Potential Implications to the ACA Under the Incoming Republican Administration – Part I: the Insurance Industry

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Government Affairs, Licensure & Regulatory, Health Insurers & Managed Care Organizations

In the uncertain atmosphere surrounding the process of ‘repealing’ and replacing the Affordable Care Act (ACA), there are some clues as to what we can expect to come next, at least with regard with the health insurance industry. Obviously, one place to look is to President-Elect Trump himself. During his campaign, then-candidate Trump published a seven-point position statement on healthcare reform. This statement called for the repeal of the ACA in total, including an explicit reference to the repeal of the individual mandate. Trump’s position statement called for the sale of health insurance across state lines, tax deductions for individuals who purchase health insurance (similar to tax deductions for employers that purchase coverage for their employees), increases on the limits for Health Savings Account contributions (“HSAs”), and allowing HSA contributions to accumulate from year to year. The position statement also called for price transparency from all healthcare providers to allow consumers to make more informed decisions, and it called for block-grants to states for Medicaid payments. Finally, the position statement recommended access to imported, safe, and dependable drugs from oversees. Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration

Posted in Accountable Care Organizations, Affordable Care Act and Other Healthcare Reform Legislation

Over the course of the last six years in Washington, D.C., one of the primary goals of the Republican Party has been to repeal the Affordable Care Act (ACA). Since the Republican Party gained control of the House of Representatives in 2010, there have been literally dozens of votes to repeal the ACA. The Senate joined this effort when the Republicans took control of it in 2014. A repeal bill was even vetoed by President Obama in 2015. However, in 2016, this effort gained new momentum when Donald Trump won the Presidency, promising to repeal it during the campaign.

But a funny thing happened on the way to repeal — many of the provisions turned out to be very popular, and 20 million Americans now have health insurance due to the ACA. Total repeal would create a huge political problem; and President-elect Trump has called for retention of some of the provisions of the ACA.

The new administration and the Republican leadership must now develop a consensus bill that keeps parts of the old bill, does not negatively impact the public, and accomplishes what the Republican-controlled Congress seeks to do. To date, there have been many ideas floated, but the American people appear to be a long way from any new complete legislative package. Over the next year we can expect hearings, position papers, debates, and task force reports on the subject. It is unclear if the Democrats will assist or only oppose whatever the Republicans do.

Over the course of the next week, Akerman will publish a series of blog posts that discuss various subject areas that will be impacted in the revision/repeal of the ACA. Our goal is to provide you with insights on various subgroups of the healthcare sector and what outcomes we foresee in each, whether you interact as a payer, a provider, integrated delivery system, or an ancillary business.

The AHA’s Letter to Santa Claus

Posted in Healthcare Law

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717 Pennsylvania Avenue, not Santa at the North Pole) advised the incoming President of its own public policy priorities and their vision for healthcare reform. Some of their requests seem to come out of Trump’s playbook – such as removing burdensome regulations on hospitals. But some may not find the same sympathetic audience – such as imposing regulations on those industries that drive up hospital costs and those that hold down hospital reimbursements. The following summarizes the AHA’s recommendations for improving the healthcare landscape: Continue Reading

DEA Tweaks, Walks Back Changes to Renewal Process

Posted in Pharmacy, Drugs, Medical Devices & Equipment, Physicians

DEA recently revised an earlier announcement that would have eliminated the grace period for renewals of controlled substance registrations. After initially declaring that prescribers and other registrants would no longer be able to renew their expired registrations during a grace period, DEA announced it would instead continue allowing that practice – for now at least. As a result, registrants who fail to file a renewal application before expiration may reinstate their registration by submitting a renewal application within one calendar month after the expiration date.

In addition, beginning January 2017, DEA will stop providing its second renewal notification by mail. Instead, it will send one renewal notice by mail approximately 60 days prior to the expiration date as well as one email reminder. DEA will begins accepting renewal applications up to 60 days before the expiration date.

Prescribers and others with DEA registrations are wise to keep track of their renewal dates to avoid gaps in their active registrations.


Are Recommendations of the White House Task Force on Behavioral Health Parity Trumped by the Election?

Posted in Accountable Care Organizations, Affordable Care Act and Other Healthcare Reform Legislation, Healthcare Law

Recently the White House Behavioral Health Parity Task Force issued guidance on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (Parity Law). The Task Force could not have known, though, that on November 8th, the election may have changed the direction of the Task Force report and subsequent implementation.  Continue Reading

HHS Publishes a New Rule to Protect Dialysis Patients From Being “Steered” into Private Coverage for the Benefit of Dialysis Centers

Posted in Health Insurers & Managed Care Organizations, Healthcare Law, Medicare & Medicaid, Physicians

On implementing significant, new requirements for Medicare-certified dialysis facilities that make payment of premiums for individual health coverage, on December 14, 2016, the Department of Health and Human Services (HHS) published an Interim final rule with comment period. The regulations become effective 30 days after the date of publication – January 13, 2017, and comments regarding the interim must be received by HHS by 5 p.m. on January 11, 2017.  Continue Reading

Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing

Posted in Hospitals & Health Systems, Pharmacy, Drugs, Medical Devices & Equipment, Physicians

During the 2016 legislative session, Florida granted authority to both advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) to prescribe controlled substances, subject to approval by their supervising practitioner. This change brings these professionals’ authority in line with what most other states allow. However, this was not a complete grant of prescribing authority and, as explained below, leaves these professionals with a few restrictions to track. Continue Reading

Now is the Time to Prepare for MACRA: 2017 Will Bring Major Changes to Physician Medicare Reimbursement

Posted in Medicare & Medicaid

MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) is bi-partisan legislation that was enacted to change Medicare reimbursement from being based on the current system of volume of services provided to reimbursement based on the quality of care, as well as value and participation in alternative payment and delivery models. MACRA replaces the Sustainable Growth Formula (SGR), which has for decades required Congress to pass periodic last minute ‘doc fixes’ to prevent physician reimbursement rates from plummeting. MACRA (also called the Quality Payment Program) replaces the Physician Quality Reporting System (PQRS) and the EHR Incentive (Meaningful Use) Programs. MACRA only affects physician and non-physician practitioner reimbursement under Part B. It does not affect Medicare Parts A, C, D or reimbursement for diagnostic tests or other items and services provided under Part B. Continue Reading

HIPAA Audits – Phase 2: On-Site Audits Scheduled for First Quarter of 2017

Posted in HIPAA, Privacy, and Data Security, Hospitals & Health Systems, Physicians

Covered Entities and Business Associates may be ringing in the New Year with the prospect of responding to on-site HIPAA audits by federal regulators. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has announced that a certain number of comprehensive on-site HIPAA compliance reviews will be done over the first quarter of next year. Details of these audits are currently being finalized and will be posted on the OCR website in the coming months. Continue Reading