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Health Care Claims Disputes: Home

A collection of statutes, treatises and cases dealing with disputes under various federal and state medical insurance plans.

Payment Impacts of ACA

This Pathfinder addresses the new sources of payment to acute care providers and the particular claims disputes that are likely to arise under the Affordable Care Act.

 

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Affordable Care Act - New Benificiaries

The Affordable Care Act adds distinct groups of newly insured persons who will receive coverage under its provisions and thus generate health care claims for the providers of these services. 

First, there is an expansion of Medicaid eligibility for those individuals and families with income below specified income limits.  There are active challenges to the implementation of this section of the law because it does not provide for subsidization of health care exchanges operated by the federal government.  

Second, there is an expansion of insurance to individuals and families who do not have access to health insurance through their employer. 

Third, there is an expansion of insurance to certain individuals under the umbrella of the insurance coverage of a parent.

Fourth, there is expanded access to insurance for individuals with preexisting conditions because insurers will no longer be able to exclude coverage nor charge extra for patients with preexisting conditions.

Fifth, there is expanded access to employees of companies with 50 or more full time employees.  Implementation of this feature is presently delayed until 1/1/2015.

 

The Patient Protection and Affordable Care Act was enacted by Public Law 111-148 of 2010, in the 111th Congress.  The source bill is H.R. 3590 111 Cong.

Affordable Care Act - New Insurers?

The nation's biggest insurers have decided against joining the exchanges on a large scale, professing uncertainty about the roll-out and how much the uninsured would participate. Most are sticking to states where they already sell insurance directly to individuals, leaving at least half a dozen states with only one or two health plans to choose from.

Affordable Care Act - History

PL 111–148 [HR 3590] March 23, 2010 enacts the PATIENT PROTECTION AND AFFORDABLE CARE ACT, PL 111-148, March 23, 2010, 124 Stat 119
 
There were seven (7) drafts of the bill.
1. 2009 CONG US HR 3590- 111th CONGRESS, 2nd Session, March 21, 2010, HR 3590, VERSION: Enrolled Bill
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

2. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, December 24, 2009, HR 3590 PP, VERSION: Public Print
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

3. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, December 24, 2009, HR 3590, VERSION: Engrossed Amendment Senate
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

4. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, November 19, 2009, H. R. 3590, VERSION: Amendment in Senate
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

5. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, October 13, 2009, H. R. 3590, VERSION: Placed on Calendar Senate
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

6. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, October 8, 2009, H. R. 3590, VERSION: Engrossed in House
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119
 
7. 2009 CONG US HR 3590 - 111th CONGRESS, 1st Session, September 17, 2009, H. R. 3590, VERSION: Introduced in House
Updating Legislation: PL 111–148, March 23, 2010, 124 Stat 119

Ammendments to Affordable Care Act

Amending laws:
Pub.L. 111–152, Title I, §§ 1001(b), 1101(a)(2), 1102(a), 1204(a), 1403(a), 1404(a), 1405(d), 1406(a), 1407, Title II, §§ 2301(a), 2303, 124 Stat. 1031, 1037, 1040, 1055, 1063, 1065, 1067, 1081, 1083 (26 §§ 125 note, 139A note, prec. 4001 note; 42 §§ 254b–2, 1395w–21, 1395w–23, 1395w–24, 1395w–27a, 1395w–29, 1395eee, 1395w–102, 18011, 18043, 18071)
Pub.L. 111–309, Title II, §§ 201, 202, Dec. 15, 2010, 124 Stat. 3289 (42 § 1395p note)
Pub.L. 111–312, Title I, § 101(b), Dec. 17, 2010, 124 Stat. 3298 (26 §§ 1 note, 21, 23 to 25, 25A, 25B, 26, 30, 30B, 30D, 36C, 137, 904, 1016, 1324, 1400C, 6211)
Pub.L. 112–10, Div. B, Title VIII, § 1858(a), Apr. 15, 2011, 125 Stat. 168 (42 § 18101)
Pub.L. 112–96, Title III, § 3205, Feb. 22, 2012, 126 Stat. 194 (42 § 300u–11)
Pub.L. 112–240, Title VI, § 642(a), (b)(1), Jan. 2, 2013, 126 Stat. 2358 (42 §§ 201 note, 300ll, 300ll–1 to 300ll–9)

Disclaimer

No Legal Advice Provided

The material on our research guide’s website is intended to provide only general information and comment to our clients and the public. This research guide is created for educational purposes only. Although we make our best efforts to ensure that the information found on our website is accurate and timely, we cannot, and do not, guarantee that the information is either. Nor do we guarantee the accuracy of any information contained on websites to which our website provides links.

Do not, under any circumstances, rely on information found on our website as legal advice. Legal matters are often complicated. The law changes frequently and varies from jurisdiction to jurisdiction. Being general in nature, the information and materials provided may not apply to any specific factual and/or legal set of circumstances. For assistance with your specific legal problem or inquiry please contact a knowledgeable lawyer, who practices in your area of need and would be pleased to determine whether she or he can assist you. The State Bar Association is ordinarily a good source for referrals for competent attorneys.

Cases

In Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S. Ct. 2566 (2012), the US Supreme Court heldl that the ACA's imposition of minimum essential health insurance coverage to be invalid under the Commerce Clause but that it was a valid as a "tax" which cleared the way for states to implement insurance clearing houses for individuals to purchase health insurance policies. Nat'l Fed'n of Indep. Bus. v. Sebelius, 132 S. Ct. at 2591 and 2601 (2012). 

Additionally, the Court held that the statutory provision allowing HHS to penalize whose States which did not participate in Medicaid expansion exceeded Congress's power under the Spending Clause. Id. at 2608.

 

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