Practice Strengths

Now that the precedent-setting national health care reform legislation has been signed into law, clients across various industries are eager to understand the potential impact on their business. Baker Hostetler has positioned itself as a leading source of information on the intricacies of the new law.

Our attorneys, analysts and legislative professionals followed the proposed legislation throughout its life cycle, providing us with a deep understanding of the final law. To address those aspects of health care reform most likely to have an impact on businesses, and on healthcare industry providers and insurers, Baker Hostetler has assembled a comprehensive cross-practice Health Care Reform Group that includes representatives from our experienced Healthcare Industry, Employee Benefits, Tax, Employment and Labor and Legislative Teams. Through this collaboration, we bring clients the most up-to-date information on implementation and significant milestones for businesses, employers, hospitals, physicians and insurers. The group also works with clients to develop customized, creative solutions for reform-related issues employers and providers may face.

With seasoned practitioners on the Health Care Reform Team, Baker Hostetler is poised to assist clients navigate the complexities that lie ahead.

Our lawyers closely follow developments in health care reform and will keep you updated on such reform topics as:

For Businesses and Employers: IRS Clarifies W-2 Reporting Requirements for Employer-Sponsored Health Plan Coverage—updated 1/19/2012 The Betting Window Remains Open: More Potential Differences Emerge Between Federal, State Exchanges—updated 1/5/2012 New FAQs Delay Summary of Benefits and Coverage Compliance Date and Provide Guidance on the Mental Health Parity Act—updated 12/8/2011 The Controversy Over State-Based Health Insurance Exchanges: Politics As Usual or Dangerous Brinksmanship?—updated 12/8/2011  Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act—updated 12/8/2011 Claims, Appeals and Review Processes—updated 8/4/2011  Coverage of Preventive Health Services—updated 7/16/2010 Dependent Child Coverage—updated 9/15/2010 Early Retiree Reinsurance Program—updated 6/30/2010 Flexible Spending Accounts and Health Reimbursement Accounts—updated 9/9/2010 Grandfathered Health Plans—updated 8/18/2011 Informational Reporting Requirements—updated 7/16/2010 Nondiscrimination Requirements—updated 1/7/2011 Preexisting Condition Limits, Lifetime and Annual Limits for Essential Health Benefits, Rescissions and Patient Choice—updated 7/19/2010 Small Business Health Care Tax Credit—updated 9/15/2010 Webinars, Presentations, Publications and Other Materials

For Hospitals and Providers: FTC Commissioner: What's So Great About ACOs? Payment Under the ACO Final Regulations: It's All in the Math! Healthcare Umpires Get Glasses With Release of Medicare Data Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act Health Care Reform Basics for Hospitals and Providers 340B Program Changes Accountable Care Organizations  Physician-Hospital Alignment  Webinars, Presentations, Publications and Other Materials

Bookmark this webpage and revisit for new developments: www.bakerlaw.com/HealthCareReform.

 

Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act

Alerts:

• 12/8/2011—New FAQs Delay Summary of Benefits and Coverage Compliance Date and Provide Guidance on the Mental Health Parity Act
• 12/8/2011—The Controversy Over State-Based Health Insurance Exchanges: Politics As Usual or Dangerous Brinksmanship?
• 10/27/2011—Methods and Criteria to Define “Essential Health Benefits” Unveiled
• 10/13/2011—OIG Work Plan Highlights PPACA and ARRA Initiatives
• 10/13/2011—Comprehensive Primary Care Initiative Builds on Patient-Centered Medical Home Concept
• 10/13/2011—2009 Demonstration Offers Insights on Bundled Payments Initiative
• 9/1/2011—A Sign of the Times: The CMS Bundled Payments for Care Improvement Initiative
• 9/1/2011—Health Reform: Agencies Publish Guidance on Summary of Benefits and Coverage and Uniform Glossary Disclosure Requirement
• 8/18/2011—The Budget Control Act and Its Potential Impact on Healthcare Policy and Institutions
• 8/4/2011—DOL Forum Addresses Automatic Enrollment Concerns Under PPACA
• 7/21/2011—Treasury and IRS Offer Interim Guidance on Community Health Needs Assessment
• 7/21/2011—HHS Publishes Long-Awaited Guidance on Insurance Exchanges
• 7/21/2011—CMS Publishes Proposed Physician Fee Schedule Rule
• 7/21/2011—CMS Publishes Proposed Rule Regarding Hospital Outpatient Prospective Payments and Ambulatory Surgical Center Payments
• 7/21/2011—CMS Announces Demonstration Project on Complex Diagnostic Lab Tests
• 7/21/2011—Employers Be Forewarned: Medicare Part D Annual Notices Must Be Provided Earlier
• 5/13/2010—Health Reform Implementation—Key Developments; Early Progress
• 5/13/2010—Health Reform: Beyond the Basics—What Every Business Needs to Know
• 4/8/2010—Health Care Reform: Employer Advisory
• 4/5/2010—Health Care and Education Reconciliation Act of 2010 (H.R. 4872): Summary of Main Tax-Related Provisions
• 4/1/2010—A Baker’s Dozen of Significant Changes in Health Reform
• 1/21/2010—Outlook on Health Reform: The Clock is Ticking
• 1/5/2010—House and Senate Health Care Proposals—Comparison of Key Tax Provisions

