August 13, 2012
by Jackie Selby and Jane L. Kuesel
As enacted in the Patient Protection and Affordable Care Act, states are required to have established operational health benefit exchanges by January 1, 2014, or the federal government will implement one for them. These exchanges will allow individuals and small businesses to buy health care coverage and are expected to add approximately 30 million currently uninsured persons to the health insurance market. Most of the health plans that will be offered on such exchanges will be managed care plans with networks of participating providers. Thus, the resulting new business will be covered by hospital, physician, and other provider participation agreements with such managed care plans.
Read the full alert here
August 9, 2012
As enacted in the Patient Protection and Affordable Care Act (“ACA”), states are required to have established operational health benefit exchanges by January 1, 2014, or the federal government will implement one for them. These exchanges will allow individuals and small businesses to buy health care coverage and are expected to add approximately 30 million currently uninsured persons to the health insurance market. Most of the health plans that will be offered on such exchanges will be managed care plans with networks of participating providers. Thus, the resulting new business will be covered by hospital, physician, and other provider participation agreements with such managed care plans.
July 10, 2012
Mary Cannon Veed
Lisa A. Baiocchi
Jesse R. Dill
Please join guest speaker, Arnstein & Lehr Chicago Partner Mary Cannon Veed, and Arnstein & Lehr Milwaukee labor and employment attorneys, Lisa A. Baiocchi and Jesse R. Dill, for an informative seminar titled “Reformed Healthcare: Now that we’ve got it, what will we have to do about it?” Due to the recent Supreme Court decision, Mary Cannon Veed will be speaking on the Patient Protection and Affordable Care Act and the impact it will likely have on both employers and employees.
July 8, 2012
Texas patient privacy protections will soon become more substantial. During the 82nd legislative session in 2011, the Texas Legislature adopted House Bill 300 (“HB 300”), which amends the Texas Medical Records Privacy Act (“Texas Act”) and takes effect on September 1, 2012. Since HB 300’s effective date is nearing, Texas covered entities, including out-of-state companies that use and/or disclose protected health information (“PHI”) in Texas, must be aware of, and take steps now to ensure compliance with, the new statutory requirements. In particular, HB 300 significantly expands patient privacy protections for Texas covered entities beyond those federal requirements as outlined by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (or “HITECH”) Act by:
June 20, 2012
Following Doug’s comments on the case for payment and delivery reform in the United States, Stuart Gerson was next to the podium to discuss whether the mandate is constitutional.
Stuart began by saying that it’s important to understand one thing – this discussion, besides the quality and efficiency issues, is about health insurance and not about healthcare itself. This is one of the real pitfalls of the US system – we provide healthcare to almost everyone, but it’s done through a series of cost-shifting and inefficiencies, and that’s what these programs are trying to address.
June 15, 2012
by Lynn Shapiro Snyder and Philo D. Hall
On March 12, 2012, the U.S. Department of Health and Human Services (“HHS”) released its final rule (“Final Rule”) implementing the new Affordable Health Insurance Exchanges (“Exchanges”) authorized under the Patient Protection and Affordable Care Act. These Exchanges are intended to establish and operate a “one-stop marketplace” in each state for individuals and small employers to obtain health insurance. While states, health issuers, and related vendors pour over all the details of the Final Rule, we thought it would be helpful to highlight 10 issues related to these Exchanges that would be of particular interest to health care providers. A significant portion of providers’ patient populations may be obtaining their health benefits coverage through one of these Exchanges.
Read the full alert here
June 10, 2012
Feds reject proposals by Alaska and Wisconsin
The Patient Protection and Affordable Care Act required that the U.S. Department of Health and Human Services (“HHS”) establish a process for reviewing unreasonable increases in health insurance premiums in the individual and small group markets. The Rate Increase Disclosure and Review Final Rule established a 10 percent national review threshold for proposed premium increases to individual and small group insurance products for the first year of the federal rate review program, September 1, 2011, through August 31, 2012. For subsequent years, the regulations require that the Centers for Medicare & Medicaid Services (“CMS”) establish state-specific thresholds; however, if no state-specific threshold is established, the 10 percent national threshold will remain in effect. The Secretary of HHS must issue a notice by June 1 of each year announcing the state-specific thresholds that will apply in the following year’s rate review program (e.g., starting September 1, 2012, for the second year).
June 5, 2012
The Patient Protection and Affordable Care Act has an awful lot in it. But at its core, the legislation is an attempt to achieve a few key goals:
- Improve access to healthcare,
- Increase healthcare quality, and
- Bend the cost curve to make healthcare more affordable.
There is little debate that each of these goals is worthy of achievement – but beyond that there is little agreement. Debate around the “individual mandate”, accountable care organizations, health insurance exchanges and the myriad other care delivery and payment reforms adopted in the ACA have grabbed the headlines of mainstream media and trade publications. There is some good (and some bad) debate going on about these provisions, many of which come from the experiences of payers and providers, private and public, that have been trying to improve healthcare for years.