State Net Capitol Journal: State and Federal Governments Struggle Over Health Care

StateNet@placeholder.com (State Net) — Tue, 14 May 2013 15:30:00 -0400

By Lou Cannon

The Affordable Care Act, the Obama administration's vaunted plan for overhauling the nation's health care system, will cost more, insure fewer people and probably take longer to implement than originally planned.

States and the federal government are struggling to meet the deadlines for creating on-line marketplaces, known as exchanges, in which individuals and families will be able to purchase affordable health insurance policies. The exchanges are supposed to begin enrolling customers by Oct. 1, 2013, and be fully operational next January. According to the Kaiser Family Foundation, states are facing "serious challenges" and some may be lagging in their efforts to meet these deadlines.

State Net Capitol Journal: ACA Could Cost Businesses in Non-Expansion States $1.3 Billion Per Year

StateNet@placeholder.com (State Net) — Tue, 14 May 2013 15:26:00 -0400

The Affordable Care Act requires companies with more than 25 employees to pay a "shared responsibility" fine of $3,000 for each worker who isn't eligible for Medicaid and who receives a federal tax subsidy because their employer doesn't offer them health insurance. The provision was intended to induce small businesses to provide such insurance.

Analysis by Brian Haile of Jackson Hewitt Tax Service, however, found that for the 22 states that have opted out of the Medicaid expansion prescribed by the ACA - but made optional by the U.S. Supreme Court - the "shared responsibility" bill for small businesses could run as high as $1.3 billion per year.

Consequently, the National Federation of Independent Businesses is

State Net Capitol Journal: States Ponder Broadening Health Care Scopes of Practice

StateNet@placeholder.com (State Net) — Fri, 19 Apr 2013 17:32:00 -0400

By Rich Ehisen

There has long been friction in the relationship between doctors and other health care providers, with the former ferociously guarding their turf against incursion from the latter. But with the Affordable Care Act soon to bring 33 million new patients into the system, many states are pondering whether it is time to allow nurses, physician assistants, optometrists and even dentists to offer patients services they could previously only get from their primary care physician.

According to State Net, as of March 25, 33 states this year have collectively introduced over 140 bills that address medical "scope of practice" issues - the standards that determine which medical providers can offer which services. Those regulations

Sands Anderson PC: The Affordable Care Act: What Employers Need to Do Now to Plan for 2014

Sands.Anderson@placeholder.com (Sands Anderson PC) — Mon, 08 Apr 2013 16:59:00 -0400

By Jessica Rogers

Beginning January 1, 2014, most U.S. citizens and legal residents will be required to have qualified health care coverage pursuant to the Affordable Care Act ("Act"). The Act requires employers defined as "large" to offer that coverage for its "full-time" employees or pay a penalty. Employers must act now to determine if they are required to provide that coverage (or pay a penalty), and to determine which employees are "full-time." The look-back periods for determining large employer status and for determining full-time status must begin in 2013.

You must determine now: (i) if you are an applicable

Steptoe & Johnson PLLC: U.S. Supreme Court Limits State Medicaid Recoveries to Medical Expenses

Andrew.Fulton@Steptoe-Johnson.com (Steptoe & Johnson PLLC) — Mon, 25 Mar 2013 17:09:00 -0400

What happened?

In a decision released last week, Wos v. E.M.A. [enhanced version available to lexis.com subscribers], the U.S. Supreme Court invalidated North Carolina's Medicaid subrogation laws because they allowed the state to recover more than the medical expense portion of a Medicaid beneficiary's settlement. The beneficiaries in Wos settled a medical malpractice suit involving injuries to their child for $2.8 million. The trial court approved the unallocated settlement but set aside 1/3 in an escrow account, pursuant to

State Net Capitol Journal: States Have Key Role In Making Affordable Care Act Work

StateNet@placeholder.com (State Net) — Thu, 21 Mar 2013 15:56:00 -0400

By Lou Cannon, State Net Capitol Journal

Winston Churchill famously described a crucial British military victory in North Africa during World War II as "not the end...not even the beginning of the end" but "perhaps, the end of the beginning."

