Health care reform will continue with a myriad of legal and regulatory changes over the next few years. Among other things, we can expect:
- Insurers will provide expanded coverage for prevention and wellness care.
- Healthcare insurance premiums will rise.
- Innovation will continue as hospitals and physicians experiment with different forms of integration and financial models.
- The ACA expands Medicaid coverage to people below 133 percent of the federal poverty level, but states can opt out of the Medicaid expansion.
- The Independent Payment Advisory Board will continue to be controversial.
- There are lots of changes for employers, including:
- Including the aggregate cost of certain employer-sponsored health coverage on employees’ Form W-2.
- Specified tax credits.
- There are lots of changes for group health plans, including:
- A requirement to provide coverage to dependent children of participants until age 26.
- A prohibition on limiting or excluding coverage for pre-existing conditions.
- A prohibition on rescinding coverage to an enrollee.
- A limitation on imposition of lifetime or annual dollar limits on the benefits provided to a particular participant.
- Changes for individual subscribers include:
- An annual statutory maximum of $2,500 on health flexible spending arrangements.
- An increased tax for a payment or distribution from a flexible spending account that is not used for qualified medical expense.
- Changes for physicians (transparency and disclosure provisions), including:
- “Physician payment sunshine” provisions (Section 6002): A. Physician Payment Transparency Provisions for Manufacturers of Drugs, Devices, Biologicals, and Medical Supplies. Requires “any applicable manufacturer that provides a payment or other transfer of value to a covered recipient (or to an entity or individual at the request of or designated on behalf of a covered recipient),” annually to submit information to the Secretary regarding the value, nature, purpose, and recipient of the transfer of value. Covered recipients are narrowly defined as “physicians” and “teaching hospitals.”
- Reporting of Payments Where There Is Physician Ownership or Investment (Section 6002)
- Prescription Drug Sample Transparency (Section 6004)
- Pharmacy Benefit Managers Transparency (Section 6005)
- Nursing Home Transparency (Title VI, Subtitle B)
- Disclosures Related to Referrals for Radiology Services (Section 6003)
- Provisions Regarding Self-Referrals
- Kickbacks, Overpayment Reporting, and Civil Monetary Penalties (CMPs)
- specific intent to commit a violation not required for AKS
- overpayment reporting
- civil monetary penalties provisions enhanced
Thorough, understandable summaries online include the following.
The U.S. government provides a good summary on implications of the Affordable Care Act for the ordinary consumer at The Health Care Law & You | HealthCare.gov.
Handy links include:
For physicians, check out these documents from the National Physicians Alliance:
For patients:
- NPA also provides Overview of the Affordable Care Act (NPA Fdn)
- AARP Health Law Guide
- Health Reform and You (Kaiser Health News)
For patients interested in tax aspects, the IRS has put out information on its website.
Another helpful timeline: http://healthreform.kff.org/timeline.aspx.
We will be posting more resources and information in upcoming articles on this blog. If you have legal questions concerning the impact of the new regulatory landscape on your healthcare practice or business, contact one of our health care attorneys today.
Contact our healthcare law and FDA attorneys for legal advice relevant to your healthcare venture.
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