Health Care Reform

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Health Care Reform. The debate surrounding health care reform focused on the need to improve access to health care, expand coverage and increase quality while decreasing overall health care spending. The challenge now is to navigate the numerous and significant changes to our industry that are following. These changes are expected to affect virtually all aspects of health care delivery - hospitals to home health and payers to peer review. And these changes will create both opportunities and challenges. As the nation's largest health care focused law firm, Hall Render is uniquely positioned to stay informed of all aspects of health care reform and to assist you in responding to the important opportunities and challenges that it will create. Health law is our business.

Hall Render's Health Law Broadcast has followed the debate and issues surrounding health care reform. This series will continue to describe the changes and provide practical guidance on how to react and implement the many aspects of health care reform. The series consists of client alerts, periodic articles and analysis and regular email updates, each written by Hall Render attorneys with in-depth knowledge and essential experience. As part of Hall Render's commitment to leading you through health care reform, this site is intended to be a single comprehensive resource for tracking the various reform-related regulatory developments and for following our analysis and practical guidance. In addition to industry and provider specific developments and analysis, you will find user-friendly access to various news and health policy sources. All to ensure that you stay informed.


Accountable Care Organizations

Accountable Care Organizations have become the buzz concept in health care today...

Clinical Integration and Antitrust

One of the basic goals of health care reform is to lower costs while increasing quality...

Employers and Employees

The Affordable Care Act was designed to provide health insurance coverage to the millions of Americans who are currently without coverage...

Fraud and Abuse/Compliance

The Affordable Care Act and related health reform initiatives signal the federal government's intent to continue aggressively fighting fraud and abuse under the federal health care programs...

Health Care Policy

Health care reform has ignited a vigorous debate about the policies and constitutionality of the Affordable Care Act...

Health Information Technology

The passage of the health care reform and the HITECH Act will combine to greatly increase the focus upon and opportunities presented by health information technology...

Hospitals and Health Systems

The passage of sweeping health care reform is expected to affect Hospitals and Health Systems more than any other health industry group...

Long-Term Care

Long-Term Care providers will feel the effects of health care reform via increased disclosure requirements, oversight, and public access to provider information, as well as a renewed emphasis on community based care aimed at enabling beneficiaries to remain in their homes...

Physicians and Physician Organizations

There is an increased emphasis on the availability of physician services and eliminating fraud and waste in our nation's health care system as part of health care reform.

Quality, Reimbursement and Reporting

The Centers for Medicare and Medicaid Services (CMS) started the shift to becoming a value-based purchaser well before health care reform...

Tax & Tax-Exempt Organizations

Among the many changes to current health care laws and regulations, the Affordable Care Act places additional requirements on tax-exempt organizations...



January 1

  • Health insurers to begin providing rebates to enrollees if the insurer exceeds the medical loss ratio established by DHHS
  • Cost sharing is eliminated for preventative services covered by Medicare
  • Medicare Part D coverage gap is reduced to 93% and brand name manufacturers will provide a significant discount under the Medicare Coverage Gap Discount Program
  • The Center for Medicare and Medicaid Innovation becomes operational
  • DHHS to finalize plan for value based purchasing program for Ambulatory Surgery Centers
  • Medicare and Medicaid health information technology incentive payments begin under the American Recovery and Reinvestment Act of 2009
  • 10% Medicare payment bonus commences for primary care and general surgery
  • Tax exempt organizations must comply with new requirements related to limitation on charges, billing and collections, and community health needs assessments
  • March 23

  • Deadline for DHHS to establish uniform explanation of coverage documents for health insurers
  • July 1

  • DHHS to adopt regulations prohibiting Medicaid payments for hospital acquired conditions
  • DHHS to redistribute 65% of unused Medicare GME residency slots
  • October 1

  • Medicare market basket update to hospitals reduced by .1%
  • DHHS to finalize plan for value-based purchasing program for home health agencies and skilled nursing facilities
  • 2012

    January 1

  • Qualified medical expense itemized deduction threshold increases to 10% of adjusted gross income
  • Medicare Part D coverage gap for generic drugs further reduced to 86%
  • Medicare Shared Savings Program commences
  • Medicaid Pediatric Accountable Care Organization Demonstration Project commences
  • Medicaid Bundle Payment Demonstration Project commences
  • So-called "excess readmission" penalty commences for hospital discharges covered by Medicare
  • March 23

  • Health insurers must use uniform explanation of coverage documents developed by DHHS
  • October 1

  • Inpatient Prospective Payment System 1% withhold begins
  • Medicaid primary care payments increase to Medicare Part B levels
  • 2013

    January 1

  • Medicare Part D co-insurance "donut hold" for generic drugs further reduced to 79%
  • DHHS to establish Medicare pilot program for alternative payment methodologies
  • Excise tax of 2.3% begins on medical device manufacturers
  • March 31

  • Devise and drug manufacturers to begin reporting payments to physicians and teaching hospitals
  • October 1

  • Inpatient Prospective Payment System 1.25% withhold begins
  • Medicare market basket update for hospitals reduced 0.3%
  • Medicare Disproportionate Share payments cuts begin
  • 2014

    January 1

  • State-based health insurance exchanges to begin for individuals and small employers
  • Payments made by and connection with health insurance exchanges are now subject to the False Claims Act
  • Medicaid eligibility extends to 133% of federal poverty level
  • Individual mandate tax penalty and cost-sharing credits begin
  • Medicare Part D coverage gap for generic further reduced to 72%
  • October 1

  • Medicare Part D coverage gap for generic further reduced to 72%
  • Medicare hospital acquired condition risk adjusted rates begin
  • Inpatient Prospective Payment System 1.5% withhold begins
  • Medicare market basket update for hospitals reduced 0.2%
  • $600 million in additional Medicaid Disproportionate Share payment cuts
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