Category Archives: Patient Protection and Affordable Care Act

Subscribe to Patient Protection and Affordable Care Act RSS Feed

California Insurance Commissioner Issues Emergency Regulations Affecting Narrow Provider Networks

On January 5, 2015, Commissioner Dave Jones issued emergency regulations affecting health insurers with respect to access to provider networks in response to consumer complaints that appointments with physicians are hard to obtain, that in-network care is far away, and that in-network provider directories are inaccurate.… Continue Reading

Preparing for the Affordable Care Act Employer Mandate

As of January 1, 2015, the Patient Protection and Affordable Care Act (ACA-otherwise known as Obamacare) begins to impose certain health coverage requirements on employers who have at least 50 employees. Even though its implications are almost one year away, it is not too soon for employers to prepare for the Employer Mandate. Employers would … Continue Reading

SB 804 Requires California Local Health Care Districts To Obtain Fair Market Value Appraisals In Certain Asset Transfers

New amendments to California’s local health care district law require districts to obtain a fair market value appraisal if the district transfers fifty percent or more of its assets (in sum or by increment) to one or more nonprofit corporations for less than fair market value, and disclose the fair market value of such assets … Continue Reading

Payment Safeguards for Provider Managed Care Arrangements

By Karie Rego As California transitions faster than other parts of the country into more and more managed care payment arrangements, the challenges and pitfalls related to payment increase. Thus, providers must identify risks and implement safeguards to protect payments. New coding issues can require additional attention. Even though in some ways coding is simpler … Continue Reading

Levels of Antitrust Scrutiny for ACOs

The Department of Justice and Federal Trade Commission recently proposed new guidelines regarding antitrust enforcement of accountable care organizations — the new health care delivery model mandated by the 2010 Patient Protection and Affordable Care Act (PPACA) pursuant to its “shared savings program.” This statement was issued in conjunction with the Department of Health and … Continue Reading

California’s Department of Managed Health Care Announces ACOs Should Expect Licensure Requirement

By Lynsey Mitchel The California Department of Managed Health Care (“DMHC”) is currently considering the regulatory landscape for Accountable Care Organizations (“ACOs”) in California. At a public meeting on January 19, 2011, the DMHC announced it will most likely require ACOs to be licensed. ACOs, created by a provision in the healthcare reform law, encourage … Continue Reading

CMS Releases Self-Referral Disclosure Protocol for Stark Violations

By Ken Yood and Lynsey Mitchel On September 23, 2010, the Centers for Medicare and Medicaid Services ("CMS") released its Voluntary Self-Referral Disclosure Protocol ("SRDP") that healthcare providers and suppliers can use to disclose violations of the physician self-referral statute or Stark Law (Section 1877 of the Social Security Act). The protocol potentially offers promising incentives for … Continue Reading

New Healthcare Law Requires Financial Disclosures By Referring Physicians

By Courtney Mathes The new healthcare laws signed by President Obama on March 23rd and 30th, and specifically the Patient Protection and Affordable Care Act (PPACA), includes a significant modification to the "in-office ancillary services" exception of the Stark Law.  Physicians who refer patients for MRI, CT or PET services, to an entity in which … Continue Reading