The New Health Care Law Reform Bill & PPACA | Foster Swift

Happy Holidays!

Wed, 24 Dec 2014 09:00:01 -0500

Thank you so much for checking out the Foster Swift Health Care Law Blog. We are taking a short break from posting and look forward to providing you the latest news and information in 2015. Happy Holidays!

Reimbursing Individual Health Insurance Policy Premiums May Result in Significant Penalties for Employers

Mindi M. Johnson — Thu, 18 Dec 2014 09:00:02 -0500

Employers, including municipal employers, have historically struggled to develop a health insurance benefit program for their employees that provides quality benefits and is cost-effective. After the Health Insurance Marketplace opened for business, many employers recommended that their employees use it to purchase individual health insurance policies, with the promise that the premium costs would be reimbursed by the employer. In fact, such employee reimbursement strategies were aggressively marketed to employers as a solution to reduce costs and comply with the requirements of the Patient Protection and Affordable Care Act (“ACA”). Little did these employers (and marketers) know, such arrangements exposed the employers to significant penalties under the ACA.

In September 2013, the IRS issued Notice 2013-54 that made clear that an employer arrangement that paid for employees’ individual health insurance policy premiums on a pre-tax basis violated the ACA. An employer that offered such an arrangement would be subject to a $100 per day per affected employee penalty ($36,500 per year, per employee).

U.S. Supreme Court will hear ACA subsidies case

Mindi M. Johnson — Wed, 19 Nov 2014 09:00:03 -0500

On Nov. 7, the U.S. Supreme Court decided it would hear a case concerning the health insurance subsidies provided to millions of Americans under the Patient Protection and Affordable Care Act. A June 2015 decision is expected in the case of King v. Burwell, which challenges the Internal Revenue Service’s authority to regulate tax-credit subsidies for coverage purchased through health insurance marketplaces established by the federal government (such as the Michigan health insurance marketplace). Nationwide, more than four out of five people who have received coverage through a federal marketplace are getting a tax credit.

"Right to Try" Becomes a Reality in Michigan

Jennifer B. Van Regenmorter, Julie LaVille Hamlet — Thu, 13 Nov 2014 09:00:04 -0500

On Friday, October 17, Governor Rick Snyder signed the Right to Try Act, which allows patients to try experimental drugs and other treatments before they have been approved by the Food and Drug Administration (FDA). The law gives patients with advanced illnesses access to drugs that successfully cleared Phase 1 of an FDA approval. Phase 1 testing seeks to establish a drug's safety and profile and evaluates possible side effects. It involves 20-80 volunteers and lasts approximately one year.

PPACA's Employer Mandate Draws Near…Non-Calendar Plans Beware!

Mindi M. Johnson — Wed, 05 Nov 2014 09:00:05 -0500

As is well known by now, transitional relief from the Patient Protection and Affordable Care Act's Employer Mandate in 2015 is available for certain applicable large employers that sponsor non-calendar year health plans. This transitional relief allows the employer to avoid penalties for those months of 2015 that predate the first day of the non-calendar plan year. What is not so well-known, however, are the requirements that must be met in order for the employer to be entitled to receive the transitional relief.

HHS Addresses Treatment of Same-Sex Spouses Under HIPAA

Julie LaVille Hamlet — Tue, 28 Oct 2014 09:00:06 -0400

Last month, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) issued guidance addressing the treatment of same-sex spouses under the HIPAA Privacy Rule in light of the Supreme Court’s decision in United States v. Windsor.

In Windsor, the Supreme Court held Section 3 of the Defense of Marriage Act (“DOMA”) to be unconstitutional. Section 3 of DOMA had excluded same-sex marriages from recognition under federal law.

As a result of the Windsor ruling, legally married same-sex spouses are entitled to additional rights under several federal regulations, one of which is the HIPAA Privacy Rule ("Rule"). The Rule provides certain protections to family members of patients. In its guidance, OCR clarifies that legally married same-sex spouses are family members for the purposes of the Rule, regardless of where they live.

