Showing 103 posts in Health Care Reform.
And Then There Was One: Economic Pressures Squeeze Metro Detroit Hospitals into Consolidation
Reduced reimbursements. A shift toward global payment. A demand for integration, quality of care and medical specializations. In order to compete amidst today’s healthcare market pressures, independent hospitals in Michigan and around the nation are increasingly deciding that they cannot go it alone. A recent Detroit News article reveals how this trend is playing out in Metro Detroit, with one of the region’s last two independent hospitals poised for acquisition.
Observers of Detroit’s healthcare environment are reportedly not surprised by the news that Crittenton Hospital Medical Center has signed a letter of intent to join St. Louis-based Ascension Health, the largest Catholic and nonprofit health system in the nation. With Monroe-based Mercy Memorial Hospital announcing on January 6 that it is joining the ProMedica health care company, the Crittenton deal will leave Doctors’ Hospital in Pontiac as the region’s last remaining independent hospital.
Laura Wotruba, spokeswoman for the Michigan Health and Hospital Association, said that this is not a Michigan issue, but rather a widespread pattern. “[It is] a national trend [and] something we’ve been seeing around the country.” Read More ›
Categories: Electronic Health Records, Health Care Reform, HIPAA, HITECH Act, Hospitals, News & Events, Regulatory
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Reimbursing Individual Health Insurance Policy Premiums May Result in Significant Penalties for Employers
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).
Categories: Employee Benefits, Health Care Reform, Health Insurance Exchange
U.S. Supreme Court will hear ACA subsidies case
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. Read More ›
Categories: Health Care Reform, Health Insurance Exchange, Tax
PPACA's Employer Mandate Draws Near…Non-Calendar Plans Beware!
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. Read More ›
Categories: Compliance, Employee Benefits, Health Care Reform, Providers
CMS Proposed Rule Affecting Home Health Agencies
The Centers for Medicare & Medicaid Services ("CMS") recently
announced proposed changes to the Medicare home health prospective payment
system (“PPS”) for the 2015 calendar year. CMS is proposing to tighten eligibility
requirements for home health services
and set a minimum requirement on Home Health Agencies ("HHAs") to
prove their effectiveness, as well as revise how much CMS will pay for certain
services. These proposed changes are expected to reduce Medicare payments to
HHAs by $58 million next year alone, a reduction of .30 percent.
To qualify for the Medicare home health benefit, a beneficiary must be under the care of a physician, have a need for skilled nursing care, physical therapy, speech-language pathology, or continued need for occupational therapy. Further, the beneficiary must be homebound and receive home health services from a Medicare approved agency.
The proposed changes include the following: Read More ›
Categories: Health Care Reform, Medicare/Medicaid
HHS Report Reveals That Many Affordable Care Act Consumers Received Large Subsidies
In a recently released 26 page report the Department of Health and Human Services revealed that federal subsidies cover 76 percent of premiums for those who have signed up for coverage under the Affordable Care Act in the 36 federally administered markets. According to the Los Angeles Times, the total cost of subsidies could exceed $16.5 billion this year, which is significantly higher than the $10 billion cost that the Congressional Budget Office projected earlier this year. Read More ›
Categories: Health Care Reform, Health Insurance Exchange
New requirements for tax exempt hospitals imposed by the Affordable Care Act
The Affordable Care Act, enacted on
March 23, 2010, has established a number of new requirements that nonprofit
hospitals must meet to maintain tax exemptions. Some of these new obligations,
all codified in Section
501(r) of the Internal Revenue Code, include community health needs
assessment and implementation, financial assistance and emergency care policies,
limits on charges, and billing and collection restrictions.
In June 2012, the IRS released proposed regulations offering guidance to tax-exempt hospitals relating to certain provisions of Section 501(r). Although, the proposed regulations do not have the force of law, hospitals may rely on these to assist in implementing the requirements.
Below is a brief summary that highlights some of the new requirements for tax-exempt hospitals. Please refer to the full rule, Section 501(r) or contact us, to explore the extent of the new requirements in more detail.
Community health needs assessment and implementation (CHNA)
Effective for tax years beginning after March 23, 2012, hospital facilities must conduct a CHNA and adopt an implementation strategy at least once every three years. Read More ›
Categories: Health Care Reform, Hospitals
Michigan Allowed to Move Dual Eligibles to Managed Care
Approximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.
A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges. Read More ›
Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers
Health Insurance Providers Beware – April 15 is Quickly Approaching
The Patient Protection and Affordable Care Act requires that certain health insurance providers pay an annual fee based on the net premiums they wrote during the preceding calendar year. The providers required to pay this fee include health insurance issuers; health maintenance organizations; certain insurance companies; insurers providing Medicare Advantage, Medicare Part D, or Medicaid coverage; and multiple employer welfare arrangements.
In order to calculate the fees, the Internal Revenue Service (“IRS”) must obtain information related to the amount of net premiums written by each health insurance provider. This is accomplished through IRS Form 8963 (Report of Health Insurance Provider Information). Health insurance providers are required to submit Form 8963 to the IRS by April 15 of each year. Read More ›
Categories: Compliance, Health Care Reform, Insurance, Tax
Employer Mandate Delayed…Again
On Feb. 12, 2014, the U.S. Department of Treasury and the Internal Revenue Service published final rules (the “Final Rules”) related to the Employer Shared Responsibility provisions of the Patient Protection and Affordable Care Act (“PPACA”). The Employer Shared Responsibility provisions, referred to as the “Employer Mandate,” generally require certain employers to offer minimum essential health care coverage to their full-time employees or face penalties. The Employer Mandate was originally scheduled to become effective on Jan. 1, 2014 but was delayed until Jan. 1, 2015.
The Final Rules include a second delay of the Employer Mandate. They provide that employers who employ 50 – 99 full time equivalent employees will not be required to comply with the Employer Mandate until Jan. 1, 2016. Additionally, those employers who employ 100 or more full time equivalent employees must offer minimum essential coverage to only 70 percent of those full time employees by Jan. 1, 2015 (as opposed to the 95 percent coverage requirement under the previous regulations). Those employers employing 100 or more full time employees will be required to offer coverage to 95 percent of all full time employees by Jan. 1, 2016. The chart below summarizes the basic details concerning this delay. Read More ›
Categories: Health Care Reform, Insurance, Tax
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.