Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Jean C. Hemphill

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Data Breach Class Action Reinstated Against Horizon Healthcare Services, Inc.

Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA and Data Security, Litigation
The U.S. Court of Appeals for the Third Circuit has vacated a district court’s dismissal of a data breach class action filed against Horizon Healthcare Services Inc., in the wake of the 2013 theft of two computer laptops containing unencrypted personal information of Horizon Healthcare plan members. The decision potentially expands the circumstances under which [&hellip… Continue Reading »

Health Care Reform in Transition While Congress Deliberates

Posted in Claims, Appeals and External Reviews, Employee Notices, Employer Responsibilities, Health Plans, Healthcare Providers / Suppliers, Litigation, Nondiscrimination, Plan Design Requirements, Preventive Services, Reporting, Stand-Alone HRAs, State Exchanges, Wellness Programs
Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze health care reform developments. This Health Care Reform Dashboard was a product of that initiative. We intend to continue following [&hellip… Continue Reading »

Federal Court Enjoins U.S. Agency’s Nursing Home Arbitration Agreement Ban

Posted in Healthcare Providers / Suppliers
The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, recently issued a final rule prohibiting nursing homes and other long-term care facilities from utilizing pre-dispute arbitration agreements, as a requirement for participating in Medicare and Medicaid programs. We predicted that the rule would face legal challenges [&hellip… Continue Reading »

U.S. Agency Prohibits Nursing Home Arbitration Agreements

Posted in Healthcare Providers / Suppliers
The Centers for Medicare and Medicaid Services (CMS), an agency within the U.S. Health and Human Services Department, has issued a final rule that includes prohibiting nursing homes and other long-term care facilities from utilizing pre-dispute arbitration agreements, as a requirement for participating in Medicare and Medicaid programs. The rule would not apply to already-existing [&hellip… Continue Reading »

FTC Finally Loses a Hospital Merger Challenge … Now What?

Posted in Healthcare Providers / Suppliers
Handing the Federal Trade Commission (FTC) its first defeat in a federal court hospital merger challenge in more than a decade, a federal district court judge yesterday denied the joint request of the FTC and the Attorney General of Pennsylvania for a preliminary injunction to prevent Penn State Hershey Medical Center (Hershey) and PinnacleHealth System [&hellip… Continue Reading »

HIPAA Audits Coming Your Way — Are You Ready?

Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA, HIPAA and Data Security
The Office of Civil Rights (OCR) of the Department of Health and Human Services has begun Phase 2 of its audit program under the Health Insurance Portability and Accountability Act (HIPAA). In this phase, OCR will: ·       Collect contact information from covered entities and their business associates; ·       Audit selected covered entities and, later, business [&hellip… Continue Reading »

Supreme Court Upholds Affordable Care Act Subsidies in King v. Burwell

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Litigation, Premium Tax Credit, State Exchanges
In a much-anticipated decision, the U.S. Supreme Court ruled today that individuals who enroll for coverage in a health insurance exchange may qualify for a subsidy to make that coverage more affordable, regardless of whether the exchange is established by the federal or a state government. The 6-3 decision in King v. Burwell upholds the [&hellip… Continue Reading »

New Guidance on Affordable Care Act Reporting Requirements

Posted in Employer Responsibilities, Reporting
The Internal Revenue Service has issued two lengthy sets of questions and answers on the requirement under the Affordable Care Act that employers report on their compliance with the employer mandate and employees’ qualification for exchange subsidies. The new guidance is divided into general information about the reporting rules and information about completing the actual [&hellip… Continue Reading »

Guidance Clarifies Certain Preventive Care Requirements

Posted in Grandfathered Plans, Plan Design Requirements, Preventive Services
Recent guidance issued jointly by the U.S. Departments of Labor, Health and Human Services, and the Treasury clarifies how the Affordable Care Act’s requirement to provide cost-free coverage for preventive care applies to several types of products and services. In particular, the guidance clarifies that:  Coverage for all types of contraception (currently 18 different types are [&hellip… Continue Reading »

Update on Summary of Benefits and Coverage Notices for Plan Years 2016 and 2017

Posted in Employee Notices, Employer Responsibilities, Summary of Benefits and Coverage
In a new frequently asked question (FAQ) released by the U.S. Departments of Labor (DOL), Treasury, and Health and Human Services on March 30, 2015, the agencies advised the public that they intend to finalize the summary of benefits and coverage (SBC) regulations (proposed on December 30, 2014 and described below) in time to apply [&hellip… Continue Reading »

Expatriate Plans Exempted from Many Affordable Care Act Provisions

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities, Excepted Benefit Plans, Plan Design Requirements, Reporting
In the Consolidated and Further Continuing Appropriations Act (the recently enacted federal budget bill often known as the “CRomnibus” legislation), Congress has exempted health plans designed to cover expatriates from most of the requirements of the Affordable Care Act. The exemption will generally apply where a group health plan provides significant health coverage and substantially [&hellip… Continue Reading »

Government Agencies Release Further Accommodations to Organizations Opposing Mandated Contraceptive Coverage

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Essential Benefits, Litigation, Plan Design Requirements, Preventive Services, State Exchanges
In response to the recent U.S. Supreme Court decision in Burwell v. Hobby Lobby, Inc., the U.S. Departments of Health and Human Services (HHS) and Labor (DOL) published proposed rules on August 22, 2014, expanding the availability of the religious accommodation to the contraceptive mandate provided in their July 2013 final regulations to closely held [&hellip… Continue Reading »

Federal Courts Make Conflicting Rulings on Premium Assistance for Federal Exchange Plan Participants

