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Tag archives: ACA

Hospital alert: CMS hospital transparency requirements in effect January 1, 2019

On January 1, 2019, all hospitals are required to make public a list of their standard charges.  As a reminder, Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires: “each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a … Continue reading

Judge declares ACA unconstitutional

On Friday, December 14, Judge Reed O’Connor of the Federal District Court in the Northern District of Texas issued a declaratory judgment holding the shared responsibility provision (also referred to as the “Individual Mandate”), and with it, the entire Affordable Care Act (“ACA”), to be unconstitutional. The case is Texas v. United States and California … Continue reading

The US Departments of HHS, Labor, and Treasury finalize expanded access to short-term, limited duration insurance

On August 1 the Departments of Treasury, Labor, and Health and Human Services (the Departments) published a final rule that will expand the availability of short-term limited duration insurance (STLDI).  A Health Law Pulse summary of the proposed rule may be read here.  STLDI is not required to comply with the Affordable Care Act (ACA) … Continue reading

GAO releases report on the differences between 340B and non-340B hospitals

On June 18, the United States Government Accountability Office (GAO) released a report on the 340B program, entitled “Drug Discount Program: Characteristics of Hospitals Participating and Not Participating in the 340B Program.” The 340B Drug Discount Program requires drug manufacturers to provide discounts on outpatient drugs to certain categories of eligible hospitals. Hospitals that serve … Continue reading

Department of Labor publishes final rule to expand access to Association Health Plans

The United States Department of Labor (DOL) published a final rule on June 19 that relaxes the regulation of, and expands access to, association health plans (AHPs).  President Donald J. Trump’s October 12, 2017 Executive Order instructed the DOL to consider expanding access to association health plans and the Department released a proposed rule on … Continue reading

Coalition of conservative groups release outline of plan to repeal and replace the Affordable Care Act

On June 19, the Health Policy Consensus Group, a coalition of conservative groups including the Heritage Foundation, the Galen Institute and the Hoover Institution, released an outline of a new proposal to repeal and replace the Affordable Care Act (ACA).  The plan is similar to the Graham-Cassidy bill that Congress failed to enact last year.  … Continue reading

Virginia to expand Medicaid in January 2019; Utah will vote on Medicaid expansion this November

Virginia is expected to become the 33rd state (plus the District of Columbia) to expand Medicaid under the Affordable Care Act (ACA) following the passage of a budget by the Virginia legislature.  The expansion will take effect on January 1, 2019 and it is expected to provide coverage to close to 400,000 individuals.  Prior attempts … Continue reading

CMS FY 2019 IPPS and LTCH PPS proposed rule targets interoperability, transparency and burden reductions

On April 24, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2019 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. CMS proposes to reduce regulatory burdens for inpatient hospitals and increase price transparency and better data sharing between hospitals and other providers … Continue reading

CMS publishes annual exchange final rule for 2019

On April 9, 2018, the Centers for Medicare and Medicaid Services (CMS) published the Notice of Benefit and Payment Parameters for 2019 final rule (Payment Notice) and related guidance affecting the health insurance markets, including: key dates for calendar year 2018; the final 2019 Letter to Issuers in the Federally-facilitated Exchanges; guidance extending the transitional … Continue reading

Twenty states file a lawsuit alleging the ACA is unconstitutional without the individual mandate penalty

A group of twenty states has filed a lawsuit against the Trump administration alleging that the Affordable Care Act (ACA) is unconstitutional.  Plaintiffs take the position that the elimination of the individual mandate penalty in  the Tax Cuts and Jobs Act (Pub. L. No. 115-97), without a corresponding elimination of the individual mandate, renders the … Continue reading

The US Departments of HHS, Labor, and Treasury propose expanded access to short-term, limited duration insurance

On February 20, 2018, the Departments of Health and Human Services, Labor, and Treasury (the Departments) published a proposed rule to expand the availability of short-term, limited-duration insurance (STLDI) in order to “provide more affordable consumer choice for health coverage.”  The proposed rule follows President Trump’s October 12, 2017 Executive Order directing the Departments to … Continue reading

Congressional hearings held on the Trump administration’s FY 2019 budget request and health care industry consolidation

On February 14, 2018, the Centers for Medicare & Medicaid Services (CMS) announced projections that national health care spending is expected to increase an average of 5.5% a year between 2017 – 2026 and will account for almost 20% of Gross Domestic Product by 2026.  This announcement provides context for the continued focus on controlling … Continue reading

Centers for Medicare & Medicaid Services proposes policies and updates to Medicare Advantage and Part D programs for 2019

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage and Part D programs through the Advance Notice and Draft Call Letter (Advance Notice) for calendar year 2019.  As required by section 1853(b) of the Social Security Act, CMS publishes annually the Advance Notice at least 60 … Continue reading

Centers for Medicare & Medicaid Services commits to supporting Medicaid work and community engagement requirements

On January 11, 2018, the Centers for Medicare & Medicaid Services (CMS) released a letter to State Medicaid Directors announcing a commitment to support section 1115 demonstration projects that include work or community engagement requirements.  This will be the first time in the fifty year history of the Medicaid program that work requirements will be … Continue reading

The US Department of Labor proposes expanded access to association health plans

Pursuant to President Donald J. Trump’s October 12, 2017 Executive Order instructing the U.S. Department of Labor (DOL) to consider expanding access to association health plans (AHP), the DOL published a proposed rule on January 5, 2018 that would modify ERISA regulations to increase the availability of AHPs.  Association health plans have been defined as … Continue reading

U.S. Senate passes tax bill eliminating penalties for failure to comply with ACA individual health insurance mandate

On December 2, the U.S. Senate passed a tax bill by a 51-49 vote.  The legislation would not repeal the Affordable Care Act (ACA) individual health insurance mandate but instead would eliminate tax penalties for con-compliance with the mandate.  Senator Susan Collins (R-ME) announced her support for the bill in a press release in which … Continue reading

Senate tax bill would effectively repeal ACA individual mandate; House legislation to reverse 340B Drug Discount Program cuts; CMS addresses prescription drug costs and the opioid crisis

On November 14, Senate Finance Committee Chairman Orrin Hatch (R-UT) released the Chairman’s Mark to the Senate version of the Tax Cuts and Jobs Act. Hatch’s version of the tax plan effectively repeals the Affordable Care Act (ACA) individual mandate by reducing the associated penalty to $0. The ACA individual mandate requires individuals to buy … Continue reading

Federal judge rejects preliminary injunction mandating ACA cost-sharing reduction payments; CBO estimates $3.8 billion deficit reduction from bipartisan ACA bill

On Wednesday, October 25, Judge Vince Chhabria, federal district court in San Francisco, rejected a request for a  preliminary injunction by 18 states and the District of Columbia to compel the Trump Administration to continue to pay cost-sharing reduction (CSR) payments to health insurance companies.  Judge Chhabria concluded:  (i) States have been preparing for months … Continue reading

Senators Alexander and Murray release draft bill intended to stabilize the ACA marketplaces

On October 17, Senate Committee on Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced a bipartisan proposal intended to stabilize Affordable Care Act (ACA) marketplaces and relax ACA State Innovation Waiver restrictions. On October 19, Chairman Alexander released the proposed health care bill known as the Bipartisan … Continue reading
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