Tag Archives: ACA

Slow repeal of the ACA and its impact on post-acute care providers

This is the sixth article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact on post-acute care providers. The term “post-acute care provider” encompasses a large and diverse group of healthcare providers that includes nursing facilities, home health agencies, hospice agencies and assisted … Continue Reading

Slow repeal of the ACA and its impact on rural healthcare and communities

This is the fifth article in our series on the effect of the “slow repeal” of the Affordable Care Act (ACA). This week’s article focuses on the potential impact of the slow repeal of the ACA on rural communities and healthcare. Continued Fragile System Leads to Uncertainty or Closure Causing Economic Ripple Effect Throughout Rural … Continue Reading

Managing MACRA – Part VII: What happens to MACRA if the Affordable Care Act is repealed?

Even without potential changes to the Medicare program, MACRA poses a significant challenge for any clinician trying to determine the best strategy to maximize Medicare reimbursement – there are hundreds of pages of guidance in the proposed and final regulations to review and understand. But, at this point, clinicians attempting to assess MACRA must also … Continue Reading

Slow repeal of the ACA and its impact on the individual health insurance industry

This is the fourth article in our series on the effect of the “slow repeal” of the ACA. This week’s article starts a three-part discussion on the potential impact of the slow repeal of the ACA on the health insurance industry, with this week’s focus on the individual health insurance market. On February 2, 2017, … Continue Reading

Slow repeal of the ACA and its effect on the pharmaceutical industry

This is the third article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact of a slow repeal of the ACA on the pharmaceutical industry (Pharma). Unlike many of the players detailed in our prior articles on the slow repeal of the ACA, … Continue Reading

Slow repeal of the ACA and its effect on physicians

This is the second article in our series on the effect of a “slow repeal” of the ACA, which began January 3, 2017, when Senate Budget Committee Chairman Mike Enzi introduced a budget resolution with instructions to the relevant Senate and House committees to develop a plan to repeal the ACA. The four committees that … Continue Reading

Slow repeal of the ACA and its effect on health systems

President-elect Donald Trump has said repealing the ACA will be a priority for his administration. On Dec. 6, 2016, Senate Majority Leader Mitch McConnell (R-Ky.) announced that a measure to repeal parts of the ACA will be the first item the Senate considers when it convenes on Jan. 3, 2017.… Continue Reading

District court interprets ‘identification’ of overpayment under 60-day rule

A New York district court issued the first judicial opinion Monday, Aug. 3 on the Affordable Care Act’s “60-day rule,” which requires that a Medicare or Medicaid overpayment be reported and returned within 60 days of the date on which the overpayment was “identified.” The decision by Judge Edgardo Ramos provided a definition of what it … Continue Reading

DOJ intervenes in first False Claim Act case involving ACA '60-day repayment provision'

The U.S. Department of Justice (DOJ) and the New York State Attorney General intervened in a federal False Claims Act (FCA) case on June 27, 2014, accusing Mount Sinai Health System of failing to report and return Medicaid overpayments within 60 days of identifying them. See U.S. ex rel Kane v. Healthfirst, Inc., et al., No. … Continue Reading

DSH Program Takes a Hit Under Healthcare Reform

Pursuant to the Affordable Care Act, the Centers for Medicare and Medicaid Services recently adopted a final rule implementing $1.1 billion in cuts to the Medicaid disproportionate share hospital (DSH) program in 2014 and 2015.  The new rule reduces Medicaid DSH payments by $500 million in 2014 and $600 million in 2015.  There are several … Continue Reading

Disincentives to Physician-Patient Discussions of End-of-Life Care

Harvey Tettlebaum, a Husch Blackwell attorney specializing in healthcare law with an emphasis in post-acute care, contributed an article to the June 2013 issue of the Journal of Health & Life Sciences Law titled “Quality Measurements, Payment, and the Law: Disincentives to Physician-Patient Discussions of End-of-Life Care.”  Here is the abstract of the article. With passage … Continue Reading

Government Announces Record-Breaking Recoveries of Healthcare Fraud Money

The Departments of Justice and Health and Human Services released a report last week showing that the government has achieved the highest return on investment in the 16-year history of the Health Care Fraud and Abuse (HCFAC) Program.  According to the report, for every dollar spent on healthcare-related fraud and abuse investigations in the last three … Continue Reading

CMS Approves Texas Bundled Payment Pilot Programs

On January 31, 2013, the Centers for Medicare & Medicaid Services (CMS) announced the health care organizations selected to participate in the Bundled Payments for Care Improvement initiative (“BPCI”).  BPCI was created by the Affordable Care Act (“ACA”) healthcare reform law to assess whether bundling payments for services in a single episode of care can … Continue Reading

New Technology May Help an Old Problem: Remote Monitoring to Reduce Readmission Rates

In less than two weeks, CMS will begin reducing a hospital’s Medicare reimbursements by as much as 1% if the hospital’s readmission rates are too high.  This reduction is part of a program authorized by the Affordable Care Act called the Hospital Readmissions Reduction Program.  You can read more about the program CMS’s website. Nearly 1 in … Continue Reading

Paul Ryan May View the ACA as Medicare's Biggest Threat, But Many Hospitals View It as a Lifeline

Last week, Paul Ryan accepted the nomination for Vice President.  In his acceptance speech, he cited “Obamacare” as the greatest threat to Medicare, but many hospitals view the expansion of coverage for low-income individuals positively.  More and more community hospitals are urging their state governments to accept payments for expanded Medicaid programs under the Affordable … Continue Reading

What Healthcare Organizations can do to Prepare for the Mandatory Compliance Condition of Enrollment

With the passage of the ACA, the voluntary nature of compliance programs is about to change. Smaller healthcare organizations and other ancillary providers who have previously not established compliance programs will now be required to adopt formal programs.  The ACA mandates providers and suppliers participating in federal health care programs to implement compliance programs with … Continue Reading

How Does the Supreme Court’s Recent Decision Impact Employers and Employer-Sponsored Health Plans?

In the wake of the U.S. Supreme Court’s June 28, 2012, decision upholding the constitutionality of the 2010 Patient Protection and Affordable Care Act, employers who had been awaiting the decision should now focus on compliance. We expect additional guidance will be released to implement several pending provisions, including those related to the 2014 employer responsibility … Continue Reading
LexBlog