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State insurance commissioners approve final regulation on Medical Loss Ratios

King & Spalding LLP
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USA
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November 1 2010

On October 27, 2010, the National Association of Insurance Commissioners (NAIC), an organization of state insurance commissioners, issued their Medical Loss Ratio Regulation (MLR Regulation) as required by the Patient Protection and Affordable Care Act (PPACA

Supreme Court rules safety net hospital cannot sue under 340b agreements

King & Spalding LLP
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USA
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April 4 2011

On March 29, the Supreme Court issued a unanimous opinion written by Justice Ruth Bader Ginsburg, which would prevent clinics and hospitals participating in the 340B prescription drug rebate program (340B Program) from suing drugmakers who overcharged such hospitals for prescription drugs

AHA files amicus brief in support of Tuomey Healthcare System

King & Spalding LLP
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USA
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January 18 2011

On January 10, 2011, the American Hospital Association (AHA) filed an amicus curiae brief in the Fourth Circuit Court of Appeals (the Fourth Circuit) in support of Tuomey Healthcare System, Inc. (Tuomey) in its defense against government allegations of False Claims Act (FCA) and Stark Law violations

CMS announces three demonstration projects to reduce improper payments

King & Spalding LLP
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USA
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November 21 2011

On November 15, 2011, the Centers for Medicare and Medicaid Services (CMS) announced that it would launch three new demonstration projects starting January 1, 2012 targeted towards the reduction of improper payments from Medicare and Medicaid

IRS issues request for comments delaying enforcement of nondiscrimination rules for insured health plans

King & Spalding LLP
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USA
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February 21 2011

The Internal Revenue Service (IRS) has issued IRS Notice 2011-1 delaying the enforcement of the nondiscrimination provisions of the Patient Protection and Affordable Care Act (PPACA) against insured group health plans until the IRS, Department of Labor (DOL), and Department of Health and Human Services (HHS) are able to publish guidance regarding the new rules

HHS announces CLASS Act will not be implemented

King & Spalding LLP
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USA
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October 17 2011

On October 14, Kathleen Sebelius, the Secretary of the U.S. Department of Health and Human Services (HHS), announced in a letter to Congressional leaders that HHS had decided that the agency would not implement the Community Living Assistance Services and Supports Act, or CLASS Act, a key portion of the Affordable Care Act

Federal agencies release proposed regulations for health plan information summaries

King & Spalding LLP
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USA
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August 22 2011

On August 22, 2011, the Department of Health and Human Services (HHS) , the Department of Labor (DOL), and the Department of the Treasury (DOT) (collectively, the Agencies) issued proposed regulations under the Patient Protection and Affordable Care Act (PPACA) governing disclosures of information about group and individual health plans mandated by section 2715 of the Public Health Service Act (PHS Act), which was added by PPACA

President proposes health savings as part of deficit reduction plan

King & Spalding LLP
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USA
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September 26 2011

On September 19, 2011, President Obama announced proposals to create more than $320 billion in health savings over the next 10 years as part of the White House’s deficit reduction plan entitled “Living Within Our Means and Investing in the Future” (the President’s Plan

CMS and Center for American Progress release bundled payment report

King & Spalding LLP
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USA
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July 25 2011

On July 18, the Center for American Progress issued a report sponsored by CMS entitled “Bundling” Payment for Episodes of Hospital Care (CAP Report), which contained recommendations for bundled payment pilot programs to be initiated by CMS in the near future

CBO study concludes Medicare demonstration projects do not result in savings

King & Spalding LLP
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USA
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January 23 2012

On January 18, the Congressional Budget Office issued its report entitled “Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment”