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
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
On June 29 Judge James Boasberg of the United States District Court for the District of Columbia vacated the approval by the Secretary of Health and Human Services of Kentucky HEALTH. Kentucky HEALTH was to be implemented on July 1. Kentucky HEALTH is the state of Kentucky’s section 1115 demonstration project that would have required … Continue reading
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
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
The Department of Justice (DOJ) announced on June 7, 2018 that it will no longer defend the constitutionality of section 5000A of the Affordable Care Act (ACA), a.k.a. the individual mandate. DOJ announced its policy change in a three page letter to Congress and a brief in response to the plaintiff’s motion for a preliminary … Continue reading
On May 25, 2018 legislation was introduced in the United States House of Representatives to suspend the annual fee on health insurance providers implemented by the Affordable Care Act (ACA) for 2020. HR. 5963 was introduced by Reps. Kristi Noem (R-SD), Jackie Walorski (R-IN), Kyrsten Sinema (D-AZ), and Ami Bera (D-CA). Section 9010 of the … Continue reading
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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