Health Care Reform: Analysis & Perspectives
The current push for comprehensive health care reform will have a tremendous impact on our clients’ businesses and strategies. Our Health Law and Employee Benefits attorneys and the consultants at ML Strategies, our government relations affiliate, are closely following, analyzing, and interpreting every aspect of this critical legislative initiative.
To help make sense of this complex piece of legislation, which totals more than 2,000 pages, Mintz Levin and ML Strategies have created a comprehensive timeline that lays out by year and by category how the reform bill will be implemented, as well as its impact on individuals and businesses. To view that timeline, please click here.
Please check back here often for the latest information, and please contact us if you have any questions.
Legislative Resources
As we continue to track the progress of the historic health care reform legislation, we have assembled links to the text of the relevant bills, as well as section-by-section summaries and related resources. Please click here to visit our Heath Care Reform: Legislative Resources page.
Health Care Fraud and Enforcement
9/1/10
The Game Has Changed: Medicare and Medicaid Overpayments
The federal government is gearing up to recover any and all overpayments made to health care providers and other entities with which it does business. Through the Patient Protection and Affordable Care Act of 2010 (PPACA), Congress recently gave more money and power to the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) to bolster federal health care fraud enforcement efforts.1 Meanwhile, the DOJ and HHS have been collaborating on fraud-fighting initiatives by launching Medicare Fraud Strike Force Teams in 2007 and establishing the Health Care Fraud Prevention and Enforcement Action Team in May 2009. HHS has also been restructuring and expanding its contractor programs focused on the review of Medicare and Medicaid claims.
7/13/10
Regulation Proposed by CMS Includes Reduced Fines but Faster Penalty Collections for Long Term Care Facilities
The Centers for Medicare & Medicaid Services (CMS) issued a proposed regulation (“Proposed Rule”) specifying certain limits on the amount of civil monetary penalties (CMPs) to be collected from long term care facilities (nursing facilities and skilled nursing facilities), setting forth requirements for the use of such funds, and modifying provider dispute rights. The Proposed Rule was published in the July 12th Federal Register and was promulgated pursuant to Section 6111 of the Patient Protection and Affordable Care Act, Pub. Law 111-148.
The Proposed Rule would potentially offer some benefits to long term care facilities subject to CMPs for violations of the conditions of participation because it would reduce CMPs by 50 percent for violations that are self-reported and corrected within ten days. However, the reduction would apply only if repeat deficiencies did not give rise to the CMPs; the facility waives its right to a hearing; and the noncompliance did not constitute a pattern of harm or widespread harm, immediately jeopardize the health or safety of a resident, or result in the death of a resident.
At the same time, the Proposed Rule would speed up the process for collecting CMPs by establishing an escrow account in which payments for CMPs would be held pending resolution of the formal appeals process. In addition, the Proposed Rule would direct allocation of CMP recoveries: 50 percent of the collected CMPs applicable to Medicare would need to be deposited with the Department of the Treasury, and the remaining funds would be used to protect or improve patient care. CMS would need to approve any such patient care activities, which could include projects that promote consumer involvement in assuring quality of care or that support and protect residents of a facility that is closing.
Finally, the Proposed Rule would provide long term care facilities with a new independent informal dispute resolution process for CMP cases. Facilities would need to request the independent informal dispute resolution process within 30 days of the notice of the imposition of the CMPs and would need to cover the expenses of the resolution process. Per-day CMPs would continue to accrue during the process, but CMS would not collect the CMPs until the earlier of 90 days after issuance of the notice of the CMPs or completion of the process.
5/26/10
Assistant Attorney General Varney’s Healthcare Antitrust Speech Emphasizes Health Insurance Industry Enforcement and Offers Supportive Remarks on Clinical Integration
At the American Bar Association’s Antitrust in Healthcare Conference on May 24, 2010, Department of Justice Antitrust Division head Christine Varney gave her first detailed thinking on health care antitrust enforcement priorities. Her remarks focused on two key areas. First, “the importance of measured, responsible antitrust enforcement in preserving open and vigorous competition in health insurance markets,” and second, “the importance of encouraging innovation and efficiency in health care delivery and the ways in which coordination and integration among health care providers can help achieve these goals while still preserving competitive markets.”
