Patient Protection and Affordable Care Act (PPACA)

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
News & Analysis as of

OIG Special Advisory Bulletin Provides Guidance on Application of Federal Anti-Kickback Statute to Pharmaceutical Manufacturer...

In recent years, copayment coupon programs have become standard promotional practices for both large and small pharmaceutical manufacturers. Copayment coupons are typically offered to commercially insured patients in order to...more

Health Care Update - October 2014 #3

In This Issue: - Policymakers Scrambling to Contain Ebola Crises - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional Initiatives -...more

OIG Proposes New Safe Harbors to the Anti-Kickback Statute and New Exceptions to the Two Civil Monetary Penalty Provisions

On October 3, 2014, the Department of Health and Human Services’ Office of Inspector General (“OIG”) published a proposed rule (“Proposed Rule”) to add new safe harbors to the federal health care program anti-kickback statute...more

Has the Affordable Care Act influenced COBRA? What if my employer fails to offer COBRA?  [Video]

Phoenix business law firm Jaburg Wilk's Employment law attorney Kraig Marton discusses how the Affordable Care Act has influenced or changed COBRA coverage. He also discusses what happens if a former employer fails to offer...more

Proposed Updates to the Civil Monetary Penalties Law for Health Care Providers

On October 3, 2014, the Office of Inspector General of the Department of Health and Human Services (“OIG”) published a proposed rule and request for comments (“Proposed Rule”) that would amend certain rules under the Civil...more

Providers Challenge CMS's Non-Hospital Rotation Rules for GME and IME

Prior to the enactment of the Affordable Care Act (ACA), CMS required hospitals to comply with a number of exacting payment and documentation rules in order to include as part of their graduate medical education (GME) and...more

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors,...more

What Employers Need to Know About Employer Payment Plans

Some employers may have offered employees pre-tax dollars to help purchase insurance. Such arrangements are called Employer Payment Plans. Now, however, Employer Payment Plans are prohibited under the Affordable Care Act...more

Proposed Approach for Applying the “Look-Back” Method When the Section 4980H Measurement Period Changes

The Internal Revenue Service (IRS) recently issued Notice 2014-49 which describes a proposed approach for determining an employee’s full-time or part-time status for purposes of the employer shared responsibility rules under...more

Highlights of OIG's Proposal to Amend Safe Harbors to the Antikickback Statute and CMP Rules, and to Add New Safe Harbors

On October 3, 2014, the Department of Health and Human Services Office of Inspector General (OIG) issued a proposed rule to establish new safe harbors under the antikickback statute and the civil monetary penalty (CMP) rules,...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 11: Rethinking ACA Compliance Strategies Involving Reference...

Under the Affordable Care Act’s rules governing employer shared responsibility—which are codified in Internal Revenue Code § 4980H—where an applicable large employer makes an offer of group health plan coverage that is both...more

Updated Timeline of Highlights for Employer Group Health Plan Compliance with the Affordable Care Act

Since enactment of the Affordable Care Act (“ACA”), the regulators have promulgated a myriad of regulations implementing the ACA’s requirements for group health plans. Over the past several years, the Obama administration has...more

EEOC Files Two Recent Lawsuits Challenging Employer Wellness Programs

The Affordable Care Act creates new incentives to promote employer wellness programs. However, employers should not rush to establish such programs without first considering the implications of the Americans with...more

Health Care Update - October 2014 #2

In This Issue: - First Look at Pioneer ACO Data Reveals Murky Path Forward - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional...more

New Challenge to 340B Rule Regarding Orphan Drugs

On October 9, 2014, Pharmaceutical Research and Manufacturers of America (PhRMA) filed a complaint (the October 9 Complaint) against the U.S. Department of Health and Human Services (HHS), the Health Resources and Services...more

Health Plan ID Requirements and Other End-of-Year Considerations

Employers and other health plan sponsors may be focused on preparing for the commencement of the employer mandate under the Affordable Care Act on January 1, 2015, but a number of other deadlines and developments are emerging...more

CMS Cost Sharing Reduction Reconciliation Reporting for QHPs

Qualified Health Plans (“QHPs”) and other stakeholders have until October 27, 2014, to comment on CMS’s proposed cost sharing reduction payment reconciliation reporting process. On Friday, September 26, 2014, CMS released...more

New Developments and Impending Deadlines for Employer Group Health Plans

As the federal government agencies continue to push forward with implementation and administration of health care reform (i.e., the Patient Protection and Affordable Care Act), there are two recent developments that we want...more

CMS Publishes Open Payments Data Detailing Payments and Transfers of Value Provided by Life Sciences Manufacturers to Physicians...

On September 30, 2014, CMS published data regarding payments and transfers of value that pharmaceutical, biologic, and medical device manufacturers provided to U.S. physicians and teaching hospitals during the period August 1...more

Sunshine Act Update: First Data Set Published

On September 30, the Center for Medicare & Medicaid Services (CMS) published the first set of data reported by pharmaceutical, medical device, biotechnology and medical supply companies, and group purchasing organizations...more

Reinsurance Program Requires Self-Insured Health Plans to File Enrollment Data by November 15 and Pay Fee Later

The Transitional Reinsurance Program - The Health Care Reform Act established a transitional reinsurance program in an attempt to stabilize premium prices for health insurance plans in the individual market. Because...more

Compliance with Internal Revenue Code §501(r) – the IRS (and Others) are Watching

Two public interest groups recently filed a complaint (Complaint) with the IRS claiming that Jackson Health System (JHS) failed to comply with the requirements of Internal Revenue Code (IRC) § 501(r) as enacted as part of the...more

OIG Releases Proposed Rule Adding New Safe Harbors to the Anti-Kickback Statute

Last week, the HHS OIG released a proposed rule published in the October 3 Federal Register that would add new safe harbors to the Anti-Kickback Statute and expand the list of conduct exempt from civil monetary penalties...more

New ACA Rules Allow Employees a Second Trip Through the Cafeteria Plan Election Line

Under Notice 2014-55, the Internal Revenue Service (IRS) will now permit a cafeteria plan to allow an employee to revoke his election for coverage under the employer's group health plan in order to purchase a qualified health...more

Excepted Benefits Under the ACA - The Government Agencies Overseeing Enforcement of the ACA Have Provided Relief for Employers...

The Patient Protection and Affordable Care Act (ACA) imposes numerous requirements on health plans, including group plans maintained by employer sponsors. An enhanced claims process, coverage for dependent children until age...more

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