Tag Archives: Affordable Care Act

FY 2017 IPPS Proposed Rule Results in Modest Increase for Hospitals

CMS recently issued a proposed rule updating fiscal year (FY) 2017 Medicare payment policies and rates under the Medicare inpatient prospective payment system (IPPS) and the long-term care hospital (LTCH) prospective payment system. Highlights of the proposed rule applicable to IPPS hospitals are the focus of this summary. With the proposed rule, CMS continues to emphasize its … Continue Reading

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The impact of these rules will be felt widely among the provider community as it struggles to face increasing pressures resulting from the plans’ continually narrowing networks The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to … Continue Reading

D.C. District Court Deals Blow to HHS 340B Program Interpretive Rule

Court says Congress has the power to make the change that HHS attempted with its Interpretive Rule, and thus it should be left to the legislative branch. A lawsuit challenging the Interpretive Rule, filed by the Pharmaceutical Research and Manufacturers of America (PhRMA) in October 2014, was recently vacated in favor of PhRMA by the … Continue Reading

CMS Continues Its Focus on Quality Initiatives with the FY 2016 IPPS Final Rule

On July 31, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a final rule (Final Rule) updating fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System. While many hospitals will see increased Medicare reimbursement rates based on … Continue Reading

Proposed 340B Rule Would Impose Penalties for Overcharging, Plus Other Charges

A recently-released proposed rule would impose civil monetary penalties on drug manufacturers that intentionally overcharge healthcare providers for medications purchased under the 340B Discount Drug Program. The proposed rule, if adopted, could open the door to significant financial penalties for manufacturers, even if it is the manufacturer’s wholesaler or other business partner that overcharges the … Continue Reading

King v. Burwell: “Thy name is an opinion on the Affordable Care Act”

The U.S. Supreme Court in King v. Burwell, upheld the availability of subsidies to individuals who purchase health insurance on either a state or federal Exchange. While the Court’s 6-3 decision is being hailed politically as a major victory for the Obama Administration and the continuation of the Affordable Care Act (ACA), the legal implications … Continue Reading

OMB Reviewing HRSA Proposed Rule For Civil Monetary Penalties And Ceiling Price Regulations For 340B Drug Discount Program

The agency that oversees the 340B Drug Discount Program (340B program) is seeking review by the White House Office of Management and Budget (OMB) of a proposed rule that would use civil monetary penalties to enforce ceiling price regulations. The Rule, proposed by the Health Resources and Services Administration (HRSA), rule seeks to enforce the … Continue Reading

The ACA Five Years Later: A Good Investment or Risky Business? We Dare Not Opine!

The enactment of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, represents a significant legislative milestone in healthcare reform and a continuing communications challenge for providers. As we approach the mid-point of the law’s 10-year implementation trek, a look back at the healthcare investor market shows that despite … Continue Reading

The Beat Goes On: Antitrust Enforcement and Healthcare*

In one form or another, the Federal Trade Commission (FTC) has been banging the drum that there is no inconsistency between antitrust enforcement and healthcare. The latest to pick-up the drumbeat is the chair of the FTC herself, Edith Ramirez. In an article appearing in the prestigious New England Journal of Medicine (NEJM) titled “Antitrust … Continue Reading

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors, protect additional conduct from enforcement under the civil monetary penalties (CMP) law related to beneficiary inducements and create a new gainsharing … Continue Reading

Lee Simowitz Discusses Antitrust in the Healthcare Industry

BakerHostetler partner Lee Simowitz spoke as part of the panel, “Negotiating the antitrust minefield,” during Modern Healthcare’s Virtual Conference and Expo, “Building Tomorrow’s Delivery Model: Forging a Path to Value,” on October 15. The Affordable Care Act is driving ever-increasing rates of consolidation in the healthcare industry. But even as hospitals and health systems explore … Continue Reading

It Is Finally Here─the Sun Shines on a New Era

The Centers for Medicare and Medicaid Services (CMS) publicly launched a database this week detailing the payments doctors and teaching hospitals have received from drug and medical device manufacturers. Under the Physician Payments Sunshine Act—a provision of the 2010 Affordable Care Act—CMS is required to collect and make available information about these payments, which certain manufacturers … Continue Reading

Late Push to Reauthorize CHIP Funding This Session

Approximately eight million children currently covered by the Children’s Health Insurance Program (CHIP) may lose access to their pediatric-specific benefits and provider networks if legislation is not passed to extend federal funding for CHIP beyond its slated expiration at the end of FY 2015. CHIP is designed to provide coverage to children and pregnant women … Continue Reading

The Sliding Scale of Health Coverage: Finding the Intersection of Cost, Access and Quality

While not a new concept, the use of narrow networks has become a lightning rod for the controversy surrounding qualified health plans (QHPs) offered on the insurance exchanges created under the Affordable Care Act (ACA) and the consumer satisfaction with access to physicians and care they expect they are purchasing. Narrowly tailored network designs, including … Continue Reading

Hobby Lobby: Likely First of Many Cases Pitting Religion Against ACA

The U.S. Supreme Court on June 30, 2014, ruled 5-4 that a closely held, for-profit corporation can qualify for an exemption from the U.S. Department of Health and Human Services (HHS) requirements mandating contraceptive coverage for employees. The exemption is only available if the mandate imposes a substantial burden on the corporation’s ability to “conduct … Continue Reading

Susan Feigin Harris and Christopher J. Swift Author Article on Hospital Premium Subsidies for Law360

In a June 24, 2014, article authored for Law360, partners Susan Feigin Harris and Christopher J. Swift discuss questions surrounding whether healthcare entities may subsidize premium payments for individuals enrolling in insurance through the health insurance exchange marketplaces established under the Affordable Care Act (ACA). In the article (“Risks and Rewards from Hospital Premium Subsidies”), … Continue Reading

The Orphan Drug Wars: HHS’s Rebuttal to Its Recent Loss to PhRMA

On June 18, 2014, the U.S. Department of Health and Human Services (HHS) publicly stated that the recent decision of the U.S. District Court for the District of Columbia to vacate HHS’s regulation covering orphan drugs and the Section 340B Drug Pricing Program (340B Program), would not prevent the agency from moving forward with its … Continue Reading

Healthcare Providers Face Increasing Financial Pressure and Bankruptcy Risk

The health of the healthcare industry can be summarized as follows: as go federal reimbursement rates, so goes the financial viability of healthcare providers, whether hospitals, nursing homes or medical practices. These declining reimbursement rates, combined with the uncertainty surrounding implementation of the Affordable Care Act (ACA), have put especially severe strains on middle-market healthcare … Continue Reading

Annual Legislative Seminar Celebrates 25 Years

This year’s Annual Legislative Seminar, held on May 7, marked the event’s 25th anniversary and featured a distinguished lineup of speakers, including 19 members of the Senate and the House who addressed issues, such as federal tax reform, the federal budget, implementation of the Affordable Care Act and proposed legislation addressing patent reform. The event, … Continue Reading
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