On Sept. 9, 2015, the New York City Board of Health unanimously passed regulations making New York the first U.S. city to require restaurants to disclose to diners those menu items that contain more than 2,300 milligrams of sodium, or the equivalent of about one teaspoon of salt. Under the newly-adopted regulations, all chain restaurants — defined as those having 15 or more locations nationwide — must add...

By Anne Compton-Brown | President Obama’s signature healthcare legislation will likely force two more significant legal hurdles after decisions this month that attack peripheral but important portions of the Affordable Care Act (ACA). On Sept. 17, 2015, the United States Court of Appeals for the Eighth Circuit held in two separate opinions that the ACA’s accommodation for nonprofit religious organizations...

By Ruth Levy & Patrick C. Devine, Jr. | The Patient Protection and Affordable Care Act (“PPACA”) established that any person who receives an overpayment from the Medicare or Medicaid programs and who does not report and return the overpayment within 60 days after it is identified will be subject to potential False Claims Act (“FCA”) liability. [1] This is known as the “60-day rule...

By Jessica Talati On August 3, Judge Edgardo Ramos of the Southern District of New York denied hospital defendants’ motions to dismiss in United States ex rel. Kane v. Healthfirst, Inc., et al . , No. 11 CIV 2325 (S.D.N.Y. Aug. 3, 2015), keeping alive a much-followed whistleblower case accusing several New York hospitals of violating the FCA by failing to report and return “identified” overpayments...

By Adam J. Rogers , Bradley M. Smyer and Karen Nelson | In a significant development for healthcare providers, a federal court in New York has adopted the government’s interpretation of the 2010 Patient Protection and Affordable Care Act’s (ACA’s) so-called 60-day rule, which governs when an “identified” overpayment must be repaid to the government before it becomes subject to federal...

Introduction | The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed care organizations that were overpaid by the Medicare or Medicaid program to report and return the overpayment within 60 days of the date when the overpayment...

By Anne Pachciarek and Rita M. Patel | On June 25, the US Supreme Court issued a 6-3 opinion in King v. Burwell upholding the Affordable Care Act’s subsidy scheme [ enhanced opinion available to lexis.com subscribers ] [lexis.com subscribers may access Supreme Court briefs for this case ] . In its decision, the Court held that taxpayers who purchase coverage on any exchange created under the ACA, including...

By: Brydon M. DeWitt This morning [June 25], the Supreme Court ruled that Affordable Care Act (ACA) premium tax credits will remain available to individuals residing in states that did not establish their own health insurance marketplaces. In King v. Burwell , the Supreme Court analyzed ACA statutory language providing that premium assistance is available to individuals purchasing coverage through health insurance...

WASHINGTON, D.C. — (Mealey’s) The Patient Protection and Affordable Care Act (ACA)’s structure suggests the availability of tax subsidies in the federal exchange, and Congress could not have intended the state insurance market “death spirals” likely to result from barring such subsidies, a divided U.S. Supreme Court held June 25 ( David King, et al. v. Sylvia Mathew Burwell, et al. , No....

WASHINGTON, D.C. — (Mealey’s) The Supreme Court on June 8 denied the State of Maine’s petition challenging mandatory continued Medicaid coverage for older children under the Patient Protection and Affordable Care Act’s maintenance of effort requirements, according to the docket ( Mary C. Mayhew, in her capacity as Secretary of the Maine Department of Health and Human Services v. Sylvia M. Burwell...

CHICAGO — (Mealey’s) Notre Dame is not entitled to a preliminary injunction while it challenges the opt-out provision of the Patient Protection and Affordable Care Act (ACA)’s contraceptive mandate, a divided Seventh Circuit U.S. Court of Appeals held May 19 ( University of Notre Dame v. Kathleen Sebelius, et al. , No. 13-3853, 7th Cir.). ( Opinion available. Document #93-150527-013Z. ) While Notre...

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on April 27 granted two Catholic groups’ petition for certiorari and vacated a Sixth Circuit U.S. Court of Appeals ruling that the Patient Protection and Affordable Care Act’s contraceptive mandate did not substantially burden religious beliefs. The court remanded the case for further consideration in light of Burwell v. Hobby Lobby Stores Inc...

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on March 9 vacated a Seventh Circuit U.S. Court of Appeals opinion that denied the University of Notre Dame an injunction in its challenge to the Patient Protection and Affordable Care Act (ACA) accommodation process and remanded the case for consideration in light of Burwell v. Hobby Lobby Stores, Inc. ( University of Notre Dame v. Sylvia Burwell, et al...

