In his article The Shield Becomes a Sword, Nick Healey discusses Article I, Section 38 of the Wyoming Constitution, which guarantees the right of every competent adult to make their own healthcare decisions and was passed in 2012 in response to concerns over the Patient Protection and Affordable Care Act (ACA) and its potential
On July 1, 2021, the Office of Personnel Management (“OPM”), the Internal Revenue Service (“IRS”), the Department of Treasury (“Treasury”), the Employee Benefits Security Administration (“EBSA”), the Department of Labor (“DOL”), the Centers for Medicare & Medicaid Services (“CMS”), and the Department of Health and Human Services (“CMS”) (collectively the “Departments”) jointly issued the Interim Rule – Requirements Related to Surprise Billing; Part 1 (hereinafter, the “Interim Rule” or the “Rule”). This Interim Rule is the first implementing regulation of the federal No Surprises Act (alternatively the “Act”) which was enacted on December 27, 2020 as part of the Consolidated Appropriations Act. Both this Interim Rule, and the Act, are effective applicable for plan years beginning on or after January 1, 2022.
Continue Reading Federal Guidance on Balance Billing: The No Surprises Act and its Interim Final Rule: Part I
If you track national health care policy developments, you’ve been busy lately.
Following weeks of growing declarations from Democrats in support of Medicare for All, US House Speaker Nancy Pelosi tamped down exuberance over any plans to replace the Affordable Care Act (ACA). Then the US Justice Department spoke up.
In a March 25 statement to the Court of Appeals for the Fifth Circuit, Justice Department lawyers said US District Court Judge Reed O’Connor’s ruling should be affirmed—that the entire ACA coverage mandate is unconstitutional, and since the provision is inseverable from the ACA, the entire Act is invalid. The ACA remains in place as the District Court ruling is under appeal.
Continue Reading Medicare for All, Part 2: Cost, Financing and Impact on Provider Payment
On Monday, March 6, 2017, House Republicans released the long awaited proposed legislation to replace the Affordable Care Act (ACA).
The GOP bill, the “American Health Care Act” (AHCA), repeals or significantly changes major portions of the ACA involving the individual and employer mandates, subsidies, and Medicaid expansion, among others. The AHCA, which is already facing political headwinds and healthcare industry objections, has not yet been scored by the Congressional Budget Office (CBO), so the economic effect and the potential change to the number of people covered by health insurance have not been officially quantified. However, the AHCA’s overall philosophy and goals are clear, and it signals areas of concern for healthcare providers and Medicaid expansion States. In this article in our series on the effect of a “slow repeal” of the ACA, this week’s discussion focuses on the significant aspects of the proposed AHCA, potential concerns for healthcare providers, and likely next steps.Continue Reading Slow Repeal of the ACA – Proposed Replacement Legislation Released
President Trump’s nominee for Secretary of the Department of Health & Human Services (HHS), Congressman Tom Price (R-Ga.), has now completed two confirmation hearings in the Senate. If confirmed, Rep. Price will direct more than $1 trillion of annual spending, as well as assist in developing and implementing a replacement for the Affordable Care Act (ACA). First, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a courtesy hearing January 18, and then the Senate Finance Committee, which has jurisdiction over the nomination, held its hearing January 24. The following is a summary of what we learned – or did not learn – over the course of those hearings.
Continue Reading Tom Price Confirmation Hearings – What We Have Learned?
One of President-elect Trump’s many campaign promises included “repealing and replacing” the Affordable Care Act (ACA), known as Obamacare. Trump nominated Rep. Tom Price, M.D. (R-Ga.) to serve as the Secretary for the Department of Health & Human Services. Trump’s selection of Price signals that Trump is pushing forward with his promise to aggressively repeal and replace the ACA. If confirmed, Price will lead 11 agencies, including the FDA and the National Institutes of Health, with a $1-trillion budget and the ultimate oversight responsibility for both Medicare and Medicaid.
Continue Reading What’s next for Trump’s HHS Secretary nominee?
Gov. John Bel Edwards signed an executive order Jan. 19, 2016, to make Louisiana the 32nd state to adopt Medicaid expansion under the Affordable Care Act. Montana’s Medicaid expansion became effective Jan. 1, and South Dakota, Virginia and Wyoming are including Medicaid expansion in upcoming state budget proposals.
This is reflective of a growing trend of so-called “red” states that are nevertheless adopting provisions of the Affordable Care Act that subsidize healthcare costs for new groups of citizens who cannot afford commercial or exchange insurance products and do not qualify for Medicare. To sweeten the pot, the Obama administration announced its 2017 budget proposal will include a legislative proposal to provide any state that expands Medicaid coverage under the Affordable Care Act with the same three years of full federal funding that states that expanded their Medicaid programs in 2014 enjoyed.
Continue Reading Red states see green: Opportunities for children’s hospitals
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…