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Study Finds States With Expanded Medicaid Experiencing Bump In ER Volume

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...

Norton Rose Fulbright: CMS Offers Settlement Of Inpatient RAC Denials

By Mark Faccenda On August 29, 2014, the Centers for Medicare and Medicaid Services (“ CMS ”) announced that certain providers with pending appeals of specified inpatient-status claims denied by Medicare contractors may elect to receive partial payment on those claims in exchange for the...

State Net Capitol Journal: California Ponders Health Insurance Rate Regulation

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...

Government Tells High Court ACA Language Supports Broad Tax Subsidy Availability

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...

DLA Piper: Healthcare Industry Compliance In A Shifting World: Putting It All Together

By: Frank E. Sheeder , Karen Nelson and Keri L. Tonn Health industry clients face regulatory and enforcement challenges on multiple fronts. It can be difficult to prioritize and allocate resources properly when government agencies’ initiatives are constantly shifting. The first, fundamental...

U.S. High Court Agrees To Decide Availability Of Subsidies In State Insurance Exchanges

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...

Ballard Spahr LLP: Student Employees Under The Affordable Care Act's Employer Mandate

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...

DLA Piper: Binding Arbitration in Managed Care Contracts - 6 Tips to Tailor Your Dispute Resolution Provisions

By Stephen L. Goff and John Barnes The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare providers and managed care payers, in terms...

DLA Piper: Government Turns Up the Heat With the False Claims Act – 5 Action Steps for Healthcare Providers

By Savaria B. Harris and Mitka T. Baker Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. Just last month, the Health...

State Net Capitol Journal: States Leave Partisan Fold On Health Care And The Minimum Wage

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...

U.S. Supreme Court Hears Arguments Over ACA Federal Exchange Subsidy Availability

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...

Top Court Cites Hobby Lobby In Vacating, Remanding ACA Accommodation Ruling

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...

7th Circuit Rejects Preliminary Injunction In ACA Opt-Out Challenge

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...

Ballard Spahr LLP: New Guidance on Affordable Care Act Reporting Requirements

By Edward I. Leeds The Internal Revenue Service has issued two lengthy sets of questions and answers on the requirement under the Affordable Care Act that employers report on their compliance with the employer mandate and employees' qualification for exchange subsidies. The new guidance is divided...

DLA Piper Health Systems Alert: MACRA: 3 Compliance Implications For Medicare Providers

By: Karen Nelson Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the Act also includes certain Medicare program integrity provisions...

Top Court Rejects Maine’s Challenge To ACA ‘Maintenance Of Effort’ Rule

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...

High Court Affirms Availability Of Tax Credits In ACA Federal Exchange

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...

Williams Mullen: Supreme Court Upholds ACA Premium Assistance Nationwide

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...

DLA Piper: Supreme Court Upholds ACA Subsidies

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 ...

DLA Piper Health Systems Alert: U.S. Health Care Payment-Driven Transformation Ahead

By David Gruber, MD, MBA* | Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...

DLA Piper Health Systems Alert: Payment-Driven Transformation Ahead For U.S. Healthcare

By David Gruber, MD, MBA* Healthcare spending is forecast to increase from US$3 trillion in 2014 to US$5.2 trillion in 2023, reflecting a compound annual growth rate of 5.9 percent. US healthcare expenditures on a per capita basis are 1.9-2.6 times the amount spent by other developed nations despite...

Barnes & Thornburg LLP: Illinois Becomes 11th State To Join Interstate Medical Licensure Compact

By Serj Mooradian On July 20, Illinois Governor Bruce Rauner signed HB 3680 , the Interstate Medical Licensure Compact Act, making Illinois the eleventh state to sign on to the Interstate Medical Licensure Compact (the Compact). Illinois follows Alabama, Idaho, Iowa, Minnesota, Montana, Nevada...

Cadwalader: Federal Court Upholds Provider Mandate to Report and Return Medicare and Medicaid Overpayments in 60 Days

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...

DLA Piper LLP: Federal Court Sides With Government In First Interpretation Of ACA’s 60-day False Claims Act Rule

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...