Resources:

• Unofficial consolidated version of PPACA and HCERA

340B Program Changes

Alerts:

• 5/13/2010—Health Reform—340B Program Changes

Claims, Appeals and Review Processes

Alerts:

• 8/31/2010—Regulatory Agencies Publish Interim Procedures for Federal External Review Processes for Non-Grandfathered Self-Insured Health Plans and Model Notices for Internal Appeal and External Review Determinations
• 7/29/2010—Guidance on Internal and External Appeals Processes Published

Resources:

• Availability of Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review Under the Patient Protection and Affordable Care Act; Notice
• Employee Benefits Security Administration’s Technical Release 2010-01
• Model Notice of Adverse Benefit Determination
• Model Notice of Final Internal Adverse Benefit Determination
• Model Notice of Final External Review Decision
• Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act

Coverage of Preventive Health Services

Alerts:

• 7/16/2010—New Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Health Services Without Cost Sharing

Resources:

• Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act (Published in the Federal Register on July 19, 2010)

Dependent Child Coverage Up to Age 26

Alerts:

• 7/19/2010—It’s Time to Start Drafting: Several Health Care Reform Model Notices Issued—Extension of Dependent Coverage to Age 26 and Opportunity to Enroll Model Notice
• 5/28/2010—Dependent Coverage to Age 26 (Effective for Plan Years Beginning After September 23, 2010)

Resources:

• DOL Dependent Coverage and Opportunity to Enroll Model Notice
• Interim Final Rule for Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient Protection and Affordable Care Act (Updated as of September 15, 2010)

Early Retiree Reinsurance Program

Alerts:

• 6/30/2010—HHS Is Now Accepting Early Retiree Reinsurance Program Applications
• 6/14/2010—Early Retiree Reinsurance Program Application Now Available
• 6/7/2010—Draft Early Retiree Reinsurance Program Application Available on the Internet
• 5/28/2010—Early Retiree Reinsurance Program Interim Rule (Published May 5, 2010)

Resources:

• Final Early Retiree Reinsurance Program Application (posted on HHS website on June 29, 2010)
• Final Early Retiree Reinsurance Program Plan Sponsor Application Instructions (posted on HHS website on June 29, 2010)
• Interim Final Rule Regarding the Early Retiree Reinsurance Program
• HHS Early Retiree Reinsurance Program Frequently Asked Questions
• Early Retiree Reinsurance Program Application
• ERRP Application Instructions

See also:

• HHS Early Retiree Reinsurance Program Application Submission Dos and Don’ts
• The Affordable Care Act’s Early Retiree Reinsurance Program Answers to Frequently Asked Questions (updated as of June 29, 2010) (published by HHS)
• Questions and Answers Regarding the Early Retiree Reinsurance Program

Flexible Spending Accounts and Health Reimbursement Accounts

Alerts:

• 9/9/2010—IRS Issues Guidance Regarding Use of Tax-Favored Vehicles to Pay for Over-the-Counter Medicines and Drugs

Grandfathered Health Plans

Alerts:

• 8/18/2011—It’s That Time of Year Again: An Open Enrollment Notice Checklist for Employer-Sponsored Group Health Plans
• 7/19/2010—It’s Time to Start Drafting: Several Health Care Reform Model Notices Issued—Grandfathered Health Plan Model Language
• 6/15/2010—New Rules on Grandfathered Health Plans
• 4/8/2010—Health Care Reform—Employer Advisory

Resources:

