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Focus on Regulation

Tag Archives: Health care reform

The IRS Proposes Additional Requirements for Charitable Hospitals

The Internal Revenue Service (IRS) issued a Notice of Proposed Rulemaking (NPRM) setting forth proposed regulations regarding the requirements for charitable hospital organizations implemented under section 501(r) of the Internal Revenue Code (IRC), added by the Patient Protection and Affordable Care Act (PPACA).  This NPRM, published in the Federal Register on June 26, 2012, builds

CMS Proposes New Standards for Medicaid and CHIP Income Eligibility

CMS released a solicitation for public input on June 21, 2012, seeking comments on two potential methodologies for converting current state Medicaid and Children’s Health Insurance Program (CHIP) net income eligibility standards to equivalent modified adjusted gross income (MAGI) standards in accordance with section 2002 of the Patient Protection and Affordable Care Act (PPACA). Starting

New Federal Health Reform Funding Announced

Two sets of new grants of federal funding under the health reform law have been announced over the past week.  First, CMS’s Center for Medicare and Medicaid Innovation (CMMI) announced the second and final group of Health Care Innovation Awards on June 15, 2012.  These 81 awards were granted to innovative projects designed to deliver

PCORI Releases Preliminary Draft Methodology Report

The Patient Centered Outcomes Research Institute (PCORI) released its Preliminary Draft Methodology Report, entitled “Our Questions, Our Decisions: Standards for Patient-centered Outcomes Research” on June 4, 2012.   Among other things, the report sets forth 60 standards to guide the process of patient-centered outcomes research.  This initial list of standards, set forth in Appendix A of

Comparative Effectiveness Research Institute Announces $96 Million in Grant Funding

The Patient-Centered Outcomes Research Institute (PCORI) released research funding announcements on May 22, 2012 for $96 million in grant funding to support clinical comparative effectiveness research (CER).  These PCORI funding announcements (PFAs) will support four of the five areas of focus outlined in PCORI’s National Priorities for Research and Research Agenda, including: Assessing different prevention,

HHS and DOL Issue New Guidance on PPACA’s Summary of Benefits Requirements

HHS, together with the Department of Labor (DOL) released an FAQ regarding the Summary of Benefits Coverage (SBC) requirement imposed by the Patient Protection and Affordable Care Act (PPACA).  This guidance builds on a Final Rule issued by the Departments on February 9, 2012, requiring health insurance issuers and group health plans to provide consumers

IRS Issues Final Rule Regarding PPACA Tax Credits

Beginning in 2014, the Patient Protection and Affordable Care Act (PPACA) will make available new premium tax credits to help individuals and families afford health insurance coverage purchased through a health insurance exchange.  On May 18, 2012, the Internal Revenue Service (IRS) issued final regulations regarding the availability of these tax credits for individuals who

CMS Limits Reporting Requirements for Plans that Meet Medical Loss Ratio Standard

The Patient Protection and Affordable Care Act (PPACA) restricts the percent of premium dollars that health insurers may spend on administration, marketing and profits, the Medical Loss Ratio (MLR). The Centers for Medicare and Medicaid Services (CMS) has amended its regulations governing MLR standards for health insurers to create notice requirements for insurers who meet

HHS Releases Guidance on Federally Facilitated Exchanges and a Draft Blueprint for Approval of Exchanges

The Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS) released its long-awaited guidance regarding the federally facilitated exchanges (FFEs) on May 16, 2011.  The Patient Protection and Affordable Care Act (PPACA) established the state-run health insurance exchange as a marketplace for individuals and small employers to

Primary Care Doctors Will Receive a Boost in Medicaid Payments in 2013 and 2014

HHS has released a proposed rule to implement the requirement established by the Patient Protection and Affordable Care Act (PPACA) that Medicaid reimburse primary care providers (i.e., family medicine, general internal medicine, pediatric medicine, and related subspecialties) at not less than Medicare levels during 2013 and 2014.  According to CMS Administrator, Marilyn Tavenner, the pay

HHS Announces $122.6 Million in Health Care Innovation Awards: First 26 Grants to Improve Care at Lower Cost

HHS Secretary Kathleen Sebelius announced the first round of organizations granted Health Care Innovation Awards.  These 26 organizations were selected from among 3,000 applications submitted in response to a $1 billion challenge issued by CMS’ Center for Medicare and Medicaid Innovation (CMMI) last November.  Made possible by the Patient Protection and Affordable Care Act (PPACA),

Implementing Health Care Reform Community-Based Care Options

The Department of Health and Human Services (HHS) released new rules to implement two community-based care options under Medicaid created by the Patient Protection and Affordable Care Act (PPACA): A final rule implementing the Community First Choice program, a new State plan option for providing home and community-based attendant services and supports to Medicaid beneficiaries

PCORI Finalizes “Patient-Centered Outcomes Research” Definition

Section 6301 of the Patient Protection and Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit organization charged with conducting and disseminating comparative clinical-effectiveness research to help patients, providers, purchasers, and policy-makers reach more informed decisions. On March 5, 2012, the PCORI board of governors voted to finalize a revised definition of