Tag Archives: Health Reform

Affordable Care Act and the Post-Election Implications for Radiology

On the Reed Smith Life Sciences Legal Update blog, Health Care team members Thomas Greeson and Paul Pitts have written about post-election implications for the radiology industry.  The report describes their assessments of the short and mid-term time horizon for a number of health policy developments such as integration (e.g., accountable care organizations), government enforcement, antitrust, … Continue Reading

HHS Announces Funding Opportunity for State Innovation Models Initiative

HHS has launched the State Innovation Models Initiative, a $275 million competitive funding opportunity for up to 30 states to design and test multi-payer payment and delivery models designed to generate savings and improve care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries.  States can apply for either Model Testing awards, intended to … Continue Reading

Congressional Health Policy Hearings

Recent hearings on health policy issues include: Senate Health, Education, Labor and Pensions Committee hearings on HIV/AIDS drug costs, health care delivery reforms, and federal laws to ensure patients’ access to care and privacy. A Senate Finance Committee hearing on “Progress in Health Care Delivery: Innovations from the Field.” A House Judiciary Subcommittee on Intellectual … Continue Reading

HHS Issues Final Rule on Framework For State Health Reform Innovation Waivers

HHS published a rule on February 27, 2012 that implements the procedural framework for submission and review of State Innovation Waiver applications under section 1332 of the ACA, effective April 27, 2012. Under the rule, states will have flexibility to apply for a State Innovation Waiver to pursue their own strategies to provide their residents … Continue Reading

CMS Seeks “Innovation Advisors” for Fellowship Program

CMS is launching a new Innovation Advisors program, which will provide fellowships to up to 200 individuals to test new models of care delivery in their own organizations and communities. CMS is seeking experts in health care economics and finance, population health, systems analysis, and operations research to support the Innovation Center in testing new models … Continue Reading

CMS/ONC Care Innovations Summit (Jan. 26, 2012)

CMS and the HHS Office of the National Coordinator are hosting the first "Care Innovations Summit" in Washington, DC on January 26, 2012 to "showcase innovative work in care delivery and payment."  Presentations will be delivered by “national thought leaders, senior government officials and visionary innovators,” who will provide information on opportunities for collaboration, funding, … Continue Reading

Health Reform “Repeal and Replace” Bills Approved by House

The House of Representatives has voted to repeal the ACA, by a largely party-line vote of 245 to 189. The House subsequently passed H. Res. 9, to instruct four House committees (Education and the Workforce, Energy and Commerce, Judiciary, and Ways and Means) to report legislation to replace the law with provisions that achieve a number of … Continue Reading

House GOP Leaders Seek Repeal of ACA

The new Republican leadership of the House of Representatives are moving ahead on legislation (H.R. 2) to repeal the Patient Protection and Affordable Care Act and the health care-related provisions in the Health Care and Education Reconciliation Act of 2010 (collectively known as the ACA).  On January 7, the House approved a procedural motion to allow … Continue Reading

Court Permits Legal Challenge to Health Reform Law to Proceed

This post was written by Carol Colborn Loepere and Scot T. Hasselman. As widely reported in the media, on October 14, 2010, a federal judge in Florida ruled that he will allow a lawsuit challenging the constitutionality of the Affordable Care Act to proceed. The lawsuit argues that the ACA’s individual mandate that people buy … Continue Reading

Health Plan Appeal, Preventive Services Coverage Rules under ACA

On July 23, 2010, the Obama Administration published an interim final rule with comment period implementing ACA requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets. The rules generally apply to plan/policy years beginning on or after September 23, 2010. … Continue Reading

Health Plan Appeal, Preventive Services Coverage Rules under ACA

On July 23, 2010, the Obama Administration published an interim final rule with comment period implementing ACA requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets. The rules generally apply to plan/policy years beginning on or after September 23, 2010. … Continue Reading

ACA Rules on Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections

On June 28, 2010, the Obama Administration published an interim final rule with comment period implementing Affordable Care Act insurance reforms it dubs “a new Patient’s Bill of Rights.”  Specifically, the regulation issued by the Departments of Health and Human Services (HHS), Labor, and Treasury implements ACA provisions regarding preexisting condition exclusions, lifetime and annual … Continue Reading

HHS Launches Early Retiree Reinsurance Program

On June 29, 2010, the HHS Office of Consumer Information and Insurance Oversight (OCIIO) announced that it is now accepting applications for the Early Retiree Reinsurance Program (EERP), a $5 billion program established by the Affordable Care Act. The EERP will reimburse participating employment-based plans for a portion of the cost of health benefits for … Continue Reading

