Tag archives: Affordable Care Act

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

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

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

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

President Trump announces end of cost-sharing reduction payments to insurers; President signs executive order promoting association health plans

On October 12, President Trump announced in a filing by the Department of Justice in the ongoing litigation challenging the cost-sharing reduction (CSR) payments that such payments will no longer be made to insurers. CSR payments help offset deductibles and other out-of-pocket expenses for Affordable Health Care Act (ACA) exchange health insurance coverage for approximately … Continue reading

U.S. Senate Republican leadership decides against full Senate vote on Graham-Cassidy ACA repeal and replace legislation; HHS Secretary Tom Price resigns under pressure from the White House

On Tuesday, September 26, Senate Republican leadership decided not to hold a full Senate vote on the Graham-Cassidy Affordable Care Act (ACA) repeal and replace legislation. The previous day, Monday, September 25, the Senate Finance Committee held a hearing on the Graham-Cassidy bill. Following the hearing, Senator Susan Collins (R-ME) announced her opposition to the … Continue reading

US Senators Graham and Cassidy revise Affordable Care Act repeal legislation prior to Finance Committee hearing; AHA requests CMS guidance on hospital co-location and shared space arrangements

On Sunday evening, September 24, U.S. Senators Lindsey Graham (R-South Carolina) and Bill Cassidy (R-Louisiana) released a revised version of their Affordable Care Act (ACA) repeal legislation in advance of the Senate Finance Committee hearing scheduled for Monday, September 25, at 2 PM EST. The amended bill is similar to the legislation previously released in … Continue reading

CMS clarifies when hospitals are primarily engaged in inpatient care; U.S. Republican Senators introduce ACA repeal legislation while Democrats promote Medicare for all

The Centers for Medicare and Medicaid Services (CMS) recently issued Survey and Certification Letter 17-44, clarifying what it means for a facility to be “primarily engaged” in inpatient care for purposes of meeting the definition of a hospital and qualifying for reimbursement as a hospital under Medicare and Medicaid. A facility is primarily engaged in … Continue reading

U.S. Senators continue ACA stabilization and repeal efforts

The Senate Health, Education, Labor and Pensions (HELP) Committee has held three hearings in the past few days attempting to reach a bipartisan agreement on stabilizing the Affordable Care Act (ACA) insurance markets and will hold a fourth hearing later this week.  HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Minority Member Patty Murry (D-WA) … Continue reading

CMS issues blanket waivers as a result of Hurricane Harvey; health care reform efforts continue

The Centers for Medicare & Medicaid Services (CMS) has issued several blanket waivers of Medicare requirements as a result of Hurricane Harvey.  Examples of requirements that CMS may waive include those relating to conditions of Medicare participation or certification, preapproval requirements, EMTALA requirements, Stark Law self-referral sanctions, and performance deadlines.  Providers do not need to … Continue reading
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