Category Archives: Affordable Care Act and Other Healthcare Reform Legislation

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What Is Your Fraud Rank?

On June 2, 2015, Center for Medicare & Medicaid Services (CMS), provided direction to state Medicaid Directors on the implementation of Section 6401 of the Affordable Care Act, Provider Screening and Other Enrollment Requirements under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).… Continue Reading

Religious Freedom and the Affordable Care Act

The fascinating interplay that weaves between the First and Fifth Amendments to the U.S. Constitution, the Religious Freedom Restoration Act (RFRA) and the Patient Protection and Affordable Care Act (ACA) continues to march on in various jurisdictions around the country, with two recent examples being the United States Supreme Court’s grant of certiorari and remand of a Seventh Circuit case, … Continue Reading

Charitable Hospitals: Financial Assistance Policies

The Internal Revenue Service (IRS) has issued the final section 501(r) regulations, implementing the amendments to the Internal Revenue Code under the Affordable Care Act and providing regulatory guidance for tax-exempt hospitals. This post describes the guidance for financial assistance policies, limitation on charges, and billing and collection practices and highlights the changes made between the proposed and final rules. … Continue Reading

ACA Issues for Employers to Stay Aware of in 2015

With the Affordable Care Act’s Employer Mandate (Pay-or-Play penalties) now officially in effect, employers with 50 or more full-time or full-time-equivalent employees should have already made all significant changes to their benefit programs necessary to ensure that they offer “minimum essential” and “affordable” coverage to their full-time employees to avoid penalties in 2015. However, there are several ongoing ACA issues … Continue Reading

Reimbursement Changes, Shift to Consumerism Discussed at Akerman Healthcare Briefing

Changing reimbursement models and a shift to consumerism were two of the hot topics discussed at Akerman LLP’s recent Healthcare Briefing event titled “Financial and Corporate Implications of the Affordable Care Act: A Look at the Past, Present, and Future”. Health care and financial industry leaders gathered Friday, November 21 in Tampa for the interactive discussion. Panelists leading the discussion … Continue Reading

Self-Insured Group Health Plans: Two Deadlines to Note

As 2014 winds down, plan sponsors are likely thinking ahead to some of the significant changes that will take effect in 2015, most notably, the employer “pay or play” mandate under the ACA. However, there are two deadlines that plan sponsors of self-insured group health plans should be aware of.

November 5, 2014 – Health Plan Identifier (Enforcement is Continue Reading

CMS launches database of manufacturer and GPO payments to physicians

The Affordable Care Act contains a provision known as the Physician Payments Sunshine Act, which requires the Centers for Medicare and Medicaid Services (CMS) to establish a national databank containing information on the financial relationships between physicians (which includes dentists, chiropractors, and other physician specialties) and teaching hospitals, applicable manufacturers, and group purchasing organizations (GPOs). CMS launched its Open Continue Reading

New ACA Rules Could Require Broader Provider Networks

“If you like your doctor, you can keep your doctor.” President Obama repeated this assurance to the American public numerous times, and the statement was prominently featured on the White House web site prior to and after adoption of the Affordable Care Act in 2010.

The Obama administration is developing regulations to address the concerns of consumers who say the … Continue Reading

Federal Appeals Court in D.C. Strikes Down Key Aspect of Health Care Reform (Just Before the 4th Circuit’s Opposite Ruling) – Any Impact on the Individual and Employer Mandates?

Yesterday, the U.S. Court of Appeals for the District of Columbia Circuit, in a 2-1 ruling by a three judge panel, invalidated an Internal Revenue Service regulation that interpreted section 36B of the Affordable Care Act (“ACA”) as authorizing premium tax credits for insurance purchased on either a state or federally-facilitated Exchange. In striking down the IRS regulation, the majority … Continue Reading

IRS Disallows Shifting Employee Health Coverage Burden to Exchanges

Certain employers hoped that they had discovered a way to “have their cake and eat it too”. In response to the looming employer mandate for employers with 50 or more employees – the requirement to offer full – time employees group health plan coverage or else face penalties under the Affordable Care Act, – some creative Human Resource leaders had … Continue Reading

Affordable Care Act Update April 7, 2014: High Courts Vet Key Provisions of the Affordable Care Act Government Extends Enrollment Deadline

March 2014 has produced quite a bit of activity regarding the Patient Protection and Affordable Care Act (“ACA”).  On March 24, 2014, oral argument was held in the latest challenges to the ACA in Sebelius v. Hobby Lobby Stores, et al. before the United States Supreme Court, and in Halbig v. Sebelius before the United States Court of Appeals for … Continue Reading

The Doc Fix: Do We Finally Have a Permanent Solution?

Will physicians finally be free from worrying that their Medicare payments will be severely slashed?  During the first week in February, Republicans and Democrats in the U.S. House of Representatives and Senate agreed on a bill which would repeal the SGR formula and thus avoid the necessity for a recurring, last minute stop-gap fix, known as the ‘doc fix’.

