Attorneys looking to formulate plans to help clients comply with the Affordable Care Act as it continues to unfold have a lot of questions themselves, say some sources here who are watching the sweeping health-care reform efforts.

As a key component of the Affordable Care Act, Washington state is setting up a health insurance exchange. The exchange, to be called Healthplanfinder, is intended to be an online market place for small businesses, families, and individuals in Washington to compare policies and gain access to health-care coverage from a number of options.

"The biggest things we don't know yet are how the concept of integrated health is going to play out, and which insurance companies want to be players in our market and which don't," says Mary Giannini, a health care attorney at the Spokane law firm Witherspoon Kelley.

The exchange is scheduled to begin enrolling participants on Oct. 1 for coverage beginning on Jan. 1, 2014. The state has received $150 million in federal grants to start up the exchange. The federal government will set up health insurance exchanges for states that choose not to operate their own exchanges.

Penny Youde, executive director of the Spokane County Bar Association, says she's also looking for guidance to find out how different companies are implementing or modifying health-care coverage under the Affordable Care Act.

She says she imagines smaller law firms also need some guidance.

"We're looking at doing some kind of a seminar to help smaller firms that don't have access to someone in that (compliance) area," Youde says. "We need someone to give us a little education on that."

Giannini says the Affordable Care Act likely will lead to a lot of legal work in the growing field of health care law.

"Health care has gotten to be fairly specialized," she says. "Some big firms in Seattle and San Francisco can put together 15 to 20 health-care lawyers."

Some facets of health-care work here have shrunk, she says, noting Witherspoon Kelley previously has done more legal work for the four largest hospitals here than it does now.

"Now, major hospital systems have in-house counsel," she says.

Giