Jolie N. Havens
Practice Areas
- Corporate and Business Organizations
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Health Care
- Academic Medical Centers
- Behavioral Health Care, Developmental Disabilities and Child Welfare
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Health Care Litigation
- Health Care False Claims Act Actions/Civil and Criminal Investigations
- Medical Malpractice
- Privacy and Security of Health Information, HIPAA Compliance and Health Information Technology for Private and Public Providers
- Provider and Patient Rights/Medicare/Medicaid
- Regulatory Compliance Challenges/Licensure and Certification
- Reimbursement, Contract, and Fraud and Abuse
- Health Care Regulatory Practice
- Health Care Taxation
- Hospice and Palliative Care Providers
- Hospitals/Health Care Operations
- Joint Ventures/Hospital-Physician Collaborations
- Long Term Care Facilities
- Managed Care
- Privacy and HIPAA Compliance/Health Information Technology
- Reimbursement Counseling/Fraud and Abuse Compliance
- State and Federal Health Care Government Relations
- Labor and Employment
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Litigation
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Health Care Litigation
- Health Care False Claims Act Actions/Civil and Criminal Investigations
- Medical Malpractice
- Privacy and Security of Health Information, HIPAA Compliance and Health Information Technology for Private and Public Providers
- Provider and Patient Rights/Medicare Litigation
- Regulatory Compliance Challenges/Licensure and Certification
- Reimbursement, Contract, and Fraud and Abuse Litigation
- Professional Liability and Discipline
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Health Care Litigation
Industries
Education
- The Ohio State University Michael E. Moritz College of Law, J.D., 2000, with Honors
Ohio State Law Journal, Associate Editor, 1999-2000 - Ohio Wesleyan University, B.A., 1997, magna cum laude
Bar & Court Admissions
Jolie is a partner in the Vorys Columbus office and the chair of the health care group. She practices throughout the country, with a focus on health care compliance and provider reimbursement, in the context of creation of new provider sites; mergers, acquisitions, and other industry consolidation and integration models; and expanding provider operations. Jolie has counseled adult and children's hospitals, physicians, pharmacies and pharmacy benefit managers, home health agencies, ambulatory surgery centers, diagnostic centers, and faculty practice plans on legal issues involving:
- payer enrollment, registration, licensure, and accreditation;
- Medicare and Medicaid billing, coding, documentation, coverage, and reimbursement, including obtaining provider-based status for both on-campus and off-campus facilities;
- compliance with federal and state fraud and abuse laws, including the federal Anti-Kickback Statute, the federal Stark Physician Self-Referral Laws, the federal False Claims Act, and related government investigations and audits before the Centers for Medicare and Medicaid and their contractors, as well as the Department of Justice and the Office of the Inspector General;
- teaching physician and non-physician practitioner supervision and billing;
- managed care contracting and provider network participation and management, including the creation and operation of physician-hospital organizations (PHOs);
- other health care laws, including the Health Insurance Portability and Accountability Act (HIPAA) and the Emergency Medical Treatment and Active Labor Act (EMTALA); and
- professional disciplinary actions.
Jolie also advises employers and group health plans in all industries on compliance issues related to the Employment Retirement Income Security Act (ERISA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), the Uniformed Services Employment and Reemployment Rights Act (USERRA), HIPAA privacy, security and portability, electronic health records, Medicare Part D, and Medicare secondary payer and coordination of benefits issues. Jolie routinely negotiates contractual arrangements with third party administrators and pharmacy benefit managers and drafts plans documents and related participant communications.
Her notable experience includes:
- Assisting clients across the health care industry with formation of compliance and reimbursement strategies relative to start-up sites, operational expansion, and mergers and acquisitions
- Representing a multi-state hospital in a multi-million dollar False Claims Act investigation, including formulation and implementation of medical records and claims review protocols, negotiations with the Department of Justice and analysis of overpayment liability
- Representing a large, urban university relative to expansion and day-to-day operations of a physician managed care network, including drafting new managed care agreements for use with participating physicians/groups and assisting with physician terminations and appeals
- Representing hospitals, physician groups and other provider types relative to consolidation, alignment, and integration strategies, including negotiating physician employment arrangements, space and equipment leasing, and practice leasing and asset purchase agreements
- Acting as lead counsel to a national pharmacy benefit manager/mail-order and specialty pharmacy
Jolie regularly speaks both nationally and locally on health care reimbursement and compliance as well as health care reform policy and compliance, and publishes often on the subjects.
Jolie is a member of the American Health Lawyers Association and the Society of Ohio Healthcare Attorneys.
Honors & Awards
- Most Powerful and Influential Woman, Ohio Diversity Council, 2018
- Columbus CEO, Top Lawyers in Columbus, 2015
- Chambers and Partners, Leading Lawyer in Health Care, 2012-2015, 2019
News
- 5/9/2019Vorys announced that partners Jolie Havens and Nici Workman have made the shortlist for the Chambers Diversity and Inclusion Awards: USA 2019.
- 4/26/2019Vorys announced that 30 of the firm’s attorneys have been recognized among the leading practitioners in the country in the 2019 edition of Chambers USA.
- 9/2/2015Jolie Havens, a partner in the Columbus office and chair of the health care group, was featured in the September 2015 edition of Smart Business Columbus.
- 6/26/2015Jolie Havens, a partner in the Columbus office and chair of the health care group, was featured in a Law360titled “Attorneys React To Supreme Court's ACA Save.”
- 5/19/2015Vorys, Sater, Seymour and Pease is pleased to announce that 39 of the firm’s attorneys have been recognized among the leading practitioners in the country in the 2015 edition of Chambers USA.
- 5/15/2015Jolie Havens, a partner in the Vorys Columbus office and chair of the health care group, was included on Columbus Business First’s “20 People to Know in Health Care” List.
- 3/27/2015Jolie Havens, the leader of the firm’s health care group, was profiled in a Columbus Business First Q&A. The questions focused on her rise to group chair at the firm and her practice.
- 11/11/2014Jolie Havens, a partner in the Columbus office and the chair of the firm's health care group, was a guest on WVXU’s Cincinnati Edition.
- 7/23/2014Jolie Havens, a partner in the Vorys Columbus office and the chair of the health care group, was quoted in a Columbus Dispatch story about two court decisions related to tax credits some individuals receive when they obtain health insurance through the federal health insurance marketplace.
- 7/1/2014Jolie Havens, a partner in the Vorys Columbus office and the chair of the health care group, was quoted in a Law360 story regarding the U.S. Supreme Court’s 5-4 decision in Burwell v. Hobby Lobby Stores Inc.
- 5/23/2014Vorys, Sater, Seymour and Pease is pleased to announce that 39 of the firm’s attorneys have been recognized among the leading practitioners in the country in the 2014 edition of Chambers USA.
- 2/3/2014Jolie Havens, a partner in the firm’s health care group, was quoted throughout a Cincy Magazine story about the Affordable Care Act’s (ACA) employer mandate.
- 1/28/2014Havens Quoted in Columbus C.E.O. Story Titled “Expert Compliance Advice: Five ACA Pitfalls to Avoid”Jolie Havens, a partner in the Vorys Columbus office and a member of the health care group, was quoted in a Columbus C.E.O. story on the issues employers and businesses owners are facing as they prepare the requirements of the Affordable Care Act (ACA).
- 10/30/2013Jolie Havens, a partner in the Vorys Columbus office and a member of the health care group, was a guest on WVXU’s Cincinnati Edition. The show she participated in was titled “Obamacare Affect on Businesses.”
- 7/10/2013Jolie Havens, a partner in the Vorys Columbus office and member of the health care group, was quoted throughout a Columbus C.E.O. story regarding the Obama administration’s decision to extend the deadline for the Affordable Care Act mandate for employers (with 50 or more employees) to offer health benefits from Jan. 1, 2014 to Jan. 1, 2015.
- 7/9/2013Jolie Havens, a partner in the Vorys Columbus office and a member of the health care group, was interviewed by Joel Riley of 610 WTVN about the Obama administration’s decision to extend the deadline for the Affordable Care Act mandate for employers by one year.
- 7/5/2013Jolie Havens, a partner in the Vorys Columbus office, was quoted in a Columbus Business First story regarding the Obama administration’s decision to extend the deadline for the Affordable Care Act mandate for employers from Jan. 1, 2014 to Jan. 1, 2015.
- 5/24/2013Vorys, Sater, Seymour and Pease is pleased to announce that 39 of the firm’s attorneys have been recognized among the leading practitioners in the country in the 2013 edition of Chambers USA. Chambers USA conducts in-depth research and ranks the leading firms and attorneys in an extensive range of practice areas throughout America.
- 3/19/2013Cincinnati partners Michael Bronson and Victor Walton and Columbus partner Jolie Havens were featured in the inaugural edition of LEAD Cincinnati in a story about the challenges employers and health care providers face as they work to achieve compliance with the Affordable Care Act.
- 11/30/2012Jolie Havens, a partner in the Vorys Columbus office, was quoted in a Columbus Business First story about the decisions employers are facing as they move forward with the implementation of policies related to the Affordable Care Act.
- 10/30/2012Jolie Havens, a partner in the Vorys Columbus office, was quoted in an Ohio Report story titled “Ohio Employers Focus On Election As Signal of Federal Health Care Law’s Future.”
- 9/9/2012Jolie Havens, a partner in the Vorys Columbus office, was quoted in a Dayton Daily News story about what might happen if the Affordable Care Act is overturned.
- 7/20/2012Jolie Havens, a partner in the health care group in the Vorys Columbus office, appeared on the Ohio News Network’s Ohio Means Business television show to discuss the steps employers need to take to comply with the health insurance mandates included in the Affordable Care Act.
- 6/29/2012Matthew Albers, G. Ross Bridgman, Jolie Havens and Linda Mendel were quoted in news stories about the U.S. Supreme Court’s decision to largely uphold the Affordable Care Act.
- 6/7/2012Vorys announced that 35 of the firm’s attorneys have been recognized among the leading practitioners in the country in the 2012 edition of Chambers USA.
- 1/4/2012Vorys announced that David A. Froling, Thomas H. Fusonie, Jolie N. Havens, Rodney A. Holaday, Jill S. Tangeman and Thomas R. Trotter have been named partners of the firm.
- 1/1/2011
- 6/24/2010
Events
- 10/25/2018On October 25-26, 2018, several Vorys attorneys presented at the 2018 Ohio Provider Resource Association Fall Conference.
- 6/5/2018Vorys Partners Jolie Havens, Elizabeth Smith and Lisa Pierce Reisz presented at the Ohio Hospital Association Annual Conference on June 5, 2018. Havens and Smith presented Into the Weeds: Legal and Business Considerations for Hospitals in the Age of Medical Marijuana and Reisz presented Navigating HIPAA’s Right to Access: Compliance Challenges and Pitfalls for 2018.
- 5/11/2018On May 11, 2018, Vorys Partner Jolie Havens addressed a group of Leadership Council on Legal Diversity Fellows in Houston, Texas.
- 5/7/2018Nine Vorys attorneys presented at The Ohio Council of Behavioral Health & Family Services Providers Compliance Training on May 7, 2018.
- 10/20/2016Several Vorys attorneys were speakers at the 2016 Ohio Council of Behavioral Health & Family Service Providers Annual Conference on October 20-21, 2016.
- 10/13/2016Vorys and The Ohio State University presented a two-day program, In-House Essential Conference on October 13-14, 2016.
- 6/28/2016Vorys attorneys Jolie Havens and Robin Canowitz were speakers at the AHLA Annual Meeting on June 28, 2016.
- 12/9/2015Vorys attorneys Jolie Havens and Stephanie Angeloni presented a webinar titled “Big Payment Change Coming For New Provider-Based Sites” hosted by Vorys on December 9, 2015.
- 6/8/2015Vorys attorneys Matt Albers, Jolie Havens and Lisa Reisz presented at the 2015 Ohio Hospital Association Annual Meeting on June 8 -9, 2015.
- 5/15/2015Vorys attorneys Jolie Havens and Kristen Carl were speakers at the Health Care Fraud and Abuse Symposium hosted by the Columbus Bar Association on May 15, 2015.
- 4/24/2015Vorys attorneys Jolie Havens and Jonathan Ishee presented a webinar titled “The Rise of Employer-Based Wellness Initiatives and Medical Clinics,” hosted by the American Health Lawyers Association on April 24, 2015.