For the Affordable Care Act (ACA) that President Obama is now more than willing to call ObamaCare, the end of the beginning occurred in June when the Supreme Court ruled that most of the law is constitutional. By re-electing Obama and keeping the Senate in Democratic hands, voters doomed quixotic Republican hopes of repealing the law. Now comes the tangled path from the beginning to the end, in which much will be demanded from insurance companies and

State Net Capitol Journal: Iowa Governor Issues Alternative to Medicaid Expansion

StateNet@placeholder.com (State Net) — Wed, 13 Mar 2013 16:56:00 -0400

Iowa Gov. Terry Branstad (R) last week unveiled an alternative to expanding Medicaid in the Hawkeye State. Under federal health care reform, states are given the option of expanding their Medicaid eligibility to cover people living at up to 138 percent of the federal poverty line. In Iowa, that would add about 150,000 new enrollees into the system.

But Branstad opposes the expansion. Last week, he instead proposed replacing the state's current health care program for poor adults - IowaCare - with a new one called the Healthy Iowa Plan that would cover only about 89,000 of those currently uninsured Iowans. IowaCare currently covers around 67,000 people. Enrollees would pay a small premium and get care at specific clinics, which he said would be paid to

LexisNexis Presents Free CLE-Accredited* Webinar: The Patient Protection & Affordable Care Act - An ObamaCare Overview & Outlook for In-House Counsel

FC-RealEstate@placeholder.com (LexisNexis Emerging Issues Law Community Staff) — Mon, 25 Feb 2013 17:04:00 -0400

Proposed rules available. Document #31-130206-022X.)

Proposed Rules

Regulations contained in the PPACA require that employee health insurance plans include no-cost sharing coverage for contraception and sterilization

Supreme Court Denies Injunction Pending Appellate Review Of Birth Control Issue

cheryl.Keely@lexisnexis.com (Cheryl Keely) — Wed, 02 Jan 2013 16:24:00 -0400

WASHINGTON, D.C. - (Mealey's) In an in-chambers order, the U.S. Supreme Court on Dec. 26 denied a request for an injunction pending appellate review of a lower court's decision rejecting a preliminary injunction to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12A644, U.S. Sup.; 2012 U.S. LEXIS 9594).

(Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, Secretary of Health and Human Services, et al., No. 12A644, U.S Sup.).

Ruling on an application for an injunction filed before her as circuit justice for the 10^th Circuit, Justice Sotomayor said Hobby Lobby Stores Inc., Mardel Inc. and five family members who indirectly own and control those corporations do not qualify for a court order against the mandate while they challenge the requirement in court

U.S. Supreme Court Orders 4th Circuit To Reconsider Health Care Act Challenge

cheryl.Keely@lexisnexis.com (Cheryl Keely) — Mon, 26 Nov 2012 17:45:00 -0400

WASHINGTON, D.C. - (Mealey's) The U.S. Supreme Court on Nov. 26 revived a Christian university's challenge to the Patient Protection and Affordable Care Act (PPACA) when it ordered the Fourth Circuit U.S. Court of Appeals to review the case in light of the high court's ruling in a similar challenge earlier this year (Liberty University, et al. v. Timothy Geithner, et al., No. 11-438, U.S. Sup.).

Certiorari Denied

The Supreme Court on June 29 denied without comment a petition for writ of certiorari in Liberty University, et al. v. Timothy Geithner, et al. (No 11-438, U.S. Sup.). In lawsuit, filed in the U.S. District Court for the Southern District of Illinois, argues that the HHS mandate violates constitutional and statutory rights by requiring the company to purchase health insurance for employees that includes coverage for contraceptives, sterilization, and abortion-inducing drugs.

Company strengthens its advanced analytics, health care offering with end-to-end solution
LexisNexis® Risk Solutions on Sept. 5 announced it has acquired EDIWatch, Inc., a privately-held leading provider of fraud, waste and abuse (FWA) technology solutions exclusively for the health care payer industry.

federal district court ruling that a wellness program instituted by Broward County, Florida, does not violate the general prohibition under the Americans with Disabilities Act against non-voluntary medical examinations and inquiries that are not job-related.