In … Continue Reading

Predictions for Top 10 Healthcare Stories for 2014

The past year was one of the most eventful in recent memory for healthcare policy. As the Affordable Care Act (“ACA”) continued its inexorable, albeit at times wobbly, march towards implementation, the headlines became more and more sensational. 2014 promises to be even more fascinating. We provide for you our prediction, in no particular order, of the biggest healthcare stories … Continue Reading

The Affordable Care Act: A Timeline of Important Dates

In the world of healthcare, the story that grabbed our headlines and attention the most this past year was, of course, the impact of the Affordable Care Act (ACA). As we move into 2014, we take a moment to look back at some of the key events in the implementation process thus far.

Our team has assembled an infographic timeline … Continue Reading

Industry Leaders Share Insights into Healthcare Reform and the Future of Healthcare Policy

Current events were top-of-mind last Friday, November 15, 2013, as Akerman LLP’s Healthcare Practice Group and Wells Fargo invited clients and industry professionals to engage in a thoughtful discussion on healthcare reform and the future of the American healthcare system.

The Healthcare Briefing featured a distinguished panel of executives and legal advisors that included Gordon Bailey, Assistant General Counsel, Florida … Continue Reading

ACA Temporary Reinsurance Fees – Clues from HHS Guidance of October 30, 2013

What is the “temporary reinsurance fee”?  The Affordable Care Act (“ACA”) requires the creation of a transitional reinsurance program for the first three years (2014-2016) of the state health insurance exchanges to help stabilize the exchange premiums.  It is intended to shift the risk of covering certain catastrophic medical expenses from the primary insurer to a reinsurer.  The funding for … Continue Reading

Healthcare: It’s Complicated

A popular 2009 movie, called “It’s Complicated,” was about relationships. The title of that movie also applies to solving the problem of providing affordable healthcare in the United States. It’s complicated.

A recent article in The Wall Street Journal criticized the Affordable Care Act (a/k/a ObamaCare) as being too complicated. According to the WSJ, “the fundamental flaw is the law’s … Continue Reading

New Proposed ACA Rules Aimed at Easing “Employer-Mandate” Requirements

Late last week, the IRS issued proposed rules intended to ease the reporting requirements that employers will face once the “employer-mandate” portion of the Affordable Care Act (“ACA”) becomes effective in 2015. The employer-mandate requires that employers with 50 or more full-time employees offer health coverage to those employees or pay a fine. If employers do not provide coverage and … Continue Reading

Avoiding ACA Fraud: Proving Individual Eligibility for Tax Subsidies Available Through Insurance Exchanges in 2014 and Beyond

Under the Affordable Care Act (ACA), certain low- and moderate-income people will qualify for health insurance tax credits beginning in 2014.  The tax credits will be jointly administered by the Internal Revenue Service (IRS) and Department of Health and Human Services (HHS) through the insurance exchanges.  The first open-enrollment period for the exchanges, and thus the first opportunity for individuals … Continue Reading

Affordable Care Act Update: Pay or Play Delay, and What Does it Say Today?

Late Tuesday afternoon, July 2, 2013, the federal government issued a statement through the US Department of the Treasury, announcing that the controversial employer shared responsibility provisions, coined the ‘pay or play’ provisions of the Affordable Care Act (ACA) have been delayed for one year.  This pushes the enforcement date of this provision from January 1, 2014 to January 1, … Continue Reading

ACA Cap on Deductibility of Compensation to Health Insurance Carriers’ Executives May Have Broad Tax Impacts

Health insurance carriers are keenly aware of many provisions of the Patient Protection and Affordable Care Act (“ACA”). But an often-overlooked ACA provision may actually impact the ability of these insurers and their non-insurance related entities, in their role as sophisticated employers, to take tax deductions for certain compensation paid to their executives.  This change results from the addition of … Continue Reading

Employers Receive Sample Exchange Notice and Face October 1 Deadline to Send to Employees

Employers have long been anticipating sample notices from the Department of Labor (“DOL”) that are required under the Affordable Care Act, informing employees (i) of the existence of the health care exchange (“Exchange”) and certain information about the services provided through the Exchange; (ii) of the possibility that in certain circumstances the employee may be eligible for a premium tax … Continue Reading

EMR Market Continues to Grow While Practitioner Satisfaction Decreases

According to a new report from healthcare market research firm Kalorama Information, the market for Electronic Medical Records (EMRs) was $20.7 billion in 2012, up 15 percent from $17.9 billion in 2011. The EMR market includes revenues from EMR and Computerized Physician Order Entry (CPOE) systems as well as directly-related services such as installation, training, servicing and consulting. A significant … Continue Reading

Coverage of Domestic Partners within Employer-Sponsored Group Health Plans: Are Changes on the Horizon?

Many employers offer group health plan coverage to domestic partners of their eligible employees. This extension of coverage is purely voluntary and not legally required, either presently or even next year under the mandates facing large employers under the Affordable Care Act (“ACA”). However, for a variety of reasons related to employee morale, recruiting and retention efforts, it is increasingly … Continue Reading

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