Pioneer ACO Results Present a Fuller Picture of the Program's Promise

Wed, 22 Oct 2014 09:00:07 -0400

Accountable Care Organizations (ACO) are still a relatively new concept in the healthcare world. ACOs emerged in 2011 as a result of an initiative by the Centers for Medicare & Medicaid Services (CMS), as we documented in our blog articles ACO Regulations Finally Released, Braving the New Frontier of Accountable Care Organizations, and Final ACO Regulations are Released - Is this the Beginning of a New Era for Health Care?

While what exactly is an ACO is still kind of nebulous, ACOs generally are groups of doctors, hospitals, and other health care providers, who voluntarily join forces for the purpose of providing coordinated care to Medicare patients. The goal of ACO’s coordinated care is to ensure that patients, especially the chronically ill, receive the correct care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. ACOs that achieve cost saving from providing timely and accurate care that meet quality benchmarks share in Medicare savings. Lofty and worthy goals, no doubt.

OIG Proposes Revisions to Anti-Kickback Safe Harbors, Beneficiary Inducement Rules, and Gainsharing Regulations

Julie LaVille Hamlet — Mon, 13 Oct 2014 09:00:08 -0400

On October 3, 2014, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a proposed rule to amend the safe harbors to the anti-kickback statute as well as the civil monetary penalty (CMP) rules. While much of the proposed rule codifies changes to the anti-kickback statute safe harbors already established by the Affordable Care Act (ACA) and Medicare Modernization Act of 2003 (MMA), it also proposes two new safe harbors and makes technical corrections to an existing safe harbor. The OIG also proposes to narrow the definition of "remuneration" in the Beneficiary Inducement CMP laws as well as codify and interpret the gainsharing CMP rules set forth in section 1128A(b) of the Social Security Act.

The proposed changes to the safe harbors and CMP laws would give providers greater flexibility to enter into beneficial arrangements with the assurance that they will not be subject to penalties under these laws. The proposed rule reflects the OIG's continued effort to adapt its regulations to the changing health care landscape.

For more details on these proposed changes, please visit our newsletter article, which provides an in-depth analysis of the proposed rule. If you have any questions on the proposed rule and how you are affected, please contact an attorney in our Health Care Practice Group.

Julie C. LaVille authored this article as a Law Clerk.

How Technology is Transforming Healthcare

Julie LaVille Hamlet — Thu, 02 Oct 2014 09:00:09 -0400

While the healthcare industry has historically been knocked as slow to adapt to emerging technologies, the technological modernization of the industry is now occurring at a furious pace. From the digitization of health care records, to improved means of communications between doctors and patients, technology is transforming healthcare.

Tech behemoths like IBM, as well as scrappy Silicon Valley startups, have recognized the potential and are pouring resources into healthcare IT. According to data from investment company Rock Health, venture capital funding to healthcare information technology companies for 2014 reached $2.3 billion as of mid-year 2014. That's more than 10 times the nearly $200 million that was invested in healthcare IT in 2007.

One of the healthcare industry's newest tech innovations, called Figure 1, is the brainchild of a doctor named Josh Landy. Figure 1 is an Instagram-style app that allows doctors to share photos of patient conditions with other medical professionals in order to get their opinions regarding diagnosis and treatment.

Hackers Declare War on Health Care and Industry Fights Back

Nicholas M. Oertel — Wed, 24 Sep 2014 09:00:10 -0400

"It's a war we're in." That's how John Halamka, the chief information officer of Boston-based Beth Israel Deaconess Medical Center, described the current state of affairs between the health care industry and the hackers and identity thieves who are trying to steal patient records.

A recent Boston Globe article detailed the threat and provided some interesting - and sobering - statistics and information:

There is high demand for health records, and a single health record may be worth $50 according to the FBI
Criminal intrusions into health care systems have risen 100 percent in the past four years
Of 614 total identity theft breaches in 2013, 269 (43.8 percent) were in health care (the most of any industry)
Despite being the subject of the most attacks, a recent study by BitSight Technologies found that health care providers are the slowest in any industry to respond to data breaches.

Hackers are motivated to target health records in order to facilitate identity theft, financial fraud and illegal drug use. The Boston Globe article, in particular, highlighted two recent incidents involving cyber-security breaches: (1) Chinese hackers seized the personal information of 4.5 million patients at a Tennessee-based hospital network, and (2) federal officials disclosed on September 4 that a hacker managed to install malicious software on HealthCare.gov.