Posted in Litigation
Does the Affordable Care Act (ACA) authorize the payment of premium and copayment subsidies, or “premium assistance subsidies,” to individuals enrolled in a federally established Exchange? On July 22, 2014, two federal courts issued conflicting opinions on this subject. The U.S. Court of Appeals for the District of Columbia Circuit, in Halbig v. Burwell, concluded [&hellip… Continue Reading »

Religious Freedom Law Exempts Employers from ACA Contraceptive Mandate, Supreme Court Holds

Posted in Litigation
The U.S. Supreme Court has ruled in favor of three for-profit corporations that claimed that the Affordable Care Act (ACA) mandate to provide preventive care coverage for certain types of contraception violated the protections afforded to them under the federal Religious Freedom Restoration Act of 1993 (RFRA). This ruling is expected to apply primarily to [&hellip… Continue Reading »

Religious Freedom Law Exempts Employers from ACA Contraceptive Mandate, Supreme Court Holds

Posted in Litigation, Plan Design Requirements, Preventive Services
The U.S. Supreme Court has ruled in favor of three for-profit corporations that claimed that the Affordable Care Act (ACA) mandate to provide preventive care coverage for certain types of contraception violated the protections afforded to them under the federal Religious Freedom Restoration Act of 1993 (RFRA). This ruling is expected to apply primarily to [&hellip… Continue Reading »

New FAQs Address Effect of Affordable Care Act on COBRA and Other Matters

Posted in Employee Notices, Employer Responsibilities, Essential Benefits, Excepted Benefit Plans, Exchange Notice, Flexible Spending Accounts (FSAs), Grandfathered Plans, Individual Coverage Mandate, Plan Design Requirements, Preventive Services, Summary of Benefits and Coverage
In a wide-ranging set of frequently asked questions (FAQs) and other guidance, the U.S. Departments of Labor, Treasury, and Health and Human Services have addressed a number of issues pertaining to the Affordable Care Act (ACA). They include issues pertaining to COBRA and the Children’s Health Insurance Program Reauthorization Act (CHIPRA), annual cost-sharing limits, preventive care, [&hellip… Continue Reading »

ACA Employer Mandate Final Regulations Released; Enforcement Delays Provided for Mid-Sized Employers

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities
Very large employers will be required to offer health care coverage to their full-time employees or pay a penalty to the federal government beginning January 1, 2015. Under the final regulations released by the U.S. Department of Treasury (Treasury Department) on February 10, 2014, however, employers with fewer than 100 full-time employees will have an extra [&hellip… Continue Reading »

Final Mental Health Parity Act Regulations Released

Posted in Essential Benefits, Plan Design Requirements
The Internal Revenue Service, U.S. Department of Labor, and U.S. Department of Health and Human Services have jointly released final regulations and new FAQs implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA provisions generally became effective for plan years beginning on or after October 3, 2009, with [&hellip… Continue Reading »

Final Regulations Issued on Contraceptive Coverage, Religious Organizations

Posted in Plan Design Requirements, Preventive Services
The U.S. Departments of Health and Human Services, Labor, and Treasury recently released final regulations on the exemption from providing coverage for contraceptive and certain other preventive services that is available to certain religious organizations. The final regulations apply to plan years beginning on or after January 1, 2014. The final rules adopt most of the [&hellip… Continue Reading »

DOL Releases Guidance on Employer Notices about Exchange Availability

Posted in Employee Notices, Employer Responsibilities, Exchange Notice
The U.S. Department of Labor (DOL) has published guidance on the notice that most employers must provide to their employees by October 1, 2013, about the insurance that will be available through health care marketplaces known as “exchanges.” The guidance includes three model notices. Under the Affordable Care Act, employers offering health coverage must notify employees [&hellip… Continue Reading »

HHS Finalizes Essential Health Benefits and Related Health Plan 2014 Requirements

Posted in Essential Benefits, Grandfathered Plans, Plan Design Requirements, State Exchanges
The U.S. Department of Health and Human Services has issued final regulations and a set of frequently asked questions and answers establishing standards for the provision of essential health benefits in the individual and small group insurance markets, both inside and outside of an Exchange. In large part, the final rules adopt standards set forth in the proposed regulations [&hellip… Continue Reading »

CMS Releases Final Rule on Physician Payment Disclosures

Posted in Providers, Sunshine Act
Public disclosure of payments from pharmaceutical, medical device, biologic, and medical supply manufacturers to physicians and hospitals will begin under a final rule on the Physician Payments Sunshine Act (Sunshine Act) published by the Centers for Medicare & Medicaid Services (CMS). Applicable manufacturers and group purchasing organizations (GPOs) will need to begin collecting data on and [&hellip… Continue Reading »

Expanded Contraception Coverage Exemption for Religious Organizations Proposed by HHS and IRS

Posted in Plan Design Requirements, Preventive Services
The U.S. Departments of Health and Human Services and Treasury have released proposed regulations, a fact sheet, and a press release on the Affordable Care Act contraceptives coverage under Women’s Preventive Health Services and the exemption for religious organizations. This proposal, issued on January 30, 2013, attempts to accommodate religious employers’ objections to all or some [&hellip… Continue Reading »

HHS Releases Proposed Application Process for Affordable Insurance Programs

Posted in Exchange Requirements, Medicare, Medicaid, and CHIP, State Exchanges
The U.S. Department of Health and Human Services (HHS) released proposed rules designed to create a single, streamlined application process for several government health insurance programs. The application process is being developed in preparation for the Health Exchange Programs that begin on January 1, 2014, under the Affordable Care Act. The proposed rules summarize changes [&hellip… Continue Reading »
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