Reed Smith Health Care Reform Review: The Affordable Care Act – Analysis and Implications for DMEPOS Suppliers

Suppliers and manufacturers of durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) will be impacted, directly and indirectly, by numerous provisions of the recently-enacted health reform legislation, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as amended by H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (Reconciliation Act), collectively known as the "Affordable Care Act" or ACA.… Continue Reading

Final Rule on Grandfathered Health Plans Under the ACA

Under the ACA, certain group health plans and health insurance coverage existing as of March 23, 2010 (the date of enactment of the ACA), are considered “grandfathered” and excused from complying with some of the ACA’s health care improvement and market reform provisions. On June 17, 2010, the Department of Health and Human Services (HHS) … Continue Reading

CMS Updates on Part D Coverage Gap Rebates/Discount Program

The ACA provides a tax-free, one-time $250 check for beneficiaries who reach the Part D coverage gap during 2010 and are not eligible for low-income subsidies. A June 10, 2010 CMS memo to Part D plan sponsors provides additional information on implementation of coverage gap rebate. The memo notes that prompt submission of prescription drug … Continue Reading

Reed Smith Health Care Reform Review: Analysis and Implications of Fraud Abuse and Program Integrity Provisions of the Affordable Care Act

In April 2010, Reed Smith provided an extensive analysis of the recently-enacted health reform legislation, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as amended by H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (Reconciliation Act). Together, these sweeping measures expand access to health insurance (including subsidies, mandates, and market reforms); reduce health care spending (particularly in the Medicare program); expand federal fraud and abuse authorities and transparency requirements; impose new taxes and fees on health industry sectors; and institute a variety of other health policy reforms.… Continue Reading

Reed Smith Analyses of PPACA Provisions

Now that the Patient Protection and Affordable Care Act of 2010 (PPACA) and the companion Health Care and Education Reconciliation Act of 2010 (Reconciliation Act) have been enacted, attention shifts to analysis and implementation efforts. Reed Smith has prepared a number client alerts analyzing various aspects of the new health reform legislation, including a major alert … Continue Reading

HHS Seeks Comments on Certain PPACA Insurance Provisions

On April 14, 2010, the Department of Health and Human Service (HHS), along with the Internal Revenue Service and the Employee Benefits Security Administration, published a notice soliciting comments on sections 1001 and 10101 of the PPACA. These provisions added section 2718 of the Public Health Service Act (PHS Act), which, among other things, requires health … Continue Reading

HHS/CMS PPACA Implementation Announcements

HHS Secretary Kathleen Sebelius has issued a letter to governors and independent insurance commissioners to gauge interest in the temporary high risk pool program established by the PPACA to provide coverage to people who are uninsured because of pre-existing conditions. CMS also has issued initial guidance to states on the new state option under the PPACA … Continue Reading

Reed Smith Issues Major Analysis of the Patient Protection and Affordable Care Act, Focusing on Health Care Provider and Medical Product Manufacturer Impact

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), a sweeping measure designed to expand access to health insurance, reduce health care spending (particularly in the Medicare program); expand federal fraud and abuse authorities and transparency requirements; impose new taxes and fees on health industry sectors; and institute a variety of other health policy reforms. The President also signed a second bill into law on March 30, 2010, the Health Care and Education Reconciliation Act of 2010 (Reconciliation Act), which includes a series of "fixes" to the PPACA, including substantive changes to the PPACA's provisions regarding Medicare prescription drug coverage, Medicare Advantage and fee-for-service payments, Stark law self-referral policy, and Medicaid matching payments, among many others. Within the thousands of pages of the new laws are numerous provisions that will have a direct and material impact on nearly every component of the health care delivery and financing systems in the United States, including health insurers, health care providers, and manufacturers of pharmaceuticals and medical devices, as well as employers, taxpayers, and patients. Moreover, the impact of some of these provisions will be felt immediately, as certain provisions are effective upon enactment, and some have January 1, 2010 effective dates. Reed Smith has prepared a major Alert concentrating on those provisions we believe are of most interest to health care providers and medical device and pharmaceutical manufacturers.… Continue Reading

Health Reform “Fixes” Signed Into Law

On March 30, 2010, President Obama signed into law H.R. 4872, the Health Care and Education Reconciliation Act of 2010, completing a year-long effort to enact health insurance reforms and Medicare, Medicaid, and other health policy changes. The Reconciliation Act incorporates a series of amendments to the broader Patient Protection and Affordable Care Act (PPACA) … Continue Reading
LexBlog