The Opportunities and Challenges of Freestanding Emergency Departments

Following our blog post regarding the retail clinic movement, “Patient Check-Ups Before Checking Out: Partnering to Bring Health Care into the ‘One-Stop Shopping’ Sector” (April 19, 2017), we continue our examination of alternative healthcare providers by examining the regulatory landscape that shapes the opportunities and challenges of freestanding emergency departments (“FSEDs”). Continue Reading

ACA Cost-Sharing Reductions: An Uncertain Future

“Cost-sharing reductions” (CSRs) are one of the primary mechanisms under the Affordable Care Act (ACA) to make health coverage affordable for consumers. CSRs are government payments to insurance companies for the purpose of reducing out-of-pocket costs (e.g., copayments and deductibles) for individuals who purchase insurance coverage through the healthcare exchanges established under the ACA. In 2016, over half of ACA exchange enrollees benefited in some manner from CSRs, for which the government paid out over $7 billion. Continue Reading

Part VI: An Update on the American Health Care Act

In Part V of our blog series, Very Opaque to Slightly Transparent: Shedding Light on the Future of Healthcare, we outlined some of the key provisions of the American Health Care Act (AHCA). Roughly two weeks after our post was published, GOP congressional leadership pulled the legislation from a floor vote, recognizing that the bill did not have sufficient support to pass in the U.S. House of Representatives. Nevertheless they persisted, and an amendment to the legislation negotiated in substantial part by Representatives Tom MacArthur and Mark Meadows injected new life into the AHCA. The so-called “MacArthur Amendment” sought to bridge the gap between conservative Republican members of the House Freedom Caucus and more moderate GOP members of the House, and an additional amendment – the “Upton Amendment” – helped seal the deal. With those two amendments attached, the bill narrowly cleared the House on a party-line vote (albeit with some GOP defectors), 217-213. Continue Reading

The Financial Impact of MACRA – Uncertainty Reigns in a Recent RAND Corporation Study

With all the talk of the Affordable Care Act’s uncertain future, it is easy to forget about the Medicare Access and CHIP Reauthorization Act (“MACRA”), a bipartisan law passed by Congress in 2015 to change the way physicians will be reimbursed by Medicare. MACRA is a complex and confusing law. A new study published by Health Affairs in April 2017, which used the RAND Corporation’s Health Care Payment and Delivery Simulation Model (the “Study”), has estimated the potential effects of MACRA payment models on physician and hospital Medicare reimbursement revenue. The results: uncertain. Continue Reading

Has the Acquisition of Cigna Corp. by Anthem, Inc. Been Relegated to the Dustbin of History? Stay Tuned!

On April 28, 2017, the U.S. Court of Appeals for the D.C. Circuit upheld a February 8, 2017 decision by the U.S. District Court for the District of Columbia to block the $54 billion acquisition of Cigna Corp. by Anthem, Inc.. U.S. et al. v. Anthem Inc. et al., case number 17-5024, U.S. Court of Appeals for the District of Columbia Circuit. Continue Reading

CEO of Molina Healthcare Discusses Implications of Cuts to Affordable Care Act

Dr. Mario Molina, CEO of Molina Healthcare, discusses the implications of potential cuts to cost sharing reduction payments under the Affordable Care Act by the Trump Administration.  Cost sharing reduction payments are viewed by many as essential in the provision of healthcare to low income individuals as they help to reduce co-pays and deductibles that may otherwise be out of reach for many.  Dr. Molina distills the issue into lay terms and provides some insight into the future of the government’s involvement in the healthcare markets under the new administration. Continue Reading

CY 2018 Medicare Advantage Final Call Letter

Sheppard Mullin continues to see a lot of interest in the Medicare Advantage (MA) marketplace from our managed care payor clients, as well as our health system clients, many of whom are well-positioned to enter this space as provider sponsored health plans. Continue Reading

A $31,000 Mistake: Failing To Manage Business Associate Agreements Proves Costly For Providers

The Center for Children’s Digestive Health (CCDH), a small, for-profit pediatric subspecialty practice that operates seven clinics in the Chicago area, has paid the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) $31,000 to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Continue Reading

Final Market Stabilization Rules – How Stable is Stable?

The Department of Health and Human Services released the final Affordable Care Act marketplace stabilization rules (“Final Rule”) on April 13, 2017. The Final Rules become effective on June 19, 2017 and will, accordingly, apply to the 2018 state and federal Affordable Care Act health insurance exchanges. The Final Rule is available here. Continue Reading

Patient Check-Ups Before Checking Out: Partnering to Bring Health Care into the “One-Stop Shopping” Sector

Retail clinics—the popular term for walk-in clinics located in pharmacies, supermarkets, and “big-box” stores—are playing an expanding role in the health care market. According to a study published by the New England Journal of Medicine, over 2,000 retail clinics were operating in the U.S. as of 2015.[1] Major players, such as CVS Health’s MinuteClinic, Walgreens’ Healthcare Clinics, and Kroger’s Little Clinic, are continuing to grow and adapt their strategy. Continue Reading

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