Although private health insurance reforms dominated the health care reform debate, the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act, taken together, also require vast changes to the Medicare and Medicaid programs, including new and strengthened mechanisms for combating fraud, waste, and abuse in the state and federal health care programs.
Because many of the provisions that target fraud, waste, and abuse became effective upon enactment, the health care industry should begin to understand these provisions immediately. This article, published on April 7, 2010 in BNA’s Health Care Fraud Report and authored by attorneys in our Health Care Enforcement Defense Group, highlights key provisions, with a particular focus on the impact the legislation will have on enforcement of the Anti-kickback Statute, the False Claims Act, the Stark law, the Civil Monetary Penalties Law, and new provisions mandating reporting and refunding of overpayments.
Despite the many differences between the House passed health care reform bill and the Senate bill passed on December 24, 2009, the two are remarkably similar with respect to the enhanced fraud and abuse enforcement provisions. This solidarity is not surprising given that many experts estimate that losses resulting from health care fraud could pay for much, or even all, of health care reform.
Medicare/Medicaid Reimbursement
7/23/10
The Impact of Health Care Reform on Graduate Medical Education Reimbursement
In this article, “The Impact of Health Care Reform on Graduate Medical Education Reimbursement,” published on July 16, 2010, in BNA’s Medicare Report, Mintz Levin attorneys Andrew Roth and Nili Yolin discuss the graduate medical education provisions in The Patient Protection and Affordable Care Act (PPACA), including the resident cap redistribution program and the new calculations for resident time for Medicare GME reimbursement purposes, and explain how these changes may allow teaching hospitals and academic medical centers to benefit from the greater Medicare GME reimbursement rates that go along with an increase to their resident slots.
5/14/10
Buried among the many pages of the Patient Protection and Affordable Care Act (PPACA) was a brief yet significant provision that will result in a vast change to the Medicare claims submission process. Section 6404 of the PPACA reduces the maximum period for submission of Medicare fee-for-services claims for services furnished on or after January 1, 2010 to one calendar year after the date of service. Before enactment of this provision, CMS permitted, by regulation, filing on or before December 31st of the following year for services furnished during the first nine months of the calendar year and on or before December 31st of the second following year for services furnished during the last three months of the calendar year. On May 7, 2010, CMS issued Change Request 6960, which details steps to be taken by the Medicare contractors to implement the new filing deadline.
5/13/10
The Centers for Medicare & Medicaid Services (CMS) has released draft guidance that details how it plans to implement the Medicare Coverage Gap Discount Program (the “Discount Program”), as authorized under the recently enacted health care reform laws. Under the laws, effective January 1, 2011, manufacturers must offer discounts to Medicare beneficiaries who receive applicable covered Part D drugs while in the coverage gap (also known as the “doughnut hole”) in order for the product to be covered under Medicare Part D.
The draft guidance sets forth the responsibilities for all entities involved in delivering the Discount Program. Manufacturers must enter into a contract with CMS to offer a discount equal to 50% of the negotiated price for the “applicable drug” for all covered Part D drugs. CMS will coordinate collecting payments from manufacturers and payments to Part D sponsors. CMS will pay Part D sponsors for manufacturer discounts based on a monthly prospective payment system, calculated using the bid projections submitted by the Part D sponsor and current enrollment. Part D sponsors must provide the discounts to “applicable beneficiaries” at the point of sale and must promptly reimburse the pharmacy for the discount. A CMS contractor will invoice manufacturers on a quarterly basis on behalf of Part D sponsors. Manufacturers will be required to pay the invoiced amounts to the Part D sponsors directly, and must pay the entire invoiced amount within 15 days of receipt, including any amounts in dispute. CMS specifically seeks comments on this proposed approach for manufacturer payments. At the end of the year, CMS will reconcile the prospective Discount Program payments with the actual manufacturer payments.
