News & Analysis as of

Reimbursements Patient Protection and Affordable Care Act (PPACA)

Baker Donelson

What the Supreme Court's "Chevron Deference" Ruling Could Mean for Health Care Law

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Baker Donelson recently published Anticipating SCOTUS Ruling on Chevron Deference – What to Know and Five Ways to Prepare explaining the United States Supreme Court's upcoming ruling which is expected to impact the regulatory...more

Maynard Nexsen

A Primer on Health Reimbursement Arrangements

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During a time when recruiting and retaining qualified employees is becoming more and more difficult, it is crucial for employers to consider (or even reconsider) their benefits offerings and determine if there are any...more

Baker Donelson

Medicaid Enrollment Redeterminations Looming

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The Consolidated Appropriations Act (CAA) enacted on December 29, 2022, decoupled the Medicaid continuous enrollment requirement from the end of the Public Health Emergency (PHE), effective March 31, 2023.1 While CMS guidance...more

Mintz - Health Care Viewpoints

CMS Proposed Rule for Refunding Overpayments Would Align With False Claims Act “Knowledge” Standard

The Centers for Medicare & Medicaid Services (CMS) proposed a rule late last year to harmonize the standard it would apply for providers to identify and refund overpayments with the “knowledge” standard under the False Claims...more

Bass, Berry & Sims PLC

False Claims Act Settlements to Know from Q3 2022

Bass, Berry & Sims PLC on

The third quarter of 2022 brought a number of noteworthy False Claims Act (FCA) settlements, including several over $20 million and one in the high nine figures. This post summarizes key settlements of interest to healthcare...more

Venable LLP

Medical Travel Benefits: What Employers Need to Know

Venable LLP on

Last month, the United States Supreme Court rendered its decision in Dobbs v. Jackson Women's Health Organization, overruling Roe v. Wade and returning the issue of abortion to the states. Since the decision, abortion has...more

King & Spalding

Don’t Be Surprised – The No Surprises Act Takes Effect January 1, 2022

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The No Surprises Act (the Act), enacted December 27, 2021, will take effect on January 1, 2022. The No Surprises Act puts into place important patient protections from surprise medical bills, while imposing significant...more

McDermott Will & Emery

[Webinar] Healthcare Anti-Discrimination Litigation: What Payors Need to Know - May 13th, 1:00 pm - 2:00 pm ET

McDermott Will & Emery on

As we continue our three-part webinar series, McDermott’s litigation and healthcare lawyers will focus on how payors can actively prepare for possible enforcement and litigation stemming from recent and potential changes to...more

King & Spalding

Court of Appeals Upholds CMS Rule Requiring Public Disclosure of Prices Negotiated Between Hospitals and Insurance Companies

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On December 29, 2020, the U.S. Court of Appeals for the District of Columbia Circuit upheld a CMS final rule promulgated in November 2019 that requires hospitals to disclose various forms of pricing information related to the...more

King & Spalding

New Risks, New Rewards, New Exposure

King & Spalding on

Value-Based Purchasing, Multiple Best Prices, Expanded Alternative URA, and other MDRP Drug Pricing Changes in Proposed Rule - On June 17, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released a major...more

Morgan Lewis

High Court Checks Government in Risk Corridors Case

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In Maine Community, the US Supreme Court found on April 27, 2020, that the Risk Corridors program created by Congress was a “money-mandating obligation” requiring the federal government to make payments under Section 1342 of...more

Ballard Spahr LLP

Health Insurance Exchanges: A $12B Judgment

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The U.S. Supreme Court has determined that the federal government must pay over $12 billion to certain health insurers that participated in health insurance exchanges in the first three years that those exchanges were in...more

Akerman LLP - Health Law Rx

SCOTUS Rules Government Must Pay $12 Billion to Unprofitable ACA Insurers

Despite Congress’ efforts to use riders to neutralize a provision of the Affordable Care Act (ACA or Act), the Federal government (Government) owes certain insurers $12 billion....more

Troutman Pepper

Supreme Court Finds Insurers Entitled To Millions In ACA Payments

Troutman Pepper on

On April 27, the U.S. Supreme Court held that the federal government is on the hook for $12 billion it failed to pay insurers under the Affordable Care Act (ACA) risk-mitigation program known as the Risk Corridors Program. ...more

Epstein Becker & Green

Supreme Court: The ACA & Risk Corridor Obligations

Epstein Becker & Green on

The U.S. Supreme Court decision in Maine Community Health Options v. United States, is a major decision affecting healthcare and resolving a significant Obamacare dispute. The Affordable Care Act famously established online...more

Sheppard Mullin Richter & Hampton LLP

Supreme Court Issues Long Awaited Ruling on Affordable Care Act Risk Corridors Program

The Supreme Court issued a long-awaited ruling on April 27, 2020, directed at a more than $12 billion challenge related to the temporary risk corridors program established by the Affordable Care Act (the “ACA”). Challenges...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Moda Health Plan, Inc. v. United States

On April 27, 2020, the U.S. Supreme Court decided Moda Health Plan, Inc. v. United States, holding that the Affordable Care Act requires the federal government to compensate insurers for significant losses their health plans...more

Seyfarth Shaw LLP

Supreme Court Rules Government Must Pay $12 Billion to Health Insurers Under ACA Risk Corridor Program

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On April 27, 2020, the US Supreme Court ruled by an 8-1 decision that the federal government must pay billions of dollars to health insurers who sold consumer policies on exchanges under the Affordable Care Act’s (“ACA”)...more

Locke Lord LLP

Supreme Court Rules 8-1 That Government Must Pay Health Insurers Under ACA Risk Corridor Program

Locke Lord LLP on

In a major win for health insurers, the U.S. Supreme Court ruled in an 8-1 decision that the federal government owes roughly $12.3 billion to health insurers who claimed losses under the risk corridor program of the...more

Bricker Graydon LLP

Could new Individual Coverage HRAs replace your group health plan?

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Employers and employees are continually feeling the pinch of rising health care costs. 2020 provides a potentially better approach to consider: Individual Coverage Health Reimbursement Arrangements (ICHRAs)....more

Ballard Spahr LLP

Coming to Market: Final Rules Issued for Individual Coverage HRAs

Ballard Spahr LLP on

The U.S. Departments of the Treasury, Labor, and Health and Human Services have issued final regulations allowing employers to establish health reimbursement arrangements and certain other types of reimbursement plans...more

Foley Hoag LLP

New Employee Benefit Rules Expand Health Reimbursement Arrangement Options for Employers

Foley Hoag LLP on

On June 13, 2019, the Internal Revenue Service (IRS), Department of Labor and Department of Health and Human Services (HHS) issued a new regulation that is intended to increase the use of tax-favored health reimbursement...more

McGuireWoods Consulting

Washington Healthcare Update

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Administration - Trump Administration Announces HRA Regulatory Proposal to Prevent Adverse Selection - The Trump administration announced a regulatory proposal to permit employees to go to the individual market to...more

Snell & Wilmer

Tax Cuts and Jobs Act: Implications for Health and Welfare Plans and Fringe Benefits

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On December 22, 2017, the Tax Cuts and Jobs Act (“the Act”) was signed into law, and it has various implications for employers who sponsor employee benefit plans. This newsletter focuses on the provisions in the Act that...more

Akin Gump Strauss Hauer & Feld LLP

President Trump Signs Tax Reform Bill into Law

On December 15, 2017, the House and Senate conference committee agreed on the terms of the final tax reform bill, previously referred to as the “Tax Cuts and Jobs Act” (the “Act”), which was subsequently approved by both...more

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