Tag Archives: Affordable Care Act (ACA)

House Fails to Override President’s Veto of ACA Repeal Bill

On February 2, 2016, the House failed to muster the votes needed to override President Obama’s veto of H.R. 3762, the “Restoring Americans’ Healthcare Freedom Reconciliation Act.”  As previously reported, the bill would have repealed key provisions of the Affordable Care Act (ACA), including insurance subsidy and mandate provisions, Medicaid expansion, tax provisions, and the … Continue Reading

Congressional Health Policy Hearings

The Senate HELP Committee is holding a January 28, 2016 hearing on “Generic Drug User Fee Amendments: Accelerating Patient Access to Generic Drugs.”  Separately, on February 4, the House Committee on Oversight and Government Reform has scheduled a hearing on “Developments in the Prescription Drug Market: Oversight.”  Other recent Congressional health policy hearings have included … Continue Reading

President Obama Vetoes Bill to Repeal Major ACA Provisions

As expected, on January 8, 2016, President Obama vetoed legislation that would have repealed key provisions of the Affordable Care Act (ACA), including insurance subsidy and mandate provisions, Medicaid expansion, tax provisions, and the transitional reinsurance program.  The bill, H.R. 3762, the “Restoring Americans’ Healthcare Freedom Reconciliation Act,” was approved by the House of Representatives on … Continue Reading

CMS Releases Draft 2017 Letter to QHP Issuers in Federally-facilitated Marketplaces

On December 23, 2015, CMS released its Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces, which provides operational and technical guidance to issuers seeking to offer qualified health plans (QHPs) in the Federally-facilitated Marketplaces or the Federally-facilitated Small Business Health Options Programs.  Comments will be accepted until January 17, 2016.… Continue Reading

Congressional Leaders Announce Spending/Tax Deal with Medicare and ACA Provisions; House Approves Tax Package

On December 15, 2015, Congressional leaders released sweeping spending and tax proposals, including a number of provisions impacting Medicare and the Affordable Care Act (ACA). The legislation is being considered on a fast track; the House approved the tax component of the package today, and it is scheduled to vote on the appropriations bill tomorrow, with … Continue Reading

Senate Votes for Budget Reconciliation Bill Repealing Key ACA Provisions

The Senate has approved an amended version of a budget reconciliation bill (H.R. 3762) that would repeal key provisions of the ACA.  As approved by the Senate on December 3, 2015, the legislation would repeal ACA insurance subsidy and mandate provision, the transitional reinsurance program, and various tax provisions and make a variety of other … Continue Reading

HHS, Treasury Issue Guidance on ACA State Innovation Waivers

The Departments of Health and Human Services (HHS) and Treasury have issued joint guidance on Affordable Care Act (ACA) “Section 1332” waivers, through which states can apply to implement alternative mechanisms to provide access to health care for their residents if certain conditions are met.  Under the ACA, Section 1332 waivers can only be approved … Continue Reading

Obama Administration Proposes 2017 ACA Marketplace Plan Benefit and Payment Parameters

On December 2, 2015, CMS is publishing its annual proposed Notice of Benefit and Payment Parameters, which would govern participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The wide-ranging rule includes a number of provisions intended to protect consumers enrolled in Marketplace plans, enhance transparency, improve marketplace premium stabilization programs, and … Continue Reading

Obama Administration Updates Rules for ACA Grandfathered Health Plans

On November 18, 2015, the Obama Administration published final regulations to update requirements for group health plans and health insurance issuers under the ACA, particularly with regard to the changes they can make to the terms of their plan/coverage while retaining their “grandfathered” status. The regulations also address preexisting condition exclusions, lifetime and annual dollar … Continue Reading

Bipartisan Budget Law Extends Medicare Sequestration, Includes Medicaid Drug Rebate, Off-Campus Hospital Outpatient Department, CMP Inflation Policies

On November 2, 2015, President Obama signed into law H.R. 1314, the “Bipartisan Budget Act of 2015” (BBA).  The two-year, $80 billion budget/debt-ceiling deal is funded in part by several significant Medicare and Medicaid policies, including an extension of Medicare sequestration, changes to Medicare payment for services provided in “new” off-campus hospital outpatient departments (OPDs), … Continue Reading

