Tag Archives: patient protection and affordable care act

Providers: Do Your Managed Care Participation Agreements Apply to New Insurance Exchange Products?

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.

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HEALTH REFORM: Providers: Do Your Managed Care Participation Agreements Apply to New Insurance Exchange Products?

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[1] and small businesses[2] 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.

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Three tools to help you navigate the Patient Protection and Affordable Care Act

When the Supreme Court upheld the provisions of the Affordable Care Act, businesses were left with many questions about how this legislation could potentially impact them. For example:

  • What constitutes “affordable” health insurance and how does the employer shared responsibility penalty actually work?
  • What will employers need to do to comply with W-2 reporting and Summary of Benefits and Coverage requirements?
  • How does the legislation impact grandfathered status of health plans and employee FSA contributions?
  • What are the tax implications resulting from this decision?
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Special Employment Law Seminar on July 12 focused on Reformed Healthcare

Arnstein & Lehr Attorney Mary Cannon Veed

Mary Cannon Veed

Arnstein & Lehr Attorney Lisa A. Baiocchi

Lisa A. Baiocchi

Arnstein & Lehr Attorney Jesse R. Dill

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.

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Texas House Bill 300 Significantly Expands State’s Patient Privacy Protections for Covered Entities

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.[1] 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[2] by:

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Patient Protection and Affordable Care Act: Attention Employers: Is your company in compliance with the Affordable Care Act?

When the U.S. Supreme Court last week held the individual mandate provision of the Patient Protection and Affordable Care Act to be constitutional, the Court also upheld all of the other employer and group health plan provisions in the Act. With effective dates of the Act’s various provisions spread over four years, employers should now be reviewing all of the Act’s provisions and confirming that they – and their group health plans – are in compliance with the provisions currently effective, and are taking the necessary steps to comply with provisions becoming effective in the future.

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Is the Mandate Constitutional – US National Health Care Act – a Presentation by Stuart Gerson

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. 

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10 Things Providers Should Know About the Health Insurance Exchange Final Rule

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.

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HEALTH REFORM: No Change in the 10 Percent Federal Rate Review Threshold

Feds reject proposals by Alaska and Wisconsin

No Change in the 10 Percent Federal Rate Review Threshold

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[1] 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).[2]

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Telemedicine and the ACA Triple Aim of Improving Access and Quality and Lowering Cost

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:

  1. Improve access to healthcare,
  2. Increase healthcare quality, and
  3. 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.

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