WASHINGTON, D.C. — (Mealey’s) Both sides faced critical questioning from Justice Anthony Kennedy during oral arguments March 4 in the case challenging the availability of subsidies in the Patient Protection and Affordable Care Act (ACA) federal exchange ( David King, et al. v. Sylvia Mathew Burwell, et al. , No. 14-114, U.S. Sup. [lexis.com subscribers may access Supreme Court briefs for this case ] ). ...

By Lou Cannon As the nation's capital resumes its customary political gridlock, both political parties are turning to the states to advance national agendas. In the process of doing so, however, they are finding that they are far from united within their own ranks. Republicans in Washington want states to help them limit the Affordable Care Act (ACA), the singular achievement of President Obama. Many in the GOP...

By Edward I. Leeds and Daniel V. Johns Effective January 1, 2015, colleges and universities will need to comply with the employer mandate under the Affordable Care Act, which will have particular implications involving certain student employees. The employer mandate requires large employers (defined as 50 or more full-time employees or full-time equivalents) to offer health coverage that meets certain mandate, an employee...

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on Nov. 7 agreed to decide whether the Patient Protection and Affordable Care Act (ACA) authorizes tax subsidies for individuals who enroll in insurance through state exchanges ( David King, et al. v. Sylvia Mathew Burwell, et al. , No. 14-114, U.S. Sup.). ( Order available. Document #93-141126-008R. ) The case was originally distributed for conference...

WASHINGTON, D.C. — (Mealey’s) No conflict among courts exists regarding the availability of tax credits for individuals obtaining insurance through federal exchanges, an outcome supported by the language and structure of the Patient Protection and Affordable Care Act (ACA), the government told the U.S. Supreme Court Oct. 3 ( David King, et al. v. Sylvia Mathew Burwell, et al. , No. 14-114, U.S. Sup.). ...

By Rich Ehisen | Note: On Nov. 4, 46 states will hold legislative elections, while 36 will elect or retain a governor. Meanwhile, 41 states will also weigh in on a wide range of ballot measures addressing some of the most controversial issues of the year, including abortion, marijuana use and the minimum wage. Over the next several weeks the SNCJ staff will preview some of what voters face on Election Day, with specific...

GREENWOOD VILLAGE, Colo. — (Mealey’s) States with expanded Medicaid under the Patient Protection and Affordable Care Act (ACA) saw a threefold increase in emergency-department visits over nonexpansion states in the second quarter of 2014, according to a Sept. 8 study. (This story is an excerpt from Mealey's Affordable Care Act Report. For information on how to subscribe to this new monthly report, please...

WASHINGTON, D.C. — (Mealey’s) The District of Columbia Circuit U.S. Court of Appeals granted en banc review on Sept. 4 of a decision finding that the Patient Protection and Affordable Care Act (ACA) provides tax credits only for individuals who enrolled through state-created exchanges ( Jacqueline Halbig, et al. v. Sylvia M. Burwell, et al. , No. 14-5018, D.C. Cir.) [an enhanced version of the opinion appealed...

WASHINGTON, D.C. — (Mealey’s) Eligible employers opposed to Patient Protection and Affordable Care Act (ACA) provisions mandating insurance coverage for contraceptives may notify the U.S. Department of Health and Human Services (HHS), which will in turn notify the employer’s insurer under a new rule issued by the government Aug. 22. (This story is an excerpt from Mealey's Affordable Care Act Report...

By Jean Hemphill and Brian Pinheiro In response to the recent U.S. Supreme Court decision in Burwell v. Hobby Lobby, Inc., [ enhanced opinion available to lexis.com subscribers ], the U.S. Departments of Health and Human Services (HHS) and Labor (DOL) published proposed rules on August 22, 2014, expanding the availability of the religious accommodation to the contraceptive mandate provided in their July 2013 final...

The looming implementation of another round of employer mandates under the Affordable Care Act (ACA) has business leaders scrambling for help from legal counsel and other advisors. This flurry of activity is prudent; compliance with ACA is a matter of federal law and many penalties for failure to comply are severe. Employers who do not meet their implementation responsibilities face potential company fines of up to $3...

INDIANAPOLIS — (Mealey’s) A state and 39 school districts challenging the legality of payments imposed on large employers under the Internal Revenue Services’ implementation and interpretation of Patient Protection and Affordable Care Act (ACA) regulations allege an addressable injury in fact, an Indiana federal judge held Aug. 12 ( State of Indiana v. Internal Revenue Service, et al. , 13-1612, S.D...