON Report

I. September 2015 – Mississippi Certificate of Need Meeting - During the September 24, 2015, Certificate of Need meeting, Dr. Mary Currier, State Health Officer, concurred with the health and planning staff analysis...more

Manatt on Health Reform: Weekly Highlights - October 2015 #3

Arizona seeks Medicaid Waiver to implement new coverage restrictions for Medicaid expansion enrollees and delivery system reform; Tennessee’s uninsured rate continues to drop; and Louisiana gubernatorial candidates line up...more

Federal Court Rejects HHS Interpretation of 340B Program’s Orphan Drug Rule

On October 14, 2015, the United States District Court for the District of Columbia (the Court) issued a decision in Pharmaceutical Research and Manufacturers of America v. United States Department of Health and Human...more

GAO Releases Report on Initial Results of CMS’s Hospital Value-Based Purchasing Program

The U.S. Government and Accountability Office (GAO) issued an October 2015 report to congressional committees concluding that the initial results of the Hospital Value-Based Purchasing (HVBP) program show “no apparent shift”...more

[Webinar] Provider Networks: Avoiding Antitrust Trouble - Oct. 15th, 10:00am PDT

The Affordable Care Act encourages providers to collaborate to improve health care. But the antitrust enforcement agencies have warned providers that “too much” collaboration can run afoul of the antitrust laws. How do...more

Health care consolidations: Complex maneuvers in a high-stakes environment

In today’s shifting health care landscape, providers are consolidating and forming strategic partnerships that position them to offer comprehensive, high-quality services at reasonable costs....more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 11 of 24): Reporting 2015 Coverage of “MV-Lite”...

In Notice 2014-69, the Treasury Department and the IRS clarified that a group health plan that fails to provide substantial coverage for in-patient hospitalization and physician services will not be treated as providing...more

Manatt on Health Reform: Weekly Highlights - September 2015 #5

New study shows Marketplace premiums parallel the employer market; Montana likely to select a private insurer to administer benefits to its Medicaid expansion population; and Washington’s Exchange customers will begin paying...more

Recap: Health Care Investors Summit – Exploring the Impact and Opportunities from Health Care Convergence

The 2015 Health Care Investors Summit, co-hosted by Foley and Deloitte & Touche, LLP, was held on September 24. This program examined convergence in health care and the effects on investing, mergers and acquisitions, provider...more

Health Update - September 2015

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure - As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face...more

Medicare GME payments and hospital mergers: A hotbed of issues

Many hospital sale and affiliation transactions involve teaching hospitals. Whether the teaching hospital involved is new to training residents or is part of a long-established teaching program, the parties will need to work...more

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

The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more

HHS Proposes Rules for Nondiscrimination in Health Care

On September 8, 2015, the U.S. Department of Health and Human Services (“HHS”) proposed new regulations implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). Section 1557 prohibits...more

Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark...

The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as...more

The Time is Right for Hospitals to Ensure 501(r) Compliance

Updated requirements for hospitals to maintain their tax-exempt status under Section 501(r) of the Internal Revenue Code are nothing new. They were enacted as part of the Affordable Care Act in 2010. However, at the end of...more

HRSA Issues 340B Program Omnibus Guidance

On August 28, 2015, the Health Resources and Services Administration (“HRSA”) published proposed Omnibus Guidance (the “Proposed Guidance”) governing policies related to section 340B of the Public Health Service Act (“PHSA”),...more

Stark Law - Is Relief in Sight?

On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed revisions to the regulations implementing the physician self-referral law, or Stark Law. If enacted, these revisions could allow...more

Updated Proposed Regulations Issued: Inpatient Hospital and Physician Services Must Be Covered

Tuesday the IRS issued proposed regulations that require an employer-sponsored health plan to include substantial coverage of inpatient hospital and physician services in order for the plan be considered as providing minimum...more

Hospital Compliance Program Overview

?In the constantly evolving climate of health care enforcement, maintaining a comprehensive and effective internal compliance program has taken on added significance, especially in the past few years. While detailed coverage...more

The 60 Day Rule — Identification and Knowing Avoidance

On August 3, 2015, the United States District Court for the Southern District of New York issued an opinion and order in Kane v. Healthfirst, Inc., et al.[1] that provides the first judicial interpretation of the requirement...more

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