Pending Budget Deal Includes Medicare Sequestration Extension, Other Medicare/Medicaid Cuts

Outgoing House Speaker John Boehner and the Obama Administration have reached agreement on a two-year, $80 billion budget/debt-ceiling deal that includes Medicare and Medicaid “offsets” to finance other spending. For instance, while the budget would provide $80 billion in discretionary spending sequestration relief over two years, it would extend Medicare sequestration for an additional year, … Continue Reading

CMS Proposes Funding Methodology for ACA Basic Health Program for 2017-2018

On October 22, 2015, CMS published a proposed methodology for determining federal payment amounts to states that elect to establish a Basic Health Program (BHP) to offer health benefits to low-income individuals otherwise eligible to purchase coverage through an Affordable Insurance Exchange/Marketplace in program years 2017 and 2018. The proposed notice uses the same methodology … Continue Reading

House Passes Budget Reconciliation Bill with ACA Mandate, Tax Repeal Provisions

Today the House of Representatives approved H.R. 3762, budget “reconciliation” legislation that would repeal four provisions of the Affordable Care Act (ACA).  Specifically, the legislation would repeal the ACA employer and individual insurance mandates, the medical device excise tax, and the so-called “Cadillac tax” on high-cost health plans (an earlier House Ways and Means Committee provision that would … Continue Reading

CMS Sends Long-Awaited Medicare 60-Day Overpayment Rule to OMB for Final Clearance

CMS is moving ahead on its much-anticipated final rule implementing Affordable Care Act (ACA) requirements on reporting and returning of Medicare overpayments.   Under the ACA, enrolled providers and suppliers (and certain other enrollees) receiving Medicare funds must report and return Medicare overpayments by the later of 60 days after the date on which the overpayment was … Continue Reading

President Obama Signs Bills to Amend ACA Small Employer Definition, Expand Access to Clinical Trials

On October 7, 2015, President Obama signed into law H.R. 1624, which amends the Affordable Care Act’s (ACA) definition of “small employer” by maintaining the definition of a small group market as 1-50 employees and thus reducing the number of employers covered by certain new health insurance coverage requirements set to go into effect in … Continue Reading

Congress Clears Bill to Block ACA Change to Definition of Small Employer; House Votes to Broaden ACA Religious Exemption

The House and Senate have approved a bill (H.R. 1624) that would amend the Affordable Care Act’s definition of “small employer” to reduce the number of employers covered by new health insurance coverage requirements set to go into effect in 2016. The legislation would define small employers as those with 50 or fewer employees (rather … Continue Reading

House Ways and Means Committee Approves Bills to Repeal ACA Taxes, Mandates, IPAB

On September 29, 2015, the House Ways and Means Committee approved budget “reconciliation” legislation that calls for repeal of five provisions of the Affordable Care Act (ACA). Specifically, the legislation would repeal the employer and individual insurance mandates, the medical device excise tax, the so-called “Cadillac tax on high-cost health plans, and the Independent Payment … Continue Reading

HHS Publishes Proposed Rule on Nondiscrimination in Health Programs and Activities

On September 8, 2015, HHS published a wide-ranging proposed rule to implement Section 1557 the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in any health program or activity that receives financial assistance from or is administered by HHS or any entity created under … Continue Reading

DOJ Win on ACA 60-Day Overpayment Rule in Kane v. Healthfirst FCA Case

In a post on our Life Sciences Legal Update blog here, we discuss the first judicial opinion interpreting the Affordable Care Act’s “60-Day Overpayment Rule” in a False Claims Act case, which was recently issued by the Southern District of New York. In Kane v. Healthfirst, Inc., et al. the court ruled in favor of … Continue Reading

Obama Administration Finalizes Regulations on ACA Coverage of Preventive Services, Including Contraceptive Services

The Obama Administration published final regulations on July 14, 2015 that implement Affordable Care Act requirements regarding coverage without cost sharing of certain preventive services, including contraceptive services. The regulations, jointly issued by the Departments of Health, Labor, and Treasury, finalize three earlier rulemakings:… Continue Reading
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