Tag Archives: Affordable Care Act (ACA)

CMS Proposes Changes to Stabilize ACA Health Insurance Markets

At the same time Republican Congressional leaders are attempting to develop legislation to repeal and replace the Affordable Care Act (ACA), CMS has published a proposed rule that is intended to help stabilize the Affordable Insurance Exchanges for 2018. According to CMS, “[t]he health and competitiveness of the Exchanges, as well as the individual and … Continue Reading

Congressional Budget Resolution Provides Framework for ACA Repeal Legislation, Hearings Focusing on ACA Issues

The House and Senate have approved a budget resolution (S.Con.Res. 3) providing instructions to Congressional committees on the federal spending framework for fiscal years 2017 through 2026. Notably, the resolution would enable the Senate to repeal provisions of the ACA pertaining to spending and revenues on a simple majority vote, without opportunity for filibuster. Such … Continue Reading

Trump Executive Order Directs Executive Agencies to Minimize “Unwarranted” ACA Economic and Regulatory Burdens

President Donald Trump’s first official act in office was to sign an executive order declaring it the policy of his Administration to seek prompt repeal of the Affordable Care Act (ACA) – but in the meantime, he calls for executive branch action “to minimize the unwarranted economic and regulatory burdens of the Act.”  Specifically, Trump’s … Continue Reading

CMS Issues Final ACA Benefit and Payment Policies for 2018; Questions Loom Over Implementation

On December 16, 2016, CMS released its Affordable Care Act (ACA) Notice of Benefit and Payment Parameters final rule and the final Annual Letter to Issuers for the 2018 plan year. Notably, the final rule revises the risk adjustment methodology to “further promote stable premiums in the individual and small group markets.” The final risk … Continue Reading

CMS Issues Additional ACA Medicaid and CHIP Eligibility, Appeals, Enrollment Regulations

CMS has published a final rule that implements various Medicaid and Children’s Health Insurance Program (CHIP) eligibility, appeals, and related administrative changes under the Affordable Care Act (ACA) that were proposed in January 22, 2013 but not included in a July 15, 2013 rule finalizing selected provisions. According to CMS, the rule will support “modernization … Continue Reading

Looking Ahead to a Trump Administration: Health Care and Life Sciences Industry Perspectives

Observers are digesting what the Trump Administration will mean for the health care and life sciences industry.  Forecasting is more challenging for this incoming Administration than most given the relatively sparse policy details released during the campaign and the lack of a government service record to examine for clues.  Today President-elect Trump’s transition team released … Continue Reading

October 16 Deadlines Quickly Approaching for the ACA’s Nondiscrimination Requirements: Are You Ready?

By October 16, 2016, all health programs and activities receiving federal financial assistance from the Department of Health and Human Services (HHS), those administered by HHS, and Health Insurance Marketplaces (Covered Entities), must be in compliance with the final pieces of the final rule issued by the Office for Civil Rights (OCR) issued May 18, … Continue Reading

Public Health Bills Advance

On September 30, 2016, President Obama signed into law S 1878, the Advancing Hope Act, which modifies the FDA’s priority review voucher program for rare pediatric diseases and extends the program through December 31, 2016. In addition, the House has approved a number of health policy bills, including the following: HR 954, the “CO-OP Consumer … Continue Reading

Congressional Hearings Focus on Health Policy Issues

A number of recent Congressional hearings have focused on health policy issues, including:  Senate Health, Education, Labor, and Pensions Committee hearings on laboratory testing in the era of precision medicine, and the safety of cosmetics. A House Judiciary Committee hearing on “Treating the Opioid Epidemic: The State of Competition in the Markets for Addiction Medicine.” … Continue Reading

Congressional Health Policy Hearings, Markups Resume After Summer Break

Congress has returned from recess, and health care policy continues to be on the agenda. The following health-related hearings and markups were held this week: The House Ways and Means Committee approved H.R. 5942, a bill to establish a demonstration program to provide integrated care for Medicare beneficiaries with end-stage renal disease, and H.R. 954, … Continue Reading