- 6/9/2014Vorys attorneys Lisa Reisz, Jolie Havens, Michael Bronson, Victor Walton, Liam Gruzs, Linda Mendel and Matthew Albers presented at the Ohio Hospital Association’s Annual Meeting on June 9-10, 2014.
- 4/8/2014Vorys attorneys Jen Dunsizer, Jolie Havens and Linda Mendel presented a webinar on April 8, 2014.
- 11/6/2013Vorys attorneys Tom Crookes, Jolie Havens, Jen Dunsizer, Meg Everett, Ashley Manfull and Ken Stump presented at the Vorys Labor and Employment Law Conference on November 6, 2013.
- 6/11/2013Vorys attorneys Ted Mattis, Jolie Havens and Linda Mendel spoke at the Ohio Hospital Association Annual Meeting on June 10-11, 2013.
- 11/9/2012Vorys attorneys Tom Crookes, Jolie Havens, Meg Everett, Ashley Manfull and Stephanie Angeloni presented at the firm's annual labor and employment law seminar on November 9.
- 9/9/2012The Ohio Council for Home Care and Hospice Fall Conference & Tradeshow was held at the Greater Columbus Convention Center, September 18-20, 2012. The Conference focused on critical health care industry issues and initiatives with various panel presentations.
- 7/24/2012With the decision from the U.S. Supreme Court largely upholding the constitutionality of the Patient Protection and Affordable Care Act (ACA), employers should be moving full speed ahead with efforts to comply with the law. Listen to an audio recording of the program.
- 7/2/2012Vorys hosted a teleseminar addressing a number of critical questions surrounding the U.S. Supreme Court’s decision on the Affordable Care Act. Listen to a recording of the event.
- 4/12/2012Several Vorys attorneys spoke at the firm's annual Cincinnati Labor and Employment Law Update on April 12.
- 3/22/2012Vorys attorneys Matt Albers, Liam Gruzs and Jolie Havens presented a teleseminar on March 22.
- 4/7/2011
- 3/31/2011
- 9/17/2010
- 9/10/2010
- 6/11/2010
- 5/11/2010
- 4/13/2010
- 3/23/2010
Insights
- 4/3/2019On April 3, 2019, the federal Food and Drug Administration (FDA) published a notice in the Federal Register (available in full here) announcing a public hearing and related comment period regarding stakeholders’ experience with products containing the cannabis derivative cannabidiol, popularly known as “CBD.”
- 2/13/2019Is a surviving spouse responsible for her deceased spouse’s medical bills if the creditor did not properly submit a claim against his estate?
- 12/21/2018Client Alert: 2018 “Farm Bill” Creates New Opportunities for Patients, Producers of Hemp-Derived CBDOn December 20, 2018, President Trump signed the Agricultural Improvement Act of 2018, popularly known as the “Farm Bill” of 2018, into law.
- 11/5/2018The Centers for Medicare and Medicaid Services (CMS) recently published two rules designed to promote the use of telehealth and remote patient monitoring (RPM) under the Medicare program.
- 10/22/2018Effective October 1, 2018, the Centers for Medicare and Medicaid Services (CMS) implemented important changes to the Medicare Inpatient Prospective Payment System (IPPS) affecting the documentation of hospital inpatient admissions.
- 8/1/2018On July 31, 2018, the Centers for Medicare and Medicaid Services (CMS) published its proposed changes to the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2019.
- 7/13/2018A U.S. House Subcommittee recently held a hearing to discuss potential reforms to the Medicaid 340B program. Although it remains unclear exactly what will come of these discussions, here are the top three changes 340B providers should watch for.
- 6/26/2018On June 25, 2018, the federal Food and Drug Administration (FDA) approved the first drug derived from the cannabis sativa plant, commonly known as marijuana.
- 3/15/2017On March 6, 2017, House Republicans released the American Health Care Act (AHCA), their plan to repeal and replace the Patient Protection and Affordable Care Act (ACA).
- 1/16/2017Over one year after the biggest statutory change in Medicare provider-based billing, Congress enacted the 21st Century Cures Act (the Cures Act) on December 13, 2016, providing relief to certain hospitals impacted by the Bipartisan Budget Act of 2015 (the BBA).
