April Showers Bring More HIPAA Settlements

Posted in Electronic Health Records & Medical Records, Healthcare Law, HIPAA, Privacy, and Data Security

April proved to be a busy month for the U.S. Department of Health and Human Services Office for Civil Rights (OCR) under its newly appointed director, Roger Severino. OCR announced three settlements of potential HIPAA violations totaling nearly $3,000,000.00 in fines. The settling parties include a wireless health services provider, a federally-qualified health center (FQHC), and a pediatric specialty provider. The settlements indicate that last year’s trend of higher settlement amounts and more robust corrective action plans appears to be continuing. Continue Reading

Medicare Advantage 2018 Rate Announcement

Posted in Health Insurers & Managed Care Organizations, Medicare & Medicaid

The Centers for Medicare and Medicaid Services (CMS) announced its 2018 Medicare Advantage (MA) capitation rates, with an expected increase of .45 percent, slightly higher than proposed in the advance notice. CMS estimates that MA health plans will realize an increase in revenue of 2.95 percent, reflecting increases in coding acuity and risk adjustment payments. CMS emphasized that the policies behind the rate determination are to support flexibility and efficiency and to encourage innovative network arrangements. Almost one-third of Medicare beneficiaries, 18.3 million Americans, receive their Medicare benefits through a Medicare Advantage managed care health plan. Items of note include: Continue Reading

House Republican Health Care Bill: Good News for Health Insurance Executives

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Health Insurers & Managed Care Organizations, Healthcare M&A, Joint Ventures, Transactions & Health Ventures

An Affordable Care Act (ACA) provision that is often-overlooked by the media, but has impacted the ability of insurers and their non-insurance related entities, in their role as employers, to take tax deductions for certain compensation paid to their highly paid employees may be ending at the end of the year. If passed, the House Republican’s health care bill repealing aspects of the ACA, titled the American Health Care Act (AHCA), provides for the termination of Section 162(m)(6) of the Internal Revenue Code (Code) on December 31, 2017. Section 162(m)(6), which took effect in 2013, had a much broader reach than the general deduction limit under Code Section 162(m).  Continue Reading

Lack of Timely Action and Knowledge of Risk Results in $3.2 Million Civil Monetary Penalty for HIPAA Violations

Posted in Electronic Health Records & Medical Records, Healthcare Law, HIPAA, Privacy, and Data Security

Children’s Medical Center of Dallas (Children’s) was hit with a $3.2 million civil penalty from the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) for failing to take steps to properly protect patient medical information. The civil penalty is the result of two data breaches caused by a lack of encryption and what was described as the hospital’s “non-compliance over many years with multiple standards of the HIPAA Security Rule.” Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part IV: Pharmacies

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Healthcare Law, Pharmacy, Drugs, Medical Devices & Equipment

The Affordable Care Act (ACA), as a whole, did not have a significant impact on pharmacy services per se. However, a complete repeal would likely impact certain areas of pharmacy services including the drug benefit for the exchange plans, the donut hole for Medicare Part D, states’ necessary Medicaid rebates, and certain recipients of 340B drugs. Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part III: Hospitals

Posted in Affordable Care Act and Other Healthcare Reform Legislation, Healthcare Law, Hospitals & Health Systems

President Trump has been clear in his intention to repeal the ACA. In fact, among President Trump’s first executive orders was one seeking to “minimize the economic burden” associated with the Patient Protection and Affordable Care Act (ACA). In addition to calling for its prompt repeal, he calls upon the executive branch to minimize the regulatory burdens of the ACA and provide the States with more flexibility to “create a more free and open healthcare market.” So what might that mean for hospitals? Shortly after the election, the American Hospital Association (AHA) sent a four page letter to then President-Elect Donald Trump advising him of its own public policy priorities and their vision for healthcare reform. (See prior blog post here). How will these AHA priorities fare during a Trump administration? Continue Reading

Potential Implications to the ACA Under the Incoming Republican Administration – Part II: Physicians

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

In contemplating the ways in which physicians may be affected by the possible repeal of the Affordable Care Act (ACA)—and certain features of any legislation that may replace it—a good place to start is with the person selected by President Trump to be the Secretary of the Department of Health and Human Services (HHS) – Representative Tom Price of Georgia, a physician himself. If confirmed, Dr. Price would be only the third physician in the 63-year history of HHS and its predecessor, the Department of Health, Education and Welfare, to serve as Secretary. Among other things, HHS controls Medicare, Medicaid, and the Affordable Care Act’s Federal health insurance exchange. Continue Reading

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

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