Tag Archives: health reform

Trump Administration Limits Affordable Care Act’s Contraceptive Coverage Mandate

On Friday October 6, 2017, the Trump administration released two interim final rules expanding the exemptions allowed under the Patient Protection and Affordable Care Act’s (the “ACA’s”) contraceptive coverage mandate. Under the ACA, employer group health plans generally are required to cover contraceptives, sterilization, and related patient education and counseling, with exemptions provided for religious houses of worship. The exemption was expanded by the Department of Health and Human Services (HHS) as a result of the Supreme Court’s decision in Burwell v. Hobby Lobby 34 S. Ct. 2751 (2014), which held health plans of closely held for-profit corporations are not required to cover contraceptives if doing so would contradict the owner’s religious beliefs under the Religious Freedom Restoration Act.

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Assessing the Aftermath of Graham-Cassidy’s Demise

Our colleague Robert F. Atlas, President of EBG Advisors, Inc., published an advisory that will be of interest to stakeholders in the health care industry: The After-Effects of Graham-Cassidy’s Demise.

Following is an excerpt:

Taken together, the failure of the ACA repeal-and-replace effort (for now) bodes well for health care providers. The percentage of the population that’s covered—and thus is less likely to represent uncompensated care for providers—will remain fairly high, notwithstanding some erosion if the individual market isn’t bolstered.

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Replace Without Repeal?

On Monday, January 23rd, Senators Bill Cassidy (R-LA) and Susan Collins (R-ME) introduced the Patient Freedom Act of 2017 (“PFA”), the first of what may be many Republican Affordable Care Act (“ACA”) “replacement” alternatives. The PFA is notable for several reasons. It is the first replacement plan to be introduced in the 115th Congress, it is sponsored by Senators who are considered comparatively moderate on health issues, and thus its content may represent an opportunity for compromise in the future, and, perhaps most interestingly, does not actually repeal the ACA. The overarching feature of the PFA is that it allows states to control which course they chart for health reform.

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HEALTH REFORM: OIG Issues Updated Guidelines for Evaluating State False Claims Acts: Is More State Litigation on the Horizon?

On March 15, 2013, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) released the UpdatedOIG Guidelines for Evaluating State False Claims Acts (“2013 Guidelines”),[1] which replaces the original version released in 2006 (“2006 Guidelines”). The 2013 Guidelines describe OIG’s methodology for determining whether a state’s Medicaid false claims law satisfies the four requirements in Section 1909(b) of the Social Security Act (“Act”) that are necessary to qualify for a 10-percentage-point increase in the state share of Medicaid-related false claims recoveries.

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HEALTH REFORM: HIPAA Omnibus Rule’s Impact on Notices of Privacy Practices

This health reform alert summarizes the key changes to the Notice of Privacy Practices (“NPP”)[1] requirements in the revised Health Insurance Portability and Accountability Act (“HIPAA”) regulations (the “Omnibus Rule”)[2] as well as what covered entities need to do to be compliant.[3] Because many covered entities may have modified their NPPs based on the Notice of Proposed Rulemaking issued on July 14, 2010 (“NPRM”),[4] this alert also details the similarities and differences between the NPRM and the Omnibus Rule related to NPPs. In addition, Table 1 of this alert provides a quick summary of the NPRM proposals adopted—or not adopted—by the Omnibus Rule.

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HEALTH REFORM: U.S. Supreme Court Opinion Addresses Availability of State-Action Antitrust Immunity

On February 19, 2013, in FTC v. Phoebe Putney Health System, Inc.,[1] a case that highlights vigorous enforcement activities by the Federal Trade Commission (“FTC”) in the health care arena, the Supreme Court of the United States issued a unanimous opinion (“Opinion”) that overturned a ruling by the U.S. Court of Appeals for the Eleventh Circuit and limited the invocation of the state-action doctrine where state laws grant government authorities general corporate powers. This new decision supports the FTC’s position that it has the authority to pursue a challenge to the hospital acquisition at issue in the case. Although the Opinion addressed the specific legislative powers granted to a hospital authority under state legislation, the Opinion will likely impact judicial interpretation of other state legislation that purports to provide parties with immunity from the federal antitrust laws, such as state hospital cooperation acts, and similar types of legislation being created to allow cooperation and integration of hospital and provider systems.

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HEALTH REFORM: CMS Issues Final Regulations on Federal "Sunshine" Law for Manufacturers and GPOs

On February 1, 2013, the Centers for Medicare & Medicaid Services (“CMS”) issued long-awaited final regulations with a lengthy preamble (collectively referred to herein as “Final Regulations”) relevant to Section 6002 of the Patient Protection and Affordable Care Act, also known as the “Physician Payment Sunshine Act.”[1] The Final Regulations are available online.

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HEALTH REFORM: Key Compliance Actions for the New HIPAA Privacy Regulations

As noted in previous Epstein Becker Green health reform alerts, on January 25, 2013, the long-awaited final omnibus rule (“Omnibus Rule”) issued by the U.S. Department of Health and Human Services (“HHS”) was published in the Federal Register.[1] The Omnibus Rule makes sweeping changes to the privacy and security regulations under the Health Insurance Portability and Accountability Act (“HIPAA”).

In light of the Omnibus Rule’s new requirements, business associates and covered entities should strongly consider reviewing their existing HIPAA privacy and security practices, including compliance policies and business associate agreements. While the Omnibus Rule takes effect on March 26, 2013, affected parties have until September 23, 2013, to come into compliance with most of its provisions. This alert reviews several of the regulatory changes and suggests action items to facilitate compliance with the new requirements.

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HEALTH REFORM: New York Issues "Invitation to Participate in the New York Health Benefit Exchange," Clarifying Application Process and State Requirements

The New York Department of Health’s Office of the New York Health Benefit Exchange issued the long-awaited “Invitation to Participate in the New York Health Benefit Exchange” (the “Invitation”) on January 31, 2013. The Invitation clarifies and summarizes the requirements for applicants to be qualified as eligible for certification as a qualified health plan (“QHP”), which permits them to be offered on the New York Health Benefit Exchange (the “NY Exchange”). Some of the more interesting and helpful features of the Invitation are summarized below. The full Invitation can be found online, along with a number of related attachments(“Attachments”).

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Patient Protection and Affordable Care Act Alert-Issue 3: Health Care Reform – Employer "Pay or Play" Mandate in 2014

The re-election of President Obama and the lack of change in the control of the houses of Congress effectively ensure that the provisions of Health Care Reform will remain in place and will continue along the path of implementation.

This is the third Alert in a series designed to help employers understand and address the effects of Health Care Reform on your businesses so you are in the best position to make decisions in response to these new requirements. Our first Alert dealt with the implementation of new health flexible spending account limits; our second Alert provided guidance on reporting cost of health care coverage on form W-2. At this point, most of the regulatory guidance needed has either not yet been issued or has only been issued in proposed form. Therefore, we will provide the best possible guidance based on existing knowledge. 

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