When the Affordable Care Act (ACA) became law more than 10 years ago, Ballard Spahr lawyers concentrating in health, employee benefits, and labor and employment law launched our Health Care Reform Initiative to track related legislative and regulatory developments. As we move into a third presidential administration with the ACA as the law, our team remains focused on Health Care Reform—Version 3.0.

Over the past decade since the ACA took effect, we’ve created and maintained a dashboard tracking relevant laws and regulations, issued dozens of our own timely alerts and guidance, written books, and hosted countless programs, including reporting on the numerous litigation challenges to the ACA over the years. Guided by our deep knowledge of the law and years of health industry experience, we have prepared clients for legislative and regulatory changes and helped them meet new requirements quickly and effectively.

As the ACA has become more integrated into a broader array of health care reform measures, we have expanded our Health Care Reform Dashboard to cover a wider range of developments, including those involving health information privacy and security, wellness programs, and the COVID-19 pandemic. We provide information and insight informed by our deep experience with the ACA along with a panoply of other laws, such as HIPAA, COBRA, ERISA, the FFCRA, and the CARES Act.

In 2021, we expect another pivotal Supreme Court ruling on the constitutionality of the ACA, extensions of COVID-related waivers and other regulatory guidance, and changes to the ACA and other federal programs that will shape how health care is provided and paid for in the United States.

Ballard Spahr's Health Care Reform team focuses on areas of concern to health care providers and health care reimbursement, including:

  • Health information technology (including telemedicine)
  • Medicare fraud and abuse regulation and enforcement
  • State regulation of corporate medical practice and licensure
  • Requirements for tax-exempt provider organizations and charitable hospitals
  • Transparency requirements

In the area of health benefits, we have advised employers and other health plan sponsors on a wide range of legislative, regulatory, and market developments. Because all employers are affected by the ACA, lawyers on the team also focus on legal developments involving:

  • Health plan responses to COVID-19 guidance
  • Employer-based health care coverage requirements
  • Employer mandates
  • HIPAA privacy and security developments
  • Employee and small-employer subsidies
  • Wide-ranging ACA market reforms, including coverage requirements for adult children and preventive care
  • Prohibitions against preexisting coverage exclusions, dollar caps on essential health benefits
  • Waiting period restrictions
  • Summaries of Benefits and Coverage
  • Coordination of private plans with Medicare, including advice on exceptions for retiree-only plans, the Medicare Secondary Payor Rules, and retiree drug subsidies
  • Drafting of vendor contracts for Medicare Advantage plans and Employer Group Waiver Plans and preparation of Certificates of Creditable Coverage under Medicare Part D
  • Employer plan-required benefits, dependent coverage, and reporting requirements
  • Part D prescription drug plans and other retiree health plans
  • Wellness and prevention programs and incentives
  • Health savings accounts, health reimbursement accounts, and flexible spending accounts and transition provisions
  • Multiple-employer welfare arrangements
  • Government and church plans