Congress has approved, and the President has signed, two pieces of legislation that create a brave new world for the provision of healthcare services in the United States, and which include a number of significant changes. The Patient Protection and Affordable Care Act (PPACA) and its companion bill, the Health Care and Education Reconciliation Act of 2010 (HCERA) referred to jointly as “the Act,” will have a direct impact on virtually all sectors of healthcare, as well as employers.

Healthcare Reform Impact focuses on various aspects of PPACA and HCERA from the provider, payor, supplier and employer perspective, including explanations of how the new laws will work; when they will come into play; what choices individuals, employers, and providers will have; and how the new laws will affect your business. There will also be new regulations and changes to existing regulations (by a variety of agencies) as a result of the new laws, and Impact will provide updates and analysis on this activity our clients.

Following is a general overview of the employer-related provisions. Please see the employer or provider/payor sections for information specific to your business. We will continue to provide updates on a regular basis.

Employer Mandates
- Changes in Lifetime and Annual Benefits and Waiting Periods
- Dependent children coverage
- Play-or-Pay Mandate on Employers
- Pre-Existing Conditions
- Automatic Enrollment
- Excise Tax on “Cadillac” Health Plans
- Annual Information Returns
- New Rules for Cafeteria Plans and other Healthcare Reimbursement Arrangements
- Wellness Incentives
- Nondiscrimination rules for insured health plans
- Retiree Medical
Participant Mandates
- Individual Mandate
- Refundable Tax Credits
- Free Choice Vouchers
- Free-Rider Mandate
- HSA Penalty Increase
- Increase in Medicare Tax Rate
- Unearned Income Medicare Contribution
- Changes to Medicare Advantage Plans
- Closing the Medicare Donut Hole
- Portability
- CLASS Act (Long-Term Care Insurance)
Payor Mandates
- No Cancellation of Policies
- Health Insurance Exchanges
- Other Insurance Market Reforms
- Small Business Health Option Programs
- Fees and Taxes
Tort Reform

Updates & Analysis

General Information

Physician Payments Sunshine Act Proposed Rule Published (12.28.2011)

HHS Delivers Sunshine Act Regulations in Time for the Holidays: Data Collection Commencement Date Postponed (12.16.2011)

11th Circuit Hears Oral Arguments on Health Reform Law (6.9.2011)

District Court Finds Health Reform Individual Mandate Unconstitutional (12.14.2010)

CMS Issues Final Rule on Changes to Stark In-Office Ancillary Services Exception (12.1.2010)

CMS Issues Proposed Rule on Changes to Stark In-Office Ancillary Services Exception (8.10.2010)

Healthcare Reform Bill Tries to Address Medicare Part D Coverage Gap Crisis (5.11.2010)

Healthcare Reform Includes Significant Transparency and Disclosures Initiatives (4.7.2010)

Accountable Care Organizations (ACOs)

On October 20, 2011, the Centers for Medicare and Medicaid Services (CMS) released final rules on implementation of the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs). McGuireWoods has prepared summaries of these rules and related guidance from other federal agencies and will be issuing additional updates to help you digest this voluminous information and navigate the legal issues affecting ACOs.

ACO Final Rule: More Flexibility for Structure and Governance (12.13.2011)

Accountable Care Organizations: Key Components to Consider (11.8.2011)

CMS Interim Final Rule on Healthcare Fraud and Abuse Laws for ACOs (11.3.2011)

IRS Provides More Guidance on ACOs (11.1.2011)

FTC and DOJ Issue Final Antitrust Guidance for ACOs (10.27.2011)

Agencies Issue Final Rules on ACOs (10.20.2011)

Additional Requests for Guidance from IRS on Accountable Care Organizations (6.15.2011)

More Guidance on Accountable Care Organizations Needed From IRS (6.6.2011)

What You Need to Know About the CMS Pioneer ACO Model (5.23.2011)

Accountable Care Organizations: Shared Savings Calculation - Part II - Expenditure Benchmark (5.6.2011)

Guidance on Healthcare Fraud and Abuse Laws for ACOs (5.3.2011)

The Role of Health Information Technology in the Implementation of Accountable Care Organizations (4.26.2011)