PPACA Implementation

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As has been widely reported, on July 22, 2014, two circuit court panels handed down conflicting decisions on whether ACA insurance premium tax credits are available for insurance purchased on federal, rather than state, insurance Marketplaces/Exchanges. On the one hand, a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit ruled 2-1…

The Centers for Medicare & Medicaid Services’ (“CMS”) Medicare Shared Savings Program final rule offers potential opportunities as well as risks to health care providers and suppliers interested in forming accountable care organizations (“ACOs”). While the core principle of the Medicare Shared Savings Program is simple—reward improvements in quality and cost containment through a share…

This post was also written by Ruth Holzman.

The IRS has issued updated guidance to drug manufacturers on the Affordable Care Act’s annual fee imposed on covered entities engaged in the business of manufacturing or importing branded prescription drugs. The guidance addresses submission of required information, IRS notification of covered entities of their…

Today the Centers for Medicare & Medicaid Services (CMS) released its long-awaited final rule to implement the Medicare Shared Savings Program as authorized by Section 3022 of the Affordable Care Act (ACA). The Shared Savings Program is intended to encourage physicians, hospitals, and certain other types of providers and suppliers to form accountable care organizations (ACOs) to provide cost-effective, coordinated care to Medicare beneficiaries. Under the final rule, an ACO that meets established quality and performance standards and surpasses a minimum savings target will be able to share a percentage of savings (in addition to traditional fee-for-service payments under Medicare Parts A and B).
Continue Reading CMS Releases Final Medicare Shared Savings Program/ACO Rule

The Patient Protection and Affordable Care Act (“PPACA”), enacted in March 2010, requires that the Secretary (“Secretary”) of the Department of Health & Human Services (“HHS”) establish a Medicare “Shared Savings Program” by January 1, 2012.  The Shared Savings Program is intended to encourage physicians, hospitals, and certain other types of providers and suppliers to…

On March 23, 2011, the Centers for Medicare & Medicaid Services (CMS) published a notice announcing that the 2011 Medicare application fee for institutional providers (excluding physicians and nonphysician practitioners) is $505. Note that CMS has adopted a broad definition of institutional entities subject to the application fee; it applies to “any provider or…

On February 2, 2011, the Centers for Medicare & Medicaid Services (CMS) published a final rule with comment period (Final Rule) implementing provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The rule is effective March 25, 2011, as mandated by the ACA (although CMS is delaying the effective date of a provision requiring fingerprint-based criminal history record checks for certain providers until after additional subregulatory guidance is issued).
Continue Reading CMS Final Rule Expands Medicare/Medicaid/CHIP Provider and Supplier Screening Requirements Under Affordable Care Act Authority

On January 6, 2011, CMS published a notice formally announcing the establishment of a new Center for Consumer Information and Insurance Oversight within CMS to implement the provisions of the ACA that address private health insurance. The new Center replaces the Office of Consumer Information and Insurance Oversight within the Office of the Secretary.

This post was also written by Ruth N. Holzman, Angelo Ciavarella and Vicky G. Gormanly.

On January 14, 2011, the Internal Revenue Service (“IRS”) issued Notice 2011-9 (the “Notice”), which extended the filing date for reporting on Form 8947 a covered entity’s 2009 sales of branded prescription drugs under the Patient Protection and…

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…

The Internal Revenue Service (IRS) has issued several ACA guidance documents, including notices on the use of health flexible spending arrangements for purchases of over-the counter medicines and the prohibition on health plans discriminating in favor of highly-compensated individuals.

The Senate Health, Education, Labor and Pensions (HELP) Committee is planning a series of hearings on the Affordable Care Act, with the first hearing on January 27 focusing on insurance market reforms. Other hearings will include such issues as quality of care and fraud and abuse provisions; dates for those hearings have not yet…

HHS published a proposed rule on December 23, 2010 regarding the disclosure and review of “unreasonable” health insurance premium increases under the ACA. The proposed rule would establish a rate review program to ensure that all rate increases that meet or exceed an established threshold are publicly disclosed and reviewed by a state or…

On December 28, 2010, the Obama Administration published a request for information regarding how group health plans and health insurance issuers can employ value-based insurance design in the coverage of recommended preventive services. The notice seeks information on, among other issues: specific plan design tools to incentivize patient behavior; how to identify high-value treatment…

The Internal Revenue Service (IRS) has issued documents related to the annual fee for manufacturers and importers of brand name pharmaceuticals under section 9008 of the ACA, which is payable beginning in 2011. Specifically, IRS Notice 2010-71 describes a proposed methodology for calculating the fee (including a discussion of covered entities, sales taken into…