- 7/11/2016Jolie Havens, a partner in the Vorys Columbus office and chair of the health care group, authored an article for Becker’s Hospital Review titled “Significant Reduction to Hospital Provider-Based Reimbursement Looms For New, Off Campus Sites.”
- 2/1/2016CVS recently announced that it has entered into clinical affiliations with four additional health care providers to “help enhance access to high-quality, affordable health care services for patients.”
- 1/29/2016Jolie Havens, the chair of the firm’s health care group, and Stephanie Angeloni, an associate in the health care group, co-authored an article for Crain’s Cleveland Business titled “Legislative Action Impacting Medicare Provider-Based Payment Means Big Change for Hospitals.”
- 11/13/2015The Bipartisan Budget Act of 2015 (11/2/2015) includes a rare bipartisan amendment to the Affordable Care Act (ACA). The ACA would have required that employers with 200 or more full-time employees auto-enroll their full-time employees in health coverage.
- 11/11/2015The Bipartisan Budget Act of 2015 (the Act) was enacted just days ago. When the Act takes effect, it will materially reduce reimbursement for new, off campus hospital outpatient departments (OPD), such as hospital-based clinics.
- 5/14/2015The IRS announced the 2016 indexed amounts for health savings accounts (HSAs) and high deductible health plans (HDHPs).
- 4/23/2015For years, the Equal Employment Opportunity Commission declined to provide formal guidance on the application of the ADA to wellness programs. It has now issued rules.
- 3/16/2015The IRS will need detailed information from employers to enforce three Affordable Care Act (ACA) tax provisions. The IRS must determine whether: (1) an employer owes a pay or play penalty for failing to offer affordable, minimum value health coverage to its full-time employees; (2) employees and/or their family members are entitled to tax credits (subsidies) for the purchase of health insurance in the public exchanges; and (3) employees and/or their family members owe penalties for failing to maintain health coverage.
- 11/12/2014Starting in 2015, a large employer will be subject to pay or play penalties if it fails to offer affordable health coverage that provides at least minimum value to its full-time employees. A health plan provides “minimum value” if it is designed to pay at least 60% of the total cost of medical services for a standard population. This is generally equivalent to a bronze level plan sold in the public health insurance Exchange.
- 9/17/2014If your company sponsors a self-insured health plan, there are two November deadlines you may have overlooked in the midst of preparation for the ACA’s pay or play penalties and 2015 open enrollment.
- 8/1/2014Jolie Havens, a partner in the Vorys Columbus office and chair of the firm’s health care group, authored an article for Columbus C.E.O. titled “Employers Should Move Ahead Despite ACA Questions.”
- 7/23/2014Two federal appeals courts ruled yesterday on a key provision of the Affordable Care Act (ACA) – and reached opposite conclusions. At issue is the component of the ACA that allows individuals who earn between 100% – 400% of the federal poverty level (FPL), or $11,670 and $46,680 for an individual, to be eligible to receive a subsidy to purchase insurance in a Health Insurance Marketplace
- 7/2014Several Vorys attorneys authored an article titled “Mental Health Parity and Addiction Equity Act Parity Analysis is Fine Tuned” for National Bar Association's Health Law Section July 2014 Newsletter.
- 4/22/2014Capping one of the most significant periods of antitrust enforcement in the history of the health care industry, today the Sixth Circuit delivered its opinion in ProMedica Health System, Inc. vs. Federal Trade Commission (No. 12-3583), denying ProMedica’s petition for review of the Federal Trade Commission’s (FTC) prior order, directing the divestiture of ProMedica’s acquisition of St. Luke’s Hospital in Toledo, Ohio.
- 4/15/2014On April 9, 2014, following the release of an injunction against the disclosure of the information, Centers for Medicare and Medicaid Services (CMS) posted all Medicare provider and utilization data (data) on its website.
- 2/27/2014The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) recently announced that 2013 was a record breaking year for health care fraud recovery. In total, $4.3 billion was returned to the federal government, primarily to the Medicare and Medicaid health care programs.
