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Full-Time Employee Status Under Health Care Reform
The Legal Intelligencer
March 19, 2013
Beginning in 2014, many employers will be required to expand their current health insurance coverage to more employees or face stiff penalties resulting from the Patient Protection and Affordable Care Act. This is because, for purposes of the "shared responsibility" (aka "pay or play") requirements, full-time employees include any employee who works, on average, at least 30 hours per week (or 130 hours per month). This definition is a significant departure for those employers who have traditionally looked to the 40-hour work week as the threshold for full-time employee status. Full Text
Accountable Care Organizations: From Theory to Practice
The Legal Intelligencer
March 19, 2013
The last two years have brought with them radical changes to the way we think about the delivery of health care services. The Affordable Care Act was a catalyst to the development of the accountable care organization (ACO). While the Affordable Care Act did not create the concept of an ACO, it did provide substantial incentives for providers to create ACO-like organizations. Full Text
Impact of Health Care Laws on M&A Transactions
The Legal Intelligencer
March 19, 2013
Most lawyers specializing in mergers and acquisitions (M&A) apply a standard approach to handling acquisitions and divestitures across a broad spectrum of industry contexts, calling in subject-matter specialists as needed to review specific representations and warranties or to address other discrete issues that arise. While this process can be successful for transactions in many industries, the complex web of statutes and regulations governing the business of health care necessitate a more integrated approach when managing any health care-related M&A transaction. Full Text
Seeing the Light With the Physician Payment Sunshine Act
The Legal Intelligencer
March 19, 2013
On February 1, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule implementing the physician payment transparency provisions, commonly referred to as the Physician Payment Sunshine Act, in the Obama administration's 2010 health care reform legislation. The Sunshine Act joins the list of significant federal laws addressing potential conflicts of interest in health care, including the Anti-Kickback Statute and the Stark Law. With implementation of the Sunshine Act now in sight, stakeholders face the real challenge of complying with, and practicing under the shadow of, the Sunshine Act and its complex and detailed regulations. Full Text
Health Care Reform and the Unionized Employer
The Legal Intelligencer
March 19, 2013
The Patient Protection and Affordable Care Act, also known as health care reform, is now three years old. Employer health plans have had a host of new administrative and coverage requirements to comply with during each of the PPACA's first three years. However, the PPACA requirements that have taken effect to date seem negligible when compared to those that will take effect in 2014 and beyond. The legal landscape of health insurance will fundamentally change in three ways next year: Full Text
Tracking Trends in Nursing Home Reorganization
The Legal Intelligencer
March 19, 2013
Courts throughout the nation recognize that "the era of the locally owned, 'mom and pop' nursing facility is gone. Increasingly, private investment groups own large chains of nursing homes. With the end of the locally owned nursing home, it has become common for nursing facilities to have complex ownership and management structures," as the court held in Schwartzberg v. Knobloch, 98 So. 3d 173, 180 (Fla. Dist. Ct. App. 2012). Full Text
'Subrogation' or 'Reimbursement': What Does It Mean Regarding ERISA (ONLINE ONLY)
The Legal Intelligencer
March 19, 2013
Many health plans (both insured and self-funded) have vigorously pursued their subrogation and reimbursement rights. Those rights are generally written in broad and sweeping terms. The provisions may allow plans to recover from settlements with liable third parties the entire amount of the medical benefits paid on behalf of the participant, irrespective of whether the participant was made whole for injuries suffered or that a sizeable portion of any recovery was paid to the participant's attorney as fees and expenses for prosecuting the case. Full Text
The Interrelationship Between Compliance and Quality of Care (ONLINE ONLY)
The Legal Intelligencer
March 19, 2013
Compliance and quality are often viewed as two distinct functions. Typically, compliance deals with the rules and proper procedures for billing Medicare and other third-party payers. Conversely, quality functions do not usually concern themselves with reimbursement. A traditional quality assurance function focuses on the nature of the care provided to the patient. Increasingly, however, these two functions are becoming interrelated as good quality is often a prerequisite to effective compliance. Full Text
New Regulations Extend Reach of Health Care Privacy and Security Obligations (ONLINE ONLY)
The Legal Intelligencer
March 19, 2013
On January 25, the Office for Civil Rights of the Department of Health and Human Services published long-awaited final regulations modifying the privacy, security, enforcement and breach notification rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), implementing the most significant changes to health care privacy and security law in a decade. Full Text
