The Patient Protection and Affordable Care Act is galactic. It sweeps over one sixth of the national economy and has staggered effective dates between 2010 and 2018. The constitutionality of the Act requires a swift resolution by the courts of appeals and then by the Supreme Court or there will be even more chaos in the United States. There is an ancient Chinese curse: "May you live in interesting times." These are interesting times.
January 14, 2011 -- New York Medicaid Redesign Team
On January 5, 2011, Governor Cuomo issued Executive Order #5 establishing a Medicaid Redesign Team to find ways to cut costs within the New York Medicaid program for the 2011-2012 fiscal year and beyond. The Governor is seeking a fundamental restructuring of the New York State Medicaid program to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure. This alert discusses the team's responsibilities and the matters it will address.
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January 10, 2011 -- CMS soliciting comments on the EMTALA’s applicability to inpatients
On December 23, 2010 CMS issued an advanced notice of proposed rulemaking to solicit public comments on two CMS policies pertaining to the applicability of the Emergency Medical Treatment and Labor Act (“EMTALA”) to hospital inpatients. This alert outlines these policies.
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November 16, 2010 -- CMS posts notice soliciting comments on initial regulations for ACOs
CMS has posted a notice that will be published in the Federal Register on November 17, 2010, soliciting comment on various aspects of the policy and standards that should be reflected in its initial regulations for ACOs and the Medicare shared savings program. This alert discusses the questions CMS has posted.
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November 15, 2010 -- The NCQA and AMGA issue statements on accountable care organization
The National Committee for Quality Assurance (NCQA) and the American Medical Group Association (AMGA) have each issued statements expressing their view on how to facilitate the success of existing and future accountable care organizations (ACOs), networks of providers furnishing services to a specified group of patients. This alert discusses the standards and principles published by NCQA and AMGA.
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October 6, 2010 -- Stricter duty hour rules for medical residents effective July 1, 2011
Last week, the Accreditation Council for Graduate Medical Education (ACGME) released Common Program Requirements further restricting the duty hours of the over 100,000 residents training in ACGME-accredited residency programs in the United States. In addition to strengthening the ACGME’s restrictions on duty hours, the new standards also require increased supervision of residents and set forth specific requirements for alertness management and fatigue mitigation.
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September 10, 2010 -- OSHA enters the duty hours debate as the ACGME prepares to vote on revisions to its duty hour standards later this month
OSHA announced last week that it would review and consider a petition calling for federal regulation of the duty hours of medical residents. The regulations proposed by the OSHA petitioners are even more restrictive than the 2011 revised standards currently under consideration by the ACGME. Any new standards approved by the ACGME this month would become effective in July of 2011. It is unclear how OSHA’s recent announcement might affect that timeline, if at all. Teaching institutions should expect and prepare for heightened scrutiny and enforcement of duty hour limits, as well as the possibility of unprecedented involvement by federal regulators.
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Health care reform update: new regulations spell out how health plans can lose their grandfathered status
On June 14, 2010, the federal government issued interim final rules that spell out how health plans could lose their “grandfathered” status under the recent health care reform legislation. Of particular note, plans could lose their grandfathered status if their employees’ cost for coverage increases beyond permitted levels or plan benefits are cut. It appears possible, however, to increase benefits offered under the plan without running afoul of the grandfathering rules.
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As part of the Patient Protection and Affordable Care Act, Congress has established a $5 billion program to benefit health plans that provide coverage to certain early retirees, generally those between the ages of 55 and 64. The Department of Health and Human Services has just issued regulations describing the operation of this subsidy program. Because the program will open next month on a first-come, first-served basis, health plans that provide benefits to early retirees should review the program now to determine if they wish to begin assembling the information needed to apply for the subsidy.
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This Tax Alert summarizes three tax provisions that were included in the recent healthcare reconciliation bill passed by Congress and signed by President Obama - the 0.9% increase in the Medicare tax, the new 3.8% Medicare tax on certain investment income, and the economic substance penalty regime-and how they will impact taxpayers.
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With the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, a new era in the history of the American health care system has begun. Key elements of the new legislation include incentives and penalties that are designed to encourage employers to offer, and individuals to procure, health care coverage. Additionally, the legislation will create new health care exchanges to purchase insurance, impose mandates on health plans, add new reporting and disclosure requirements, and, of course, levy new taxes. In sum, the new legislation will provide significant challenges to employers, and the purpose of this alert is to discuss important implications to employers.
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Perspectives from The Hill: U.S. House passes health care reform bill
By: Hon. Thomas M. Reynolds
The House of Representatives passed their health care bill on November 7th, 2009 with a vote of 220-215. The bill has the choice of a public health insurance option, tax credits to make health care affordable, asks employers to pitch in their fair share, and covers 96% of Americans according to the CBO (5 million more than the Senate bill). This is the first time in our country's history that the House has passed a comprehensive health care bill.
Two amendments were offered in the House, a Republican substitute amendment which failed to pass, 176-258, and an amendment offered by Congressman Stupak (D-MI) which would prohibit any health care plan in the new Exchange from offering abortion coverage. The Stupak amendment passed, 240-194.
Similarly, the Senate passed their health care bill on December 24th, 2009 with a vote of 60-39. The Senate bill doesn’t have a public health insurance option and will tax certain health benefits to help pay for reform. The Senate’s version implements a tax on enhanced plans that provide increased benefits, rather than taxing gross annual income. The bill changes today’s health care system by requiring all citizens to purchase a health insurance policy. Furthermore, health companies will cover 31 million more participants.
On March 21, 2010 the House passed the Senate’s health care bill H.R. 3590 by a final vote of 219-212 with 34 Democrats opposing and no Republicans voting for the measure. In addition, the House passed H.R. 4872, the Reconciliation Act of 2010, which included “fixes” to make the package palatable to House Democrats, by a final vote of 220-211. The Senate’s original bill, H.R. 3590, was signed into law by the President on March 23, 2010. The reconciliation “fixes” package will be considered in the Senate. The passage of the Senate health care bill and a package of improvements at the same time allows the Senate to pass the improvements using the budget reconciliation process (which is not subject to a filibuster or cloture and requires only 51 votes in the Senate to pass).