C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

Tag Archives: ACA

Upcoming Webinar: Looking Back & Looking Beyond – The First 100 Days in Health Care Policy

Posted in Events, Exchanges, Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
On Tuesday, April 18, 2017, our Health Care Group will hold a webinar on the health care policy and transition challenges still at play as the Trump Administration nears the end of its 100 days in power.  During the webinar, participants will hear important insights and predictions on what a Trump-led Executive Branch will mean… Continue Reading

District Court Issues Nationwide Injunction on ACA 1557 Regulations on Gender Identity and Abortion

Posted in Administrative Law
On December 31, 2016, in Franciscan Alliance v. Burwell, Case No. 7:16-cv-00108-O, the District Court for the Northern District of Texas  issued a nationwide injunction finding that portions of the U.S. Department of Health & Human Services, Office for Civil Right’s (OCR) Final Rule for ACA Section 1557 violated the Administrative Procedures Act and cannot… Continue Reading

GAO Finds HHS Exceeded Authority in Implementation of Transitional Reinsurance Program

Posted in Exchanges, Health Care Reform & ACA, Uncategorized
The Government Accountability Office (GAO), in a letter to members of Congress, found that the implementation of the Transitional Reinsurance Program by the U.S. Department of Health and Human Services (HHS) violates the Affordable Care Act. The Transitional Reinsurance Program is one of three premium stabilization programs authorized by the Affordable Care Act (ACA), commonly… Continue Reading

Senate Finance Committee Members Hear from Partner Troy Barsky and Hospital System Executives on Necessary Stark Law Reforms

Posted in Fraud, Waste & Abuse, Health Care Reform & ACA, Medicaid, Medicare
Yesterday, our colleague Troy A. Barsky testified before the U.S. Senate Finance Committee led by Chairman Orrin Hatch (R-Utah) and provided recommendations for modernizing the Stark Law to regulate self-referrals without impeding the care coordination and value-based payment models promoted by health care reform legislation. Other witnesses before the Committee included Dr. Ronald A. Paulus,… Continue Reading

Next Generation ACO Model Enters its Second & Final Application Cycle

Posted in Health Care Reform & ACA
This month, the Centers for Medicare & Medicaid Services (CMS) announced the beginning of the second application cycle for its Next Generation ACO Model (Next Gen Model).  We discussed the goals of the Next Gen Model and how it compares to the Medicare Shared Savings Program and Pioneer ACO models in this post from last… Continue Reading

CMS Proposes New ACO Performance Measures

Posted in Health Care Reform & ACA, Medicare
On January 28, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would change the methodology used to evaluate and adjust the performance of Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs). The proposed rule is intended to improve long-term incentives for ACOs and create a path for long-term… Continue Reading

C&M Alert on the “Overdue” 60-Day Overpayment Rule for Part A & B Providers

Posted in Fraud, Waste & Abuse
Our Health Care Group attorneys have authored a new alert explaining the implications of the final rule on the reporting and return of overpayments (the “Overpayment Rule”) the Centers for Medicare & Medicaid Services (CMS) issued earlier this month.  CMS promulgated the Overpayment Rule nearly two years after the agency issued its final rules governing… Continue Reading

CMS Issues Guidance on Part D’s “Any Willing Pharmacy” Requirement

Posted in Health Care Reform & ACA, Medicare
Citing concerns about transparency and timing, on August 13, 2015, CMS issued a memorandum to clarify guidance to Medicare Part D sponsors regarding the any willing pharmacy requirement. Medicare Part D sponsors are required to contract with any pharmacy that meets the Part D sponsor’s standard terms and conditions.  CMS requires that the standard terms… Continue Reading

Context Matters: Supreme Court Rules in Favor of ACA Subsidies

Posted in Exchanges, Health Care Reform & ACA
The “what will Congress do” news leads can now stop. The Supreme Court issued its decision in King v. Burwell and Congress does not need to fix anything because, by a vote of 6-3 in an opinion written by Chief Justice John Roberts, the Supreme Court held that the subsidy provisions of the ACA are… Continue Reading

Crowell’s Long-Term Care Policy Update—Recapping the Discussions and Debates

Posted in Health Care Reform & ACA, Medicaid, Medicare
On April 17th, Crowell & Moring’s Government Affairs and Health Care Groups hosted speakers from Capitol Hill, federal agencies, and national trade groups during a thought-provoking half-day Long Term Care Policy Update forum (“LTC Forum”).  The LTC Forum was spearheaded by James Flood and Scott Douglas, who recently joined the firm from the Government Affairs… Continue Reading

Thousands may lose Affordable Care Act health coverage absent residency and income verification

Posted in Health Care Reform & ACA
The Centers for Medicare & Medicaid Services (“CMS”) recently announced that it had identified and contacted more than 300,000 people to obtain proof of their citizenship or legal residency status. Failure to provide this documentation by September 5 could result in these individuals losing their Affordable Care Act (“ACA”) health coverage, effective September 30. This… Continue Reading

U.S. Territories Exempt from ACA Market Reform, Non-Discrimination Provisions

Posted in Health Care Reform & ACA
Insurers in U.S. Territories will soon be exempt from popular market-reform and non-discrimination provisions of the Affordable Care Act (ACA). In a July 16 letter, the Department of Health and Human Services (HHS) clarified that the ACA provisions on guaranteed availability, community rating, single risk pool, medical loss ratio, and essential health benefits only apply… Continue Reading

COBRA, Cost-Sharing, and Other Matters Clarified in the Affordable Care Act’s Nineteenth Set of FAQs

Posted in ERISA, Exchanges, Health Care Reform & ACA
On May 2, 2014, the Internal Revenue Service, Department of Health and Human Services, and Department of Labor (the “Departments”) collectively released the Affordable Care Act’s (ACA) nineteenth set of Frequently Asked Questions (FAQs). The FAQ addressed outstanding questions regarding Health Care Continuation Coverage (COBRA) and Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)… Continue Reading