CMS Proposes ACA Marketplace Benefit and Payment Parameters for 2018

CMS has proposed its annual Notice of Benefit and Payment Parameters, which would apply to participation in Affordable Care Act (ACA) Health Insurance Marketplaces for 2018. In particular, the rule proposes revisions to the risk adjustment methodology to address, among other things:   risk associated with enrollees who are not enrolled for a full 12 months; … Continue Reading

Recent Congressional Health Policy Hearings and Markups

A number of Congressional committees have recently considered legislation and/or held hearings on various health policy proposals.  The Ways and Means Committee approved seven bills related to health care coverage and tax policy, including various bills to: expand access to health reimbursement arrangements and health savings accounts; ease employer insurance coverage mandates for students and … Continue Reading

HHS Finalizes ACA Nondiscrimination Protections for HHS Programs

The Department of Health and Human Services (HHS) has published a final rule implementing Section 1557 of 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 … Continue Reading

Congressional Health Policy Hearings

The Senate Special Committee on Aging recently held a hearing on the status of efforts to find a cure for Alzheimer’s disease, and the panel plans an April 27, 2016 hearing to examine prescription drug price increases. In addition, the House Education and Workforce Subcommittee on Health plans an April 14 hearing entitled “Innovations in … Continue Reading

Energy & Commerce Committee Advances Medicaid/CHIP Legislation with Lower Provider Tax Limit

The House Energy & Commerce Committee has voted to approve H.R. 4725, Common Sense Savings Act of 2016, which includes a number of Medicaid and Children’s Health Insurance Program (CHIP) reforms. Among other things, the bill would: reduce the limit on Medicaid provider taxes from 6% to 5.5% of net patient revenues; reduce federal Medicaid … Continue Reading

House Budget Committee Clears FY 2017 Budget Resolution with Medicare, Medicaid Cuts

The House Budget Committee has approved the budget resolution providing instructions to Congressional committees on the federal spending framework for FY 2017. The resolution calls for the adoption of major reforms to the Medicare program that would cut spending by $449 billion over 10 years, while Medicaid and other health care spending would be reduced … Continue Reading

March Congressional Health Policy Hearings

Congressional committees have held hearings recently on various health policy issues, including: Energy and Commerce Committee hearings on CMS implementation of the Medicare physician fee schedule reform provisions included in the Medicare Access and CHIP Reauthorization Act (MACRA), financing and delivery of long-term care, and the public health response to the Zika virus. A Ways … Continue Reading

CMS Finalizes 2017 Requirements for ACA Marketplace Plans

CMS has published its annual Notice of Benefit and Payment Parameters, which governs participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017.  The sweeping rule addresses protection of consumers enrolled in Marketplace plans, network adequacy, marketplace premium stabilization programs, and various other refinements to Marketplace requirements.  Major provisions of the rule include … Continue Reading

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

On February 29, 2016, CMS is publishing its final 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 final methodology is the same … Continue Reading

Congressional Health Policy Hearings

Several Congressional committees have held hearings recently on health policy issues, including: A House Energy and Commerce Health Subcommittee hearing on the Medicaid and CHIP Federal Medical Assistance Percentage formula. House Ways and Means Committee, Senate Finance Committee, and Energy and Commerce Committee hearings on President Obama’s proposed FY 2017 HHS budget request. A Senate … Continue Reading

CMS Eases 60-Day Overpayment Requirement in Final Rule While Raising New Questions

The Centers for Medicare & Medicaid Services (“CMS”) released today the long awaited final rule clarifying the statutory requirement under the Affordable Care Act for providers and suppliers to report and return Medicare overpayments within 60 days (the “Overpayment Final Rule”).  The Rule only applies to Medicare Part A and Part B providers and suppliers … Continue Reading

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
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