Affordable Care Act Review

Affordable Care Act Review

Category Archives: Providers – Not-for-Profit

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And . . . the . . . CBO . . . Scooooores!

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Here are the highlights we took (quickly) from this afternoon’s Congressional Budget Office Cost Estimate for the American Health Care Act. The AHCA “would reduce federal deficits by $337 billion over the 2017-2026 period.” In 2018, “14 million more people would be uninsured under the [AHCA] than under current law. Most of that increase would… Continue Reading

ACA Repeal: The Middle Part

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Screenplays, new business ventures and major legislation typically have problems in Act II.  Hopes were raised so high in Act I.  Now, things seem to drag on and on, pointlessly.   Friends tell you to give up or start over and enemies . . . well. Last week, two House committees – Energy and Commerce, Ways… Continue Reading

Developments February 6 – 10: Is the Price Right?

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
During the week reviewed, no new bill was introduced which, if passed, would repeal or replace the Affordable Care Act, and little else happened at the three main ACA enforcement agencies – DOL, HHS and IRS. Department of Labor The Department of Labor still has no Secretary and the nominee, Andrew Puzder, has not yet… Continue Reading

The End of the Beginning: Developments January 27 – February 5

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Nothing resembling a repeal/replace consensus bill emerged from any committee in either chamber during the survey period.  Instead, in a Fox News interview broadcast just before the Super Bowl, the President confessed that ACA repeal may require more than a year.  A concise summary by Peter Sullivan in The Hill is online here. Consistent with… Continue Reading

Hitch In the Giddy-up: Round-up of Developments January 19 – 27

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
As previously reported, § 2001 of the 2017 budget bill required all ACA repeal/replace bills to be filed and reported from assigned committees by Friday, January 27, 2017.  That didn’t happen.  Since our last posting, the bills listed below have been filed and assigned to committees, but no ACA bill has emerged from committee in either… Continue Reading

President Trump’s First ACA “Executive Action”

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
Shortly after his January 20 inauguration, President Trump signed an Executive Order (promptly published by Politico) titled, “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Appeal.”  It’s most notable for what it doesn’t do – i.e., compel any agency to take, or to refrain from taking, any particular ACA enforcement… Continue Reading

Fitness Enthusiasm Wanes Early: ACA-Related Congressional Actions January 5 – 12

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
On January 5, the House passed the “Regulations from the Executive in Need of Scrutiny Act of 2017” (H.R. 26), streamlining the process for Congressional review and rejection of administrative agency rules, including a 10-year sunset provision for rules that Congress has not expressly approved. In a late night “vote-a-rama” held January 11-12, the Senate… Continue Reading

ACA Repeal Reality Check

Posted in Affordable Care Act, carrots, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
We didn’t take ten weeks off because there was nothing to talk about.  Rather, we concluded around Labor Day that anything useful to be said about ACA compliance, pre-election, would be interpreted as political advocacy, so we decided to watch and wait.  The anti-ACA candidate won, and his party carried Congress, too.  That settles that,… Continue Reading

How (and How Not) to Read This Blog

Posted in Affordable Care Act, Business Organizations, Community Health Needs Assessments, Coverage Mandates, Employee Leasing, Exchanges, Federal Contractors, Government Employers, Grandfathered Status, Independent Contractors, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes, Uncategorized
Nearly three years ago, having spent hundreds of hours immersed in ACA minutiae, we anticipated that clients would not react well to fees for services that consisted principally of telling them that they had asked the wrong question. So we decided, against tradition and much conventional wisdom, to sink lots of unpaid partner time into… Continue Reading

HHS 2017 Notice of Benefit and Payment Parameters

Posted in Affordable Care Act, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
This is the annual hodge-podge of changes to the risk adjustment, reinsurance, and risk corridors programs, cost sharing parameters, cost-sharing reductions, and Healthcare.gov user fees, usually filling hundreds of Federal Register pages. Stuff gets buried deep, scattered among 45 CFR Parts 144, 146, 147, 153, 154, 155, 156 and 158. Yesterday (101 pages) was no… Continue Reading

Nondiscrimination in Health Programs and Activities: Proposed Rules from HHS

Posted in Affordable Care Act, Coverage Mandates, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
ACA § 1557(a) (42 U.S.C. § 18116(a)) says: Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681… Continue Reading

King v. Burwell Forecast: Cloudy with a Chance of Panic

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
This is a compliance blog; we don’t do politics. But we can’t explain compliance consequences of the Supreme Court’s King v. Burwell opinion without acknowledging the political context. Here’s the June calendar of the Supreme Court of the United States.               Opinions are posted online on Monday or Tuesday, typically. As early as… Continue Reading

CMS Approves Another Hybrid Medicaid Expansion – Indiana

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Providers - For Profit, Providers - Not-for-Profit
In a January 27, 2015 press release, the Centers for Medicare and Medicaid Services (CMS) announced approval of most of an ACA Medicaid expansion proposal called the Healthy Indiana Plan.  Here are highlights of approved elements: Begins February 1, 2015, funded 100% by HHS through 2016, the federal share to decline thereafter; Beneficiary contributions to “POWER” accounts… Continue Reading