In Seff v. Broward County Florida, the court determined that the wellness program qualified for an ADA safe harbor that applies to a bona fide employee benefit arrangement, the terms of which are based on underwriting risks, classifying

Fulbright & Jaworski: "GAO Issues Report Estimating PPACA Effect on Employer-Sponsored Health Coverage"

FulbrightandJaworski@placeholder.com (Fulbright and Jaworski L.L.P. ) — Fri, 24 Aug 2012 12:26:00 -0400

Mark Faccenda

On August 13, 2012, the U.S. Government Accountability Office ("GAO") issued a report in which it determined that the Patient Protection and Affordable Care Act's ("PPACA") immediate effect on employer-sponsored healthcare coverage would be minimal. Report GAO-12-768, entitled Estimates of the Effect on the Prevalence of Employer-Sponsored Health Coverage, estimated a two-year change " rang[ing] from a net decrease of 2.5 percent to a net increase of 2.7 percent in the total number of individuals with employer-sponsored coverage . . . affecting up to about 4 million individuals

Fulbright & Jaworski : "Telemedicine Amidst Healthcare Reform: Avoiding Legal Pitfalls"

FulbrightandJaworski@placeholder.com (Fulbright and Jaworski L.L.P. ) — Thu, 23 Aug 2012 20:26:00 -0400

By Mark Anthony Kadzielski, Kristina Pervi Ayers and Jee-Young Kim

The United States Supreme Court's recent decision upholding the Patient Protection and Affordable

Williams Mullen Alert: Health Care Reform Outlook

WilliamsMullen@placeholder.com (Williams Mullen) — Fri, 17 Aug 2012 13:47:00 -0400

By Brydon M. DeWitt and Michael J. Ferrell

With the Supreme Court's landmark decision upholding the Affordable Care Act, employers have a renewed interest in what the Act will mean for their businesses in the years ahead. Employers need to be aware of the possible political outcome as they continue to make sure their plans are in compliance.

Political Aspects of the Supreme Court Ruling on Health Care

The political reaction to the Court's majority decision has been swift and predictable. No sooner had the court ruled than both sides of the political aisle began plotting their next moves. Proponents immediately vowed to vigorously defend and implement the Act expeditiously. Meanwhile, opponents renewed

Cadwalader Client & Friends Memo: A 'Hat Trick' of Heightened False Claims Act Risks for Health Care Providers

Cadwalader@placeholder.com (Cadwalader, Wickersham & Taft LLP) — Tue, 14 Aug 2012 17:15:00 -0400

Introduction

At the risk of stating the obvious, fighting and prosecuting health care fraud are top priorities for the Federal Government, and the False Claims Act ("FCA") is its weapon of choice in the battle. In a speech in June, Stuart Delery, the Acting Assistant Attorney General for the Department of Justice ("DOJ") Civil Division, stated the DOJ has recovered over $11 billion under the FCA, including over $7.4 billion in health care fraud.2 The Federal Government has a willing and motivated ally: more than 630 qui tam matters were filed with the DOJ, over two-thirds of which allege false claims to government health care programs.3 These numbers represent the greatest number of lawsuits ever filed within a year in the 150-plus year

Colorado Federal Judge Grants Preliminary Injunction In Contraception Mandate Case

cheryl.Keely@lexisnexis.com (Cheryl Keely) — Mon, 30 Jul 2012 12:36:00 -0400

DENVER - (Mealey's) A Colorado federal judge on July 27 granted a preliminary injunction in favor of a for-profit secular employer that will prevent the federal government from enforcing a mandate contained in the Patient Protection and Affordable Care Act (PPACA) that requires most employers to provide birth control coverage as part of their employee health plans (William Newland, et al. v. Kathleen Sebelius, in her official capacity as Secretary of the United States Department of Health and Human Services, et al., No. 12-12-1123, D. Colo.; 2012 U.S. Dist. LEXIS 104835).

(Opinion available. Document #31-120801-017Z.)

Emerging Issues Law Community Spotlight on Health Care Reform