5/7/10
CMS Kicks Off Program Integrity Rulemaking Process
On May 5, 2010, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule (IFR) with comment period, implementing certain portions of the Medicare and Medicaid program integrity provisions included in the Patient Protection and Affordable Care Act. The IFR is effective July 6, 2010.
Now that the much-anticipated health care reform legislation has passed, the country’s attention will turn away from contentious debates about issues such as the public option, public funding, and coverage for abortion services, and undoubtedly will turn toward the effects of the Legislation on individuals and businesses.
In particular, all sectors of the health care industry should be focusing on the Legislation’s provisions intended to increase the quality of care provided by, and the efficiency and accountability of, the Medicare program while decreasing overall costs. These potential changes, along with the restructuring of the health insurance markets, are the cornerstone of health care reform.
Our recent article in BNA’s Medicare Report discusses the payment mechanisms, demonstration programs, and other steps taken to increase quality and efficiency in the traditional Medicare programs (Parts A and B), and provides an overview of the other significant changes to the Medicare program, including Medicare Advantage (Part C) the Prescription Drug Benefit program (Part D), and revisions to payment methodologies in Part A and Part B.
1/25/10
Payment Reform - A Catalyst for Increased M&A Activity
The pending health care reform legislation includes Medicare reform proposals that are designed to improve the quality and efficiency of care and provider accountability while also reducing overall costs. Even if no legislation is enacted, it is worth considering the possible effect of proposals for payment reform and the development of provider networks—referred to as “accountable care organizations” (ACOs)—on M&A activity. Both the House and Senate bills contain extensive provisions aimed at moving Medicare, and eventually perhaps the payment mechanisms for other payors throughout the health care system, toward payment policies intended to promote value, efficiency, and quality and away from fee-for-service-based reimbursement. Less far-reaching federal legislative initiatives, potential regulatory activity by the Centers for Medicare & Medicaid Services, parallel initiatives at the state level (such as the proposal for payment reform and ACO development under consideration in Massachusetts), and private payor initiatives all seem to be leading in the same direction.
Health IT / Electronic Medical Records
8/9/10
New Proposed HIPAA Rules May Benefit Researchers
On July 8, 2010, the Department of Health and Human Services (HHS) published proposed modifications to the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules (the Proposed Rules) implementing the Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the American Recovery and Reinvestment Act of 2009.
7/21/10
Health Law Alert: Federal Money for EHR Meaningful Users in Closer Reach
On July 13, 2010, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released, final regulations implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provisions that provide incentive payments for the meaningful use of certified electronic health record (EHR) technology. These regulations finalize the January 13, 2010 proposed rule, much of which was not well-received by the health care industry. This was in large part due to the requirement that eligible professionals meet 25 criteria (or 23 for hospitals) to demonstrate meaningful use, which the health care industry believed was too burdensome, given the novelty of EHR technology. CMS has attempted to address this—as well as other concerns—raised by the proposed regulations.
The U.S. Department of Health and Human Services (HHS) released long-awaited proposed regulations (the “proposed regulations”) implementing key provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Congress enacted the HITECH Act as part of the American Reinvestment and Recovery Act of 2009, codifying a host of significant changes to the HIPAA privacy, security, and enforcement rules. In addition HHS, through the proposed regulations, made some minor, technical changes to HIPAA. Although the February 17, 2010 effective date for many HITECH Act provisions has passed, the proposed regulations provide specific information on when HHS expects covered entities and business associates to comply with these obligations, and on when covered entities and business associates alike can expect the HHS Office of Civil Rights to begin enforcement efforts. Additional details about important compliance deadlines appear below.