Providers May Get Guidance on the 60-Day Rule

Posted in Affordable Care Act, Providers - For Profit, Providers - Not-for-Profit
The ACA turned mistaken overpayments by intermediaries, carriers and Medicaid agencies into potential False Claims Act violations by healthcare providers when it required that an overpayment be reported and refunded within 60 days after it was “identified.”  The ACA does not define what constitutes “identification” of an overpayment, so providers have been left to wonder… Continue Reading

HHS Notice of Benefit and Payment Parameters for 2016

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Government Employers, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit
Running 324 pages, plus a six-page summary in its pre-release (easy to read) version this massive annual update will be published officially in the November 26, 2014 Federal Register.  Based on something like March Madness bracketology, we narrowed the large, attention-worthy field to these final four. No. 1: As previously threatened, HHS will amend 45 CFR § 156.145 to… Continue Reading

MOOP and Reference-Based Pricing

Posted in Affordable Care Act, Coverage Mandates, Grandfathered Status, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit
With group health plan premium increases limited by market and regulatory forces, insurers and self-insurers have raised deductibles, co-insurance, co-pays and other cost-shifting provisions, subject to the ACA’s 2015 maximum out-of-pocket (“MOOP”) limits – $6,600 per individual, $13,200 per family.  But “reference-based pricing” complicates MOOP enforcement.  In Frequently Asked Questions (“FAQ”) guidance issued October 10,… Continue Reading

ACA Review Research

Posted in Affordable Care Act, Business Organizations, carrots, Community Health Needs Assessments, Coverage Mandates, Employee Leasing, Exchanges, Federal Contractors, Government Employers, Grandfathered Status, Independent Contractors, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes, Uncategorized
Recently, we have received requests to re-post prior articles on the 90-day waiting period, the employer mandate final rules (supplemented here, here, here and here), and our pop quiz for ACA consultants.  As we approach our 100th article, some readers apparently find the scroll-down browsing process tedious.  So do we.  Here are two other ways to find… Continue Reading

Health Care Regulation and Physician Unionization

Posted in Affordable Care Act, Providers - For Profit, Providers - Not-for-Profit
We’ve all seen the commercials – “stop taking Fantasima and call your doctor immediately if you notice any of these symptoms . . . .”  If health care regulations came with such warnings, physician unionization should be a listed symptom. Increasing oversight, declining payment rates and administrative burdens imposed by public and private insurers have… Continue Reading

Who’s At Risk for Non-Payment During the ACA Subsidy “Grace Period”?

Posted in Affordable Care Act, Exchanges, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit
It’s buried deep, in small type, in a set of rules issued almost a year, and thousands of Federal Register pages ago.   Here’s the setup.  Jimmy has a chronic medical problem, and knows it, but he cannot afford insurance payments each month, even with the available subsidy.  So he puts off buying insurance until he… Continue Reading

CMS Rule On Third-Party Premium and Cost-Sharing Payments to Insurers

Posted in Affordable Care Act, Business Organizations, Exchanges, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit
Since our post about East v. Blue Cross and Blue Shield of Louisiana, Et Al., M.D. La. 3:14cv00115, CMS has issued more precise guidance on the subject of third-party premium and cost-sharing payments to insurers, in the form of an interim final rule, effective immediately, codified at 45 CFR § 156.1250: Issuers offering individual market QHP’s,… Continue Reading

ACA Advisor Pop Quiz

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Employee Leasing, Federal Contractors, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes
We have been concerned for many months that some of our clients and friends are getting unreliable ACA compliance advice.  This is not a knock on insurance agents, or brokers, or TPA’s or any other class of advisors.  We work with some who are as helpful to our mutual clients as we are to them. … Continue Reading

First Test Drive of the ACA’s No-Frills Non-Discrimination Law

Posted in Affordable Care Act, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit
ACA § 1557 (42 U.S.C. § 18116(a)) made several existing non-discrimination laws applicable to “any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title,” while also… Continue Reading

OIG’s 2014 Work Plan: A Provider “Must-Read”

Posted in Affordable Care Act, Providers - For Profit, Providers - Not-for-Profit, Uncategorized
On January 31, 2014, the Office of Inspector General (“OIG”) for the Department of Health and Human Services released its Work Plan for Fiscal Year 2014. The Work Plan sets forth OIG’s audit and enforcement priorities for the coming year and, as such, is a must read for health care providers.  The success of OIG’s… Continue Reading

DHHS, Insurers Discourage Non-Profits from Providing Premium Subsidies for Exchange Plans

Posted in Affordable Care Act, Exchanges, Providers - Not-for-Profit
As detailed in Tuesday’s Wall Street Journal, the federal Department of Health and Human Services (“DHHS”) and insurance companies are actively discouraging efforts by non-profit organizations, including hospitals and charities, to provide subsidies for low-income patients who purchase qualified health plans (“QHP”) through a health care exchange under the Affordable Care Act (“ACA”).  DHHS in… Continue Reading