• DOL Grandfathered Health Plan Model Language
• Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan under the Patient Protection and Affordable Care Act (Updated June 17, 2010)
• Grandfathered Health Plans Fact Sheet
• Grandfathered Health Plans FAQs

Informational Reporting Requirements

Alerts:

• 7/16/2010—IRS Invites Public Comments on Expanded Informational Reporting Requirements (Effective for Payments Made After December 31, 2011)

Resources:

• IRS Notice 2010-51

Health Care Reform Basics for Hospitals and Providers

Articles:

• 4/7/2011—ACOs, Shared Savings and the Brave New World of Regulation
• 3/17/2011—Florida Federal Judge Stays His Decision, Government Files Appeal and Review is Fast-Tracked by 11th Circuit
• 3/17/2011—HHS Releases Proposed Rule on Waivers for State Innovation
• 3/3/2011—New CMS Guidance on the Affordable Care Act’s MOE Provisions
• 12/9/2010—Health Reform’s Untold Story—Restructuring Precedes Regulation
• 10/28/2010—ACOs—NCQA Releases Standards and Measures; Seeks Public Comment
• 9/30/2010—FTC, CMS and OIG to Conduct ACO Workshop
• 9/30/2010—CMS Posts Stark Self-Disclosure Protocol
• 9/30/2010—Seventh Circuit Allows Research Time in IME FTE Count
• 9/30/2010—New CMS Rule Tightens Provider Screening Requirements
• 6/10/2010—CMS Shares Thoughts on ACOs and Shared Savings Programs
• 5/13/2010—Health Reform—340B Program Changes
• 5/13/2010—Health Reform Implementation—Key Developments; Early Progress
• 5/13/2010—Health Reform: Beyond the Basics—What Every Business Needs to Know
• 4/29/2010—New Federal Oversight Structure for Market Reforms
• 4/26/2010—Let the Rulemaking Begin...!
• 4/15/2010—The Devilish Details
• 4/1/2010—A Baker’s Dozen of Significant Changes in Health Reform
• 3/18/2010—Health Reform of Not, Changes in Physician-Hospital Alignment Are Here
• 3/4/2010—Health Reform—New Activity and Expired Deadlines
• 2/18/2010—Together We May Prosper: The Demand for Healthcare Reform and Two Innovative Models for Physician-Hospital Alignment
• 2/4/2010—The President’s FY 2011 Budget Request—A Health Reform Workaround?
• 1/21/2010—Outlook on Health Reform: The Clock is Ticking
• 1/21/2010—Health Reform’s Impact on Providers as Employers: Key Issues to Consider
• 12/10/2009—While Debate Looms Over Senate—Delivery System Reform Appears Poised for Passage
• 11/12/2009—The House Reform Bill—Winners and Losers; Revenue-Raisers; Next Steps
• 10/29/2009—Speaker Pelosi Unveils New Version of House Bill
• 10/1/2009—America’s Health Future Act of 2009: Revenue Provisions and Other Tax Changes
• 9/17/2009—The Storms of August Blow Into September
• 8/6/2009—Four Committees Done; One to Go
• 7/23/2009—Putting the Puzzle Together
• 6/25/2009—House Reform Bill Eliminates Physician-Owned Hospital Exception; Includes New and Enhanced Fraud Deterrents
• 6/11/2009—Healthcare Coverage in a Post-Reform World
• 5/28/2009—Third Roundtable Addresses Proposals for Financing Health Reform
• 5/14/2009—Second Roundtable Addresses Options for Expanding Coverage
• 5/14/2009—Second Policy Options Paper Offers Details for Reforming Everything Including the Kitchen Sink
• 5/14/2009—Medicare Payment Changes Detailed in Obama’s Line-Item Budget Request
• 5/14/2009—Health Industry Groups Pledge to Reduce Spending
• 4/30/2009—Helath Reform Update: Initial Roundtable Discussion, Policy Options Add Momentum
• 4/16/2009—Health Reform Moves Ahead: White House Establishes Office for Health Reform
• 4/16/2009—Congressional Budget Blueprint Provides for Reform
• 4/2/2009—Baker Hostetler Clients and Friends Hear From Congressional Leaders on Health Care Reform
• 3/19/2009—March Madness Comes Early to Health Reform
• 3/5/2009—The President’s 2010 Budget—A Down Payment on Health Reform?
• 12/11/2008—Obama-Biden Transition Team Update
• 11/13/2008—Health Care Reform—Senator Baucus Unveils His “Call to Action”
• 10/30/2008—Assessing the Candidates’ Health Care Plans—Does It Matter?
• Webinars, Presentations, Publications and Other Materials

