Health Reform Update. October 30, 2012

Transcription

1 Health Reform Update October 30, 2012

2 About the Speakers Tim Gillis, Shareholder Akerman Tim Gillis represents public and private companies and their owners/investors in a variety of corporate and securities transactions. Tim has concentrated his practice on structuring and negotiating complex business transactions, including mergers and acquisitions, venture and growth capital investments, debt and equity financings, private placement securities offerings, and franchise offerings. He regularly represents clients with respect to all of their corporate transactions, and effectively serves as their outside general counsel. Harvey Granger, Senior Vice President and General Counsel Baptist Health System Harvey Granger joined Baptist Health in 1987 as in-house corporate counsel. He now serves as Baptist Health s Senior Vice President and General Counsel. He is responsible for providing advice to the Executive and Senior Leadership and the Boards of Directors of Baptist Health and its affiliates regarding all legal matters including compliance with Medicare and other legal and regulatory requirements, litigation and insurance matters, mergers and acquisitions, and IRS requirements for tax exempt organizations.

3 About the Speakers Seth M. Phelps, Assistant General Counsel Blue Cross and Blue Shield of Florida ( BCBSF ) Seth Phelps has extensive experience in the areas of state and federal regulatory compliance, dispute resolution, utilization management, intellectual property and federal taxation of health benefits. He works daily with BCBSF employees on new product development including consumer directed health plans, complex utilization review issues, and appeals matters. He currently is extensively involved with the interpretation and implementation of the Affordable Care Act. He also serves as the Secretary to Health Options, Inc. He joined BCBSF in 2001, and has over 17 years of experience as an attorney. Prior to joining Blue Cross and Blue Shield of Florida, he served as in-house Counsel for BuildNet, Inc., an Internet start-up in the residential building industry. Prior to BuildNet, Inc. Seth was in-house counsel for Blue Cross and Blue Shield of North Carolina. Robert Slavkin, Shareholder Akerman Robert Slavkin practices healthcare law representing a variety of healthcare clients, providing guidance on complex issues including compliance with all appropriate federal and state statutes and regulations. These include federal anti-kickback, Stark laws, Medicare, Medicaid, HIPAA, and FDA regulations, as well as operational and compliance issues facing healthcare clients. Robert has developed significant experience regarding the federal and state laws surrounding the pharmacy, pharmaceutical, and managed care industries, with particular emphasis on the Medicare Managed Care and the Part D programs.

4 Patient Protection and Affordable Care Act (P.L ) Overall approach to expanding access to coverage Require most U.S. citizens and legal residents to have health insurance. Create state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals/families with income between % of the federal poverty level (the poverty level is $18,310 for a family of three in 2009) and create separate Exchanges through which small businesses can purchase coverage. Require employers to pay penalties for employees who receive tax credits for health insurance through an Exchange, with exceptions for small employers. Impose new regulations on health plans in the Exchanges and in the individual and small group markets. Expand Medicaid to 133% of the federal poverty level.

5 Summary of Affordable Care Act INDIVIDUAL MANDATE EMPLOYER REQUIREMENTS EXPANSION OF PUBLIC PROGRAMS Requirement to have coverage Requirement to offer coverage Expand Medicaid to all non- Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL

6 Summary of Affordable Care Act CHANGES TO PRIVATE INSURANCE Temporary high-risk pool Medical loss ratio and premium rate reviews Dependent coverage Insurance market rules

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