We have been asked what might the effect of the US Supreme Court’s upcoming decision on the Patient Protection Affordable Care Act of 2010 (PPACA), might be on our clients. The sections of the law that most impact clinical site and vendor agreements are: 1) Section 6002 which requires industry to report to CMS any payments or other transfers of value they furnish to physicians and teaching hospitals, and 2) the Medicare Secondary Payer Rule for reporting payments for treatment of study subject injuries.  As an industry, we have no way of knowing what effect the outcome of the SCOTUS decision will be but we’ll be paying attention to the impact it will have on these two requirements, specifically.

The US Health and Human Services website has a nice snapshot of PPACA, as it exists today, and I am including it here, as any discussion ultimately devolves into a jumbled dialogue of sorts, that is really just a bunch of talking points that we counter to the best of our knowledge. This is very high level but the full law can be viewed here. Despite the “buzz”, in my opinion, the law is easy to understand. One may fundamentally disagree with certain of its terms but it is an easy read for any native English speaker.

From HHS:

About the Law

The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health. View Key Features of the Affordable Care Act or read a year-by-year overview of features.

Coverage

• Ends Pre-Existing Condition Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing condition.
• Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent’s health plan.
• Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake.
• Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment.

Costs

• Ends Lifetime Limits on Coverage: Lifetime limits on most benefits are banned for all new health insurance plans.
• Reviews Premium Increases: Insurance companies must now publicly justify any unreasonable rate hikes.
• Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care – not administrative costs.

Care

• Covers Preventive Care at No Cost to You: You may be eligible for recommended preventive health services. No copayment.
• Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan’s network.
• Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan’s network.

Content created by Assist. Sec./Public Affairs – Digital Communications Division Content last reviewed on November 14, 2014

 

My topic is: “Legal and Contracting Strategies That Maximize Partnerships and Ensure a Successful Due Diligence Process” Hope to see some familiar faces there. I am looking forward to offering guidance on formulating a contracting strategy that makes responding to diligence request memos as painless as possible!     view speaker profile