- 2/21/2014The employer pay or play penalties were originally scheduled to apply in 2014 but the IRS gave employers a one-year reprieve. Final regulations and FAQs published February 10, 2014 explain how the penalties will work in 2015 and provide several helpful transitional rules.
- 1/29/2014The Office of Inspector General posted OIG Advisory Opinion No. 14-01 on January 21, 2014 in response to a nonprofit senior housing and geriatric care provider’s question of whether it may pay an independent placement agency a fee for referring new residents to certain of its facilities. Despite concerns that the arrangement could potentially generate prohibited remuneration under the Anti-Kickback Statute (AKS), the OIG found that the facts and circumstances of the arrangement sufficiently mitigated any fraud and abuse risks.
- 1/21/2014Summary: ACA mandates don’t apply to health plans classified as “excepted benefits.” The government has proposed regulations expanding the definition of excepted benefits to include self-insured dental and vision coverage even if that coverage is provided without employee contributions.
- 11/22/2013On October 30, 2013, in a letter to Representative Jim McDermott, U.S. Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius clarified that qualified health plans (QHPs) available in the health insurance Marketplaces created under the Affordable Care Act (ACA) are not “federal health care programs.”
- 11/14/2013New final regulations under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) apply to group health plans in plan years beginning on or after July 1, 2014 (January 1, 2015 for calendar year plans). The regulations generally incorporate the 2010 interim final regulations and subsequent FAQs, with some notable clarifications.
- 11/8/2013The IRS has added a second exception to the use-or-lose rule for health flexible spending accounts (FSAs). Employers now have three alternatives for end-of-year health FSA credit balances...
- 10/9/2013The IRS and DOL issued new guidance prohibiting the application of pre-tax funds to the payment of individual health insurance premiums and imposing new conditions on health flexible spending accounts and health reimbursement arrangements.
- 10/7/2013On September 23, 2013 the IRS issued Notice 2013-61. The Notice sets forth streamlined refund procedures for overpayments of federal employment taxes paid by employers and employees relating to health benefits provided to legally married same-sex spouses. The Notice addresses health benefits provided both in 2013, and prior open years. The IRS had previously released Revenue Ruling 2013-17 setting forth its position that same-sex partners legally married under the laws of any state would be considered married for federal tax purposes regardless of where the couple resides. Under this state of celebration standard, the laws of the state where the marriage was celebrated (rather than the state of domicile) governs marital status for federal income tax purposes.
- 9/20/2013Jolie Havens authored a column for the Houston Business Journal outling 7 possible strategies that large Texas employers can consider to comply with the Affordable Care Act’s employer cost-sharing mandate.
- 9/16/2013In a recently published policy memorandum, the Centers for Medicare & Medicaid Services (CMS) provided guidance regarding the automatic assignment of Medicare Provider Agreements upon a change of ownership.
- 9/6/2013Marriages between same-gender spouses will be recognized for federal income tax purposes if valid where performed (the state of celebration) regardless of whether the state in which the spouses live (the state of residence) recognizes the marriage.
- 7/15/2013The postponement of the pay or play penalties and related reporting from 2014 to 2015 gives employers a welcome opportunity to reassess their compliance strategies and plan for a more measured implementation of new systems. However, the pay or play penalties are related to the availability of federal premium assistance for the purchase of health insurance on an exchange. The absence of pay or play penalties and related reporting in 2014 may increase the number of employees buying health insurance on an exchange with federal premium assistance in 2014.
- 7/8/2013The White House and Treasury announced on July 2nd that they are delaying enforcement of the ACA’s employer coverage mandate (which requires employers with 50+ full-time equivalent employees to provide affordable, adequate health coverage to substantially all of the employer’s full-time employees and their children) until 2015 to enable a more orderly roll-out of the reporting and disclosure requirements that will form the basis for the imposition of the employer penalties.
- 6/5/2013New final regulations for wellness programs apply to plan years beginning on and after January 1, 2014. If you have a wellness program and a health plan operating on a calendar year, you will want to consider the new requirements in preparing for 2014 open enrollment.
- 5/21/2013Employers must distribute a new Notice of Coverage Options to all employees (full-time and part-time, regardless of eligibility for benefits). The initial distribution of the Notice must be before October 1, 2013. Thereafter, the Notice must be given to each new employee within 14 days after work begins.