Nondiscrimination Requirements

Alerts:

• 1/7/2011—IRS Announces Delay in Nondiscrimination Rules for Insured Medical Plans
• 10/6/2010—IRS Provides Initial Guidance on Application of Nondiscrimination Rules to Fully Insured Plans

Resources:

• Notice 2011-1 Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans
• Request for Comments on Requirements Prohibiting Discrimination in Favor of Highly Compensated Individuals in Insured Group Health Plans: IRS Notice 2010-63

Physician-Hospital Alignment / Accountable Care Alignment (ACOs)

Alerts:

• 11/10/2011—Antitrust Enforcement and ACOs
• 10/27/2011—A Baker’s Dozen of Key Highlights From the ACO Final Rule
• 4/7/2011—ACOs, Shared Savings and the Brave New World of Regulation

Articles:

• 12/8/2011—Payment Under the ACO Final Regulations: It's All in the Math!
• 12/8/2011—FTC Commissioner: What's So Great About ACOs?
• 8/18/2011—Pioneer ACOs—CMS Clarifies Requirements
• 10/28/2010—ACOs—NCQA Releases Standards and Measures; Seeks Public Comment
• 9/30/2010—FTC, CMS and OIG to Conduct ACO Workshop
• 6/10/2010—CMS Shares Thoughts on ACOs and Shared Savings Programs
• 3/18/2010—Health Reform or Not, Changes in Physician-Hospital Alignment Are Here
• 2/18/2010—Together We May Prosper: The Demand for Healthcare Reform and Two Innovative Models for Physician-Hospital Alignment

Preexisting Condition Limits, Lifetime and Annual Limits for Essential Health Benefits, Rescissions and Patient Choice

Alerts:

• 7/19/2010—It’s Time to Start Drafting: Several Health Care Reform Model Notices Issued—Patient Protection Model Notice and Prohibition on Lifetime Limits Model Notice
• 6/23/2010—New Rules Restrict Preexisting Condition Limits, Uncap Lifetime and Annual Limits for Essential Health Benefits, Limit Rescissions and Expand Patient Choice

Resources:

• DOL Patient Protection Model Notice
• DOL Prohibition on Lifetime Limits Model Notice
• Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule (Updated June 28, 2010)

See also:

• Obama Administration Summary of the New Changes

 

Small Business Health Care Tax Credit

Alerts:

• 9/15/2010—Small Business Health Care Tax Credit—Draft Form 8941 Released By IRS
• 5/20/2010—Small Business Health Care Tax Credit

Resources:

• IRS Draft Form 8941
• IRS Press Release: IRS Releases Form to Help Small Businesses Claim New Health Care Tax Credit
• IRS Step-By-Step Guide
• IRS’ Small Business Health Care Tax Credit: Frequently Asked Questions
• IRS Notice 2010-44
• IRS Revenue Ruling 2010-13
• Additional IRS (Informal) Guidance

Health Care Reform Webinars, Presentations, Publications and Other Materials

As the discussion about health care reform continues, businesses in every industry are inundated with information about the potential effects of the legislation. Attorneys in Baker Hostetler’s Healthcare Industry, Employee Benefits, Tax, Employment and Legislative Teams have offered periodic webinars to cut through the clutter, addressing key issues in greater depth and providing practical guidance you can put to use today. Many members of our Health Care Reform Team are recognized leaders in their fields, and as a result, are much in demand for speaking engagements on health care reform throughout the country, as well as contributions to well-known publications and other events.

• “Shifting Political Winds: The Impact on the Healthcare Industry,” Baker Hostetler Webinar (12/17/2010)
• “What the Health Care Reform Act Means for Hospitals, Academic Medical Centers, Physicians and Patients,” Baker Hostetler Webinar (5/19/2010)
• “Healthcare Reform 360°: Policy, Politics and Provider Implications,” Baker Hostetler Webinar (10/29/2009)
• “Health Care Reform—What’s Next?” presentation by Susan Feigin Harris at the State Bar of Texas Annual Meeting (6/11/2010)
• “All Eyes on Quality: The Increasing Role of Quality in Federal Program Payment and Enforcement Policies,” presentation by Gregory N. Etzel at the University of Texas Health Law Conference (6/11/2010)
• Shared Savings Opportunities