Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Jean C. Hemphill

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District Court Rules ACA Unconstitutional

By Edward I. Leeds and Jean C. Hemphill on Posted in Health Plans, Healthcare Providers / Suppliers, Individual Coverage Mandate, Insured Plans, Litigation, Short Term Limited Duration Insurance (STLDI)
The Affordable Care Act returned to the front page this weekend when a federal district court in Texas issued an opinion striking down the entire law as unconstitutional. The case arose from a lawsuit filed by a contingent of Republican state attorneys general, one governor, and a few individuals. They asserted that Congress’s elimination of [&hellip… Continue Reading »

Final Regulations Expand Availability of Individual Insurance Not Meeting ACA Requirements

By Edward I. Leeds and Jean C. Hemphill on Posted in Annual and Lifetime Limits, Essential Benefits, Excepted Benefit Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Individual Coverage Mandate, Insured Plans, Plan Design Requirements, Preexisting Conditions, Short Term Limited Duration Insurance (STLDI)
The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued final rules modifying the definition of short-term, limited-duration insurance (STLDI). STLDI provides health coverage that is intended to be transitional in nature. It is not regarded as individual health insurance or minimum essential coverage and is exempt from certain Affordable [&hellip… Continue Reading »

DOL Releases Final Regulation Expanding Association Health Plans

By Jean C. Hemphill and Edward I. Leeds on Posted in Essential Benefits, Health Plans, Nondiscrimination, Plan Design Requirements
The U.S. Department of Labor (DOL) on Tuesday released final regulations modifying the Association Health Plan (AHP) rules to expand their availability for small and large employers and to address their affordability by eliminating certain coverage requirements applicable to qualified health plans under the Affordable Care Act (ACA). The regulations aim to balance the need [&hellip… Continue Reading »

Bipartisan Budget Act of 2018 Enacts Changes to Employee Retirement and Health Benefit Plans, and Medicare

By Jean C. Hemphill, Edward I. Leeds and Brenda M. Ching on Posted in Accountable Care Organizations, Health Plans, Healthcare Providers / Suppliers, Legislation, Medicare, Medicaid, and CHIP
Following a brief shutdown of the federal government, on February 9, Congress passed and President Donald J. Trump signed into law the Bipartisan Budget Act of 2018 (Budget Act), which provides Congress until March 23 to enact appropriation and certain other funding measures and establishes a general agreement on spending that will last into 2019. [&hellip… Continue Reading »

IRS Prepares to Enforce ACA Employer Mandate

By Edward I. Leeds, Jean C. Hemphill and Laura P. Heacock on Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities, Enforcement, Health Benefits, Health Plans, Healthcare, State Exchanges
The IRS has announced its intent to begin enforcing the employer-shared responsibility provisions (otherwise known as the employer mandate or pay-or-play provisions) of the Affordable Care Act for the 2015 calendar year. The IRS also published a template letter that it will mail to any applicable large employer (ALE) if it determines the ALE owes [&hellip… Continue Reading »

Developments in the Affordable Care Act

By Brenda M. Ching, Jean C. Hemphill and Edward I. Leeds on Posted in Essential Benefits, Exchange Requirements, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Insured Plans, Legislation, Litigation, Premium Tax Credit, Premium Tax Credit (Exchange Subsidies), Short Term Limited Duration Insurance (STLDI), Stand-Alone HRAs, State Exchanges
After a brief lull in activity, recent developments are likely to involve all three branches of government in addressing issues under the Affordable Care Act. The Legislature: It is often said that Congress rarely takes action until a crisis needs to be addressed. With the demise of this summer’s repeal and replace effort, initiatives to [&hellip… Continue Reading »

Recess Update on Repeal and Replacement of the Affordable Care Act

By Jean C. Hemphill, Edward I. Leeds and John Devine on Posted in Health Plans, Healthcare, Healthcare Providers / Suppliers
The momentary lull in congressional activity on health care provides an opportune time for an update on the efforts to repeal and replace the Affordable Care Act (ACA). Following the House of Representatives’ approval of the American Health Care Act on May 4, 2017, the Senate Republican leadership introduced its own version, the Better Care [&hellip… Continue Reading »

ACA Repeal and Replace Plan is Released

By Jean C. Hemphill, Brian M. Pinheiro, Brenda M. Ching and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, Legislation
The House Ways and Means and Energy and Commerce Committees have released, in two parts, budget reconciliation legislation, the first steps of Congress’ proposal to “repeal and replace” the Affordable Care Act. Reconciliation legislation is limited to budget-related provisions and restricts legislators’ ability to address fully all of the repeal and replacement provisions that we [&hellip… Continue Reading »

CMS, IRS Address Affordable Care Act Issues in Transition

By Jean C. Hemphill and Edward I. Leeds on Posted in Employer Responsibilities, Exchange Requirements, Reporting, State Exchanges
The Centers for Medicare and Medicaid Services (CMS) and the IRS have each published guidance on matters arising under the Affordable Care Act (ACA). It is too early to tell whether these measures—some of the first guidance published under the ACA by the new administration—are singular acts or signals of guidance to come, as Congress [&hellip… Continue Reading »

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

By John L. Culhane, Jr., John Devine, Jean C. Hemphill, Alan S. Kaplinsky, Edward J. McAndrew, Philip N. Yannella and Zaven A. Sargsian on 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

By Edward I. Leeds and Jean C. Hemphill on 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

By Alan S. Kaplinsky, Jean C. Hemphill and Mark J. Levin on 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

By Alan S. Kaplinsky, Mark J. Levin and Jean C. Hemphill on 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?

By Jean C. Hemphill, Leslie E. John, Jason A. Leckerman and John Devine on 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?

By Edward I. Leeds and Jean C. Hemphill on 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

By Brian M. Pinheiro, Jean C. Hemphill, Diane A. Thompson, Edward I. Leeds and Christopher W. Welsch on 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

By Edward I. Leeds, Brian M. Pinheiro, Jean C. Hemphill and Diane A. Thompson on 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

By Edward I. Leeds and Jean C. Hemphill on 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

By Jean C. Hemphill, Brian M. Pinheiro, Diane A. Thompson, Edward I. Leeds and Sharon M. Marshall on 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

By Edward I. Leeds, Brian M. Pinheiro, Jean C. Hemphill and Diane A. Thompson on 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

By Jean C. Hemphill and Brian M. Pinheiro on 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

By Jean C. Hemphill, Diane A. Thompson, Brian M. Pinheiro, Edward I. Leeds and Alisa M. Huth on 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

By Brian M. Pinheiro, Jean C. Hemphill and Edward I. Leeds on 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

By Brian M. Pinheiro, Jean C. Hemphill and Edward I. Leeds on 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 »
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