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What is Shannon Wiley looking forward to at this year's Asembia Specialty Pharmacy Summit? Find out more>


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Experience Spotlight

Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

With the help and support of the Tennessee Medical Association, 21 Tennessee physicians of underserved communities joined together and retained Bass, Berry & Sims to file suit against the Centers for Medicare & Medicaid Services to stop improper collection efforts. Our team, led by David King, was successful in halting efforts to recoup TennCare payments that were used legitimately to expand services in communities that needed them. Read more

Tennessee Medical Association & Bass, Berry & Sims

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Thought Leadership

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Thought Leadership Spotlight

Download the Healthcare Fraud & Abuse Review 2017, authored by Bass, Berry & Sims

The Healthcare Fraud & Abuse Review 2017 details all healthcare-related False Claims Act settlements from last year, organized by particular sectors of the healthcare industry. In addition to reviewing all healthcare fraud-related settlements, the Review includes updates on enforcement-related litigation involving the Stark Law and Anti-Kickback Statute, and looks at the continued implications from the government's focus on enforcement efforts involving individual actors in connection with civil and criminal healthcare fraud investigations.

Click here to download the Review.

Impact of the June 28 Supreme Court Decision on Group Health Plans


June 29, 2012

As you have almost certainly heard, the United States Supreme Court announced its decision to uphold the Patient Protection and Affordable Care Act ("Affordable Care Act") as constitutional on June 28. What this means for employer-sponsored group health plans is that all existing guidance remains in effect and your implementation of the Affordable Care Act should remain on track.

The Affordable Care Act provisions (still) on the immediate horizon for group health plans include the following:

New Summary of Benefits and Coverage and Advance Notice of Material Modification

As we described here, the Summary of Benefits and Coverage ("SBC") requirement becomes effective on the first day of the first open enrollment period, and plan year, beginning on or after September 23, 2012.

Once the SBC requirement is effective, any material modifications made to the plan or policy (as reflected in the SBC) during the year will need to be communicated at least 60 days prior to the effective date of the mid-year change (more flexible notice requirements apply for changes effective on reenrollment or renewal).

New Health FSA Limit

For plan years beginning on or after January 1, 2013,* a limit of $2,500 will be imposed on employee salary reduction contributions under a health flexible spending arrangement ("Health FSA"). According to recent Internal Revenue Service ("IRS") guidance, sponsors have until December 31, 2014 to formally amend their cafeteria plans to reflect this limit, although Health FSAs must be administered to comply with this new limit as of the applicable effective date.
*This delayed effective date was recently announced by the IRS (in the same guidance cited immediately above).

First Dollar Coverage for Women's Preventive Care Services—Non-Grandfathered Health Plans Only

For plan years beginning on or after August 1, 2012, most non-grandfathered health plans must expand the list of preventive care services provided without cost sharing to include certain women's preventive services.

Form W-2 Informational Reporting of Group Health Plan Costs

Effective for the Forms W-2 to be issued to employees in January 2013 for the current (2012) tax year, employers will be required to report in Box 12 the aggregate cost (reflecting both the employer's and employee's shares) of certain group health plan coverages—generally, medical plan costs are reported, but other coverages may need to be included.

Annual Reporting and Payment of Fees to Fund Patient-Centered Outcomes Research Trust Fund

Beginning for plan or policy years ending on or after October 1, 2012, sponsors (of self-insured plans) or insurance issuers (of insured plans) will be required to report and pay an annual fee of $1 ($2 in the second year) per covered life. These fees are currently proposed to be reported and paid once annually for the prior calendar year on the Form 720 Quarterly Federal Excise Return due each July 31 (first due July 31, 2013).

We have addressed various aspects of the Affordable Care Act in prior newsletters and alerts. We also plan to keep our clients updated as Affordable Care Act implementation continues. Links to these prior communications are available on our Employee Benefits Practice Group page.

If you have questions, please contact any of the attorneys in our Employee Benefits Practice Group.

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