- 5/2013
- 5/10/2013Under the pay-or-play penalties going into effect next year, an employer is subject to penalties if it does not offer "affordable" health coverage to its full-time employees (using the new 30-hour federal standard). The IRS has now proposed that premium discounts and other rewards for participation in an employer-sponsored wellness program not be taken into account in determining whether the health coverage offered by your company is affordable.
- 4/22/2013On April 17, 2013, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) issued a notice completely revising its Provider Self-Disclosure Protocol (SDP). OIG originally published the SDP in 1998 to establish a process for providers to voluntarily identify, investigate, disclose and resolve potential fraud involving federal health care programs.
- 3/18/2013The Centers for Medicare and Medicaid Services (CMS) recently released a final rule on the Physician Payment Sunshine Act. The final rule imposes new reporting requirements on group purchasing organizations (GPO) and manufacturers of drugs, devices, biologicals or medical supplies for which payment is available under Medicare, Medicaid or the Children’s Health Insurance Program.
- 2/28/2013Recent government guidance addresses permissible employee cost sharing under your company's group health plan. This Vorys Client Alert summarizes what you need to know about out-of-pocket limits, annual and lifetime dollar limits, first dollar preventive care, and tobacco surcharges.
- 1/18/2013In Revenue Procedure 2013-12, the IRS recently updated the Employee Plans Compliance Resolution System (EPCRS). The EPCRS program permits a retirement plan sponsor to correct operational, coverage and plan documentation errors in certain prescribed ways so as to preserve the tax-qualified status of the retirement plan.
- 1/8/2013IRS proposed regulations (published December 28, 2012) are a roadmap to the employer pay-or-play penalties going into effect in 2014 under the Patient Protection and Affordable Care Act (the ACA). Employers may rely on the proposed regulations until further guidance or final regulations are published.
- 12/11/2012The regulatory agencies (the IRS, DOL, and HHS) have started to fill in some (but by no means all) of the gaps in the Affordable Care Act guidance needed to implement the transformation of health coverage that is supposed to happen in 2014.
- 12/7/2012The Internal Revenue Service (IRS) has released final regulations on the excise tax imposed on the sale of certain medical devices (the Device Tax) under the Affordable Care Act. The Device Tax will impact the sale of any taxable medical device by the manufacturer, producer, or importer of the device, at a rate of two-point-three percent (2.3%) of the sale price.
- 9/5/2012The most significant changes under the Patient Protection and Affordable Care Act (ACA) are scheduled to go into effect in 2014. One of those changes is the imposition of shared responsibility penalties on large employers that fail to offer health coverage to all of their full-time employees (or offer health coverage to full-time employees that is deemed to be unaffordable or inadequate).
- 6/7/2012The future of the Patient Protection and Affordable Care Act (ACA) will be determined by the Supreme Court decision expected this month. In the meantime, the regulatory agencies have continued to develop guidance that will apply to employers' group health plans – assuming health care reform survives intact.
- 4/18/2012The Patient Protection and Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute to study the effectiveness of various treatments. The Institute's work will be supported by the Patient-Centered Outcomes Research (PCOR) fee.
- 4/4/2012For the first time in decades, an Ohio agency has issued a statement on the status of the corporate practice of medicine prohibition. On March 15, 2012, the State Medical Board of Ohio (the Medical Board) published a statement unequivocally declaring that Ohio law does not prohibit an Ohio licensed physician from rendering medical services as an employee of a corporation or any other form of business entity.
- 2/15/2012An SBC is a standardized explanation of health coverage intended to help individuals make apples-to-apples comparisons of their options for health coverage. The Internal Revenue Service, Department of Labor and the Department of Health and Human Services (the Departments) published proposed SBC rules and an SBC template on August 22, 2011.
- 1/30/2012The IRS issued Notice 2012-9 on January 3, 2012, clarifying some of its earlier guidance in Notice 2011-28 on reporting the cost of health coverage on Form W-2. The aggregate cost of health coverage will be reported in Box 12 with Code DD, starting with 2012 Form W-2s (distributed in January 2013).
- 1/3/2012Starting in 2014, every non-grandfathered individual health insurance policy and insured small employer group health plan will have to cover essential health benefits.
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