With comprehensive health care reform legislation completed, Congress has now turned its focus on other initiatives that may ultimately have an impact on the implementation of health care reform implementation. The Senate's Select Committee on Aging recently held the first hearing specifically focusing on how the Federal Communication Commission (FCC)'s National Broadband Plan (NBP) can impact health care. With the title The National Broadband Plan and Bringing Health Care Technology Home, senators engaged a list of expert witnesses and asked questions on a range of issues related to health IT and the NBP. Among the concerns discussed were the current barriers to adoption of health IT, concerns with e-care technologies, and the coordination of the different government agencies such as the Department of Health and Human Services and the FCC, with jurisdiction over health IT.
3/26/10
HHS Announces Delay in Enforcement of HITECH Rules as Applied to Business Associates
The HITECH Act makes “business associates” directly responsible for complying with certain provisions of the HIPAA privacy rule and all of the HIPAA security rules. Although these rules were slated to take effect in February 2010, HHS has not yet issued rules on this particular requirement. HHS’s Office of Civil Rights has let it be known that a proposed rule implementing the HITECH Act’s privacy and security provisions as they apply to business associate liability is in the works. The proposed rule will also deal with new limitations on the sale of protected health information, marketing, and fundraising communications, and stronger individual rights to access electronic medical records, among other things. According to the Office of Civil Rights, the proposed rule “will provide specific information regarding the expected date of compliance and enforcement of these new requirements.” We take this to mean that enforcement of these particular HITECH Act provisions will be delayed. However, interim final rules implementing HITECH Act provisions relating to enforcement and breach notification have already been issued and are currently in effect.
3/5/10
Is Your Electronic Health Record Technology “Meaningful?”
Is your electronic health record technology “meaningful?” The National Coordinator for Health Information Technology issued a proposed rule on March 2 to help answer that question for the thousands of health care providers that will request Medicare/Medicaid payments for the meaningful use of certified electronic health record (EHR) technology.
1/15/10
Meaningful Use = Meaningless Dollars?
The recession has impacted the pockets of Americans and state governments alike. Already facing huge budget shortfalls due to declining revenues, states have been forced to deal with the high demand for public programs. To that end, states are looking for mechanisms that will control Medicaid spending, yet improve medical quality and efficiency. The American Recovery and Reinvestment Act (ARRA) provided some much needed Medicaid fiscal assistance, including approximately $19 billion for payments and incentives to providers under public programs to adopt and implement health information technology. Its provisions require providers to demonstrate “meaningful use” of this technology, but the benefits may in fact be equally meaningful for states and providers.
1/4/10
CMS Issues Proposed Rule on Meaningful Use of EHR Technology
On December 30, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule implementing incentive payments under the Medicare and Medicaid programs for the “meaningful use” of certified electronic health records (EHR) technology. Congress mandated the Medicare and Medicaid EHR incentive programs as part of the American Recovery and Reinvestment Act of 2009 to incentivize eligible health care providers (professionals, hospitals, and critical access hospitals) to adopt EHR technologies. Incentive payments for eligible hospitals may begin as early as October 2010, while payments to other eligible providers may begin in January 2011.
11/04/09
HHS Issues Interim Final Rule Implementing Civil Penalty Provisions of HITECH Act
On October 30, 2009, the U.S. Department of Health and Human Services (HHS) published the interim final rule implementing statutory changes to HIPAA’s civil enforcement rules resulting from the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The Interim Final Rule was effective November 30, 2009.
8/26/09
HHS Issues Rules Relating to Breach Notification and Related Items under the HITECH Act
The Department of Health and Human Services issued an interim final rule on August 19, 2009, establishing standards for notification of breaches of unsecured protected health information (PHI) under the HIPAA privacy and security rules. The rule clarifies certain key definitions and concepts, generally in a manner that is favorable to covered entities and business associates, while remaining true to the HITECH Act and the intent of Congress. The interim final rule also makes minor modifications to, and formally adopts, HHS’s April 17, 2009 proposal relating to which technologies and methodologies will render PHI unusable, unreadable, or indecipherable to unauthorized individuals (and, as a consequence, exempt from the Act’s breach notice requirements).
Employer Implications
The United States Department of Labor has issued model notices, available at http://www.dol.gov/ebsa/, to assist health plan sponsors and health insurance issuers implement requirements of the Patient Protection and Affordable Care Act of 2010, together with the Health Care and Education Reconciliation Act of 2010 (collectively, the “Act”).
The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively, the “Act”) create a broad roster of new requirements and prohibitions affecting individual and group health insurance contracts and employer-sponsored group health plans. These include curbs on lifetime and annual limits, coverage of preventative care, and limitations on waiting periods, among many others. On June 22, 2010, the Internal Revenue Service, U.S. Department of Labor, and U.S. Department of Health and Human Services issued an interim final regulation (the “Regulation”) interpreting the provision of the Act.
The Patient Protection and Affordable Care Act of 2010, together with the Health Care and Education Reconciliation Act of 2010 (collectively, the “Act”), have ushered in a new era of comprehensive health care regulation. A key feature of the Act is its impact on group health insurance carriers and employer-sponsored group health plans, which are principally (though not exclusively) regulated under the Act’s provisions governing “Individual and Group Market Reforms” and “Health Insurance Market reforms” (collectively, “insurance market reforms”). The obligation on the part of group health plans and policies to implement the insurance market reforms is mitigated to a degree under the Act’s “grandfather” rules, which delay certain of the Act’s requirements and provide a complete exemption from the other requirements.
5/18/10
HHS Issues “Early Retiree Reinsurance Program” Guidance
The Patient Protection and Affordable Care Act of 2010 together with the Healthcare and Education Reconciliation Act of 2010 established the Early Retiree Reinsurance Program for the purposes of subsidizing retiree medical benefits by reimbursing participating plan sponsors for the costs of providing group health plan coverage to early retirees. “Early retirees” consist of former employees age 55 and older who are not yet eligible for Medicare and who are not active employees of an employer maintaining or currently contributing to a plan, or of an employer that has made substantial contributions to fund a plan. The Program not only covers medical claims for early retirees, but also their eligible spouses, surviving spouses and dependents. Pursuant to the mandate of the Act, the Secretary of Health and Human Services issued a regulation on the Program as of May 5, 2010. The Program is effective June 1, 2010 and terminates on January 1, 2014.
5/13/10
Agencies Issue Guidance on Health Care Reform’s New Child Coverage Rules
The Patient Protection and Affordable Care Act of 2010, together with the Health Care and Education Reconciliation Act of 2010 (collectively, the “Affordable Care Act”), provide that, effective for plan years beginning on or after September 23, 2010, a plan or issuer that makes available dependent coverage of children must make such coverage available to children until the attainment of 26 years of age (the “Coverage Requirement”). In a sister provision effective upon enactment of the Affordable Care Act (March 31, 2010), the Affordable Care Act amends Section 105(b) of the Internal Revenue Code (the “Code”) to provide that medical reimbursements made to an employee with respect to any child of the taxpayer are not taxable through the end of the taxable year in which the child turns 26 (the “Tax Provision”).
Since the enactment of the Affordable Care Act, federal government agencies have published two key items of guidance with respect to these provisions. On April 27, 2010, the Internal Revenue Service issued Notice 2010-38, which provides guidance on the Tax Provision. On May 13, 2010, the Internal Revenue Service, Department of Labor and Department of Health and Human Services issued interim final rules with respect to the Coverage Requirement. Our Advisory highlights the key provisions of this guidance.
The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (together, the “Act”), adds a new federal requirement, referred to as “employer responsibilities,” that takes effect in 2014. Under the Act’s employer responsibility provisions, “applicable large employers” must pay a non-deductible excise tax penalty if any of their full-time employees are certified as having purchased health insurance through a state exchange with respect to which a tax credit or cost-sharing reduction is allowed or paid to the employee. Colloquially referred to as a “free rider surcharge” (since it is imposed only when the government subsidizes coverage for employees of an employer), this provision is more complex and nuanced than it might at first appear. This client advisory explains the key features of employer responsibility and considers some implications for plan design.
4/20/10
Immediate Imputed Income Relief under the New Health Care Reform Law
Effective March 30, 2010, The Patient Protection and Affordable Care Act of 2010, together with the Health Care and Education Tax Credits Reconciliation Act of 2010, amend Section 105(b) of the Internal Revenue Code to provide that medical reimbursements made to an employee are not taxable with respect to any child of the taxpayer through the end of the taxable year in which the child turns 26. This alert informs employers, particularly Massachusetts employers, of the immediate effects of this provision on taxation of health coverage provided to children of employees.
4/14/10
FAQs: Health Care Reform and Employee Benefits
Employers who participated in our April 7th webcast, “Health Care Reform: What’s Happened and What’s Next,” asked many penetrating questions about the implications of health care reform on employee benefits. As promised, here are our answers.
Health care reform impacts employers in many significant ways. While the effects of reform on insurance coverage and other requirements have been widely publicized, much less well understood are various amendments to the Fair Labor Standards Act (FLSA). One such amendment requires employers to provide nursing mothers break time to express milk and, perhaps more significantly for employers, a private and secure place, other than a bathroom, in which to do so.
3/24/10
Assessing the Impact of Federal Health Care Reform on Employers and Group Health Plans
This client advisory focuses on the impact of federal health care reform on employers. It explains the key features of the Patient Protection and Affordable Care Act (H.R. 3590), which was passed by the Senate in December and adopted by the House on March 21, and compares the amendments proposed by the House in the Health Care and Education Reconciliation Act of 2010. Although certain provisions may be modified by future legislation, and there is a likelihood that some or all of the Act may be challenged on constitutional or other legal grounds, these eventualities should not distract employers and their advisors from the enormity of the task at hand. The new requirements and rules adopted under the Act, as it may be modified by the House amendments, will first need to be absorbed and then ultimately integrated and reflected in the basic design and operation of the medical benefit programs of all U.S. employers.
Pharma and Biotech
In recent advisories, we reported that the Patient Protection and Affordable Care Act (aka the health care reform bill) includes $1 billion in tax credits and grants for small and mid-size life sciences companies under the Qualifying Therapeutic Discovery Project Program. The IRS recently issued guidance on how to apply under the program. Applicants will use a new Form 8942 to certify their eligibility and summarize their “qualified investments” on which they seek credits or grants. Applicants will also submit a Project Information Memorandum describing the project and its health care and economic merits. Applications must be postmarked by July 21, 2010.
5/25/10
How to Apply for a Billion-Dollar Tax Credit and Grant Opportunity—New Guidance from the IRS
On May 21, 2010, the IRS issued highly anticipated rules on the Qualifying Therapeutic Discovery Project credit. In recent advisories, we reported that the Patient Protection and Affordable Care Act (a/k/a - the health care reform bill) includes $1 billion in tax credits and grants to defray the costs of therapeutic research for small and mid-size life sciences companies, including drug, therapeutic, and diagnostic companies. The new, temporary program offers a choice between an income tax credit and a cash grant (not to exceed $5 million per company) for up to 50% of a company’s costs paid or incurred in 2009 and 2010 and directly related to a “qualifying therapeutic discovery project” (QTDP).
The Patient Protection and Affordable Care Act includes $1 billion in tax credits and grants to defray the costs of therapeutic research by small and mid-size life sciences companies, including drug, therapeutic, and diagnostic companies. The new, temporary program offers a choice between an income tax credit and a cash grant for up to 50% of a company’s costs paid or incurred in 2009 and 2010 and directly related to a “qualifying therapeutic discovery project” (QTDP).
The Treasury Department, after consultation with the Department of Health and Human Services, is expected to announce final guidance on the application process and selection criteria for the QTDP credit and grant program by May 21, 2010. But what can companies do now to prepare for what is sure to be a highly competitive application process?
4/5/10
Billion-Dollar Tax Credit and Grant Opportunity for Life Sciences Companies
Among the varied provisions in the voluminous Patient Protection and Affordable Care Act, a/k/a the Health Care Reform Bill, Congress has appropriated up to $1 billion in tax credits and grants to defray the costs of therapeutic research by small and mid-size life sciences companies. Beneficial even for companies without income tax liability, these incentives will soon be awarded in an application process that is sure to be highly competitive.
Other Health Care Reform Issues
8/24/10
NAIC, AHIP, HHS Push MLR Regulations Forward
8/17/10
Health Reform Implementation Moves Forward Despite Continued Opposition
Over the past couple of weeks, the federal government has continued with its plans to implement the new health care reform law in the face of continued opposition and new developments in the pending lawsuits challenging the new law. On Friday July 30th, despite heavy opposition from Congress, industry groups, and patient advocates, the Centers for Medicare & Medicaid Services (CMS) announced that it would stick to a proposed regulation requiring a 2.9% reduction in Medicare inpatient payment rates to begin correcting what the agency claimed were previous overpayments to hospitals. In the past, CMS has often modified or eliminated contentious plans to reduce rates, so the decision to stick to the proposed regulation was perceived as a powerful message that the Obama administration intends to fully implement the law.
7/28/10
IRS, DOL, and HHS Issue Guidance on Preventive Care under Health Care Reform
The insurance market reforms enacted as a part of The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively, the “Act”) establish a series of new requirements that will apply, in phases, to individual and group health insurance contracts and employer-sponsored group health plans. Included is a curb on cost-sharing for “evidenced-based preventive services.” On July 14, 2010, the Internal Revenue Service, the U.S. Department of Labor, and the U.S. Department of Health and Human Services issued an interim final regulation (the “Regulation”) interpreting the preventive services provisions of the Act. This alert summarizes the key features of the Regulation.
3/15/10
Health Care Endgame
In the past couple of days, momentum has increased significantly in Washington, D.C. in the effort to reform the nation’s health care system. While discussions on the final details of the President’s requested modifications continue behind closed doors, House and Senate leaders released a final timeline late last week for the health care endgame, setting the stage for a politically charged atmosphere this week in health care.
1/11/10
Emergency Care—Will Health Care Reform Come to the Rescue?
Emergency departments and trauma centers play a key role in issues of public health and national security, be it in response to a pandemic or other disaster. However, the United States’ system for the delivery of emergency medical services, in particular trauma center services, faces challenges in the areas of funding and reimbursement, access, coordination of services, geographic/regional disparity, and the ability to respond in the event of a pandemic, disaster or other catastrophic event. Both the House and the Senate health care reform bills, in varying ways, attempt to address these and other issues. As a result, any final legislation likely will create opportunities for facilities and states to capture funds that will benefit both providers and patients.
1/4/10
The Medical Home: A New Foundation for Health Care
Health care reform legislation places a strong emphasis on improving primary care services and care coordination. Both the House and Senate bills encourage further testing and implementation of the “medical home” model, an approach to primary care for patients of all ages, in coordination or partnership with the patient and, as appropriate, the patient’s family. Primary care providers have, for some time, advocated that the medical home model is key to providing efficient, high‑quality, coordinated care. Both the Senate and House bills reflect that the medical home model, and a payment methodology that supports it, is a central component of reforming the health care delivery and payment system.
1/4/10
Comparative Effectiveness Research Proposals: Potential Implications for Stakeholders
The House and Senate health care reform proposals create federal comparative effectiveness research centers to conduct, support, and disseminate findings from comparative effectiveness research. Generally, comparative effectiveness research is evidence‑based research to evaluate and compare the health outcomes and clinical effectiveness of two or more medical treatments. Although the goal of both proposals is to identify effective and efficient treatment options, they give rise to questions about exactly how comparative effectiveness research results will be used, and the extent to which they will influence coverage and reimbursement policies or otherwise impact patient care and potentially limit provider treatment choices.
