Health Care Reform
Monday, September 20, 2010
Rose Willis discusses health care reform.
The Patient Protection and Affordable Care Act of 2010 (PPACA), signed into law by President Obama in March and legislatively modified by the Healthcare and Education Reconciliation Act of 2010, marks a historic step in the overhaul of the U.S. health care system. Although some changes are effective immediately, many of PPACA’s provisions will be implemented incrementally through 2014 and beyond and are subject to numerous regulations yet to be issued by the Secretary of Health and Human Services (Secretary). In short, while the debates surrounding the language of the bill may be over, the work relating to implementing and understanding PPACA has just begun.
Under PPACA, most Americans will be required to have a “minimum essential” package of health insurance by 2014 or face penalties. Government subsidies will be offered to help defray the cost of private health insurance. Online, state-specific insurance “exchanges” are required by 2014 to assist individuals in searching for health insurance. Large employers may face penalties in certain situations if they do not offer health insurance to their full-time employees by 2014. Qualifying small employers who choose to offer health insurance to their employees would be eligible for tax credits to assist with purchasing this coverage.
PPACA impacts all health care providers in a variety of ways. For the first time, each provider that bills a federal health care program will be required to develop and implement a compliance program that is effective in combating fraudulent and abusive practices. The specific terms of these compliance programs have not yet been issued by the Secretary, but are likely to be based on the “seven essential elements” of an effective compliance program as identified in the U.S. sentencing guidelines.
PPACA incorporates a number of provisions aimed at Medicare cost savings and combating fraud and abuse. The act sets forth parameters establishing a “Medicare Shared Savings Program,” also known as “accountable care organizations” (ACOs), wherein eligible ACOs may obtain financial incentives for exceeding the quality performance standards set forth by the Secretary. Providers that rely on the in-office ancillary services exception to the federal Stark law to refer certain imaging services to entities in which they have ownership interests will be required to inform the patient that the services may be obtained from alternative suppliers and also to provide a list of alternative suppliers to the patient. Also, PPACA amended the “intent” requirement in the antikickback statute, providing that “specific intent” is not required to violate the statute, making it easier to prosecute providers and suppliers under the antikickback statute. PPACA imposes additional obligations on nonprofit, taxexempt hospitals relating to community health needs assessments and financial assistance policies, among others.
Although the passage of PPACA is considered a major step toward health reform, full implementation of the law will not be complete for many years, as thousands of pages of regulations still need to be issued by the Secretary. Miller Canfield’s health law attorneys and its multispecialty Health Reform Taskforce are dedicated to staying continuously informed of all newly issued regulations, rules and notices relating to PPACA to ensure that its clients are well-versed in how this law impacts their business practices.
Rose Willis is an associate at Miller Canfield. She practices in the firm’s health law and corporate and securities law groups. Willis has assisted health care industry clients in a variety of matters, including analyzing fraud and abuse issues, licensing and certificate of need laws, reimbursement issues and compliance programs. For more information, contact her at (248) 267-3276 or willisr@millercanfield.com.
MD News September/October 2010