Tag Archives: PPACA Implementation

Circuit Split on Availability of ACA Tax Credits in Federal Exchanges

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 that … Continue Reading

Reed Smith Analysis and Overview of the Medicare Shared Savings Program for Accountable Care Organizations

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 of … Continue Reading

IRS Guidance on ACA Branded Prescription Drug Fee for 2012

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 preliminary fee calculation; … Continue Reading

CMS Releases Final Medicare Shared Savings Program/ACO Rule

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

Summary and Analysis of Medicare’s Shared Savings Program for Accountable Care Organizations

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 … Continue Reading

CMS Establishes $505 Provider/Supplier Application Fee for 2011

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 supplier … Continue Reading

CMS Final Rule Expands Medicare/Medicaid/CHIP Provider and Supplier Screening Requirements Under Affordable Care Act Authority

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

IOM Work on Development of ACA Essential Health Benefits Package

The Institute of Medicine (IOM) has begun work on advising the HHS Secretary on how to define EHBs for purposes of the ACA insurance package provisions. The IOM Board on Health Care Services held a workshop on this topic in January 2011, and the next meeting is scheduled for March 2-3 in Costa Mesa, CA.… 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

HHS Announces Reorganization of Health Reform Office

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.… Continue Reading

PCORI Methodology Committee Members Named

The Government Accountability Office (GAO) has announced the appointment of 15 members to the Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI).  The Committee is charged with helping PCORI develop methodological standards and guidance for comparative clinical effectiveness research.  … Continue Reading

IRS Extends Filing Date for Reporting 2009 Sales of Branded Prescription Drugs Under the Affordable Care Act, Clarifies Information Requested From Covered Entities

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 Affordable Care Act of 2010, … 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

IRS Guidance on ACA Provisions

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.… Continue Reading

HHS Establishes Office to Coordinate Policies for Dual Eligibles

CMS has announced it is establishing the “Federal Coordinated Health Care Office,” which is mandated by the ACA to ensure more effective integration of Medicare and Medicaid benefits for individuals eligible for both programs and improving coordination between the federal government and states in the delivery of benefits for such individuals.… Continue Reading

Restrictions on Medicaid Payments to Entities Outside of US

CMS has issued guidance to state Medicaid directors on Section 6505 of the ACA, under which a state may not make payments for items or services provided under the state Medicaid plan or under a waiver to any financial institution or entity located outside of the United States. The provision is effective January 1, 2011, unless … Continue Reading

Upcoming Senate Hearings on ACA Implementation

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 been … Continue Reading

HHS Proposed Rule on “Unreasonable” Health Insurance Premium Increases

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 HHS to … Continue Reading

Comments Requested on Value-Based Insurance Design for ACA Preventive Care Benefits

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 settings, providers, and … Continue Reading

IRS Guidance on ACA Fee on Prescription Drug Manufacturers/Importers; Comment Request on Medical Device Excise Tax.

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 account; … Continue Reading

FDA Seeks Stakeholder Participation in ACA Biosimilars User Fee Meetings

On December 8, 2010, the Food and Drug Administration (FDA) published a notice requesting that stakeholders – particularly patient and consumer advocacy groups, health care professionals, and scientific and academic experts – notify FDA if they intend to participate in consultation meetings on the development of a user fee program for biosimilar and interchangeable biological product … Continue Reading

CMS Reminder on ACA Timely Claims Filing Requirement

Under the ACA, all Medicare fee-for-service claims for services furnished on or after January 1, 2010 must be filed with the appropriate Medicare contractor no later than one calendar year from the date of service or the claim will be denied. CMS is reminding providers and suppliers that Medicare claims with service dates from October 1, … Continue Reading

Affordable Care Act (ACA) Medical Loss Ratio Rule Issued

On December 1, 2010, the Department of Health and Human Services (HHS) is publishing an interim final rule with comment period implementing ACA medical loss ratio requirements. Under the rule, beginning in 2011, insurance companies in the individual and small group markets must spend at least 80% of the premium dollars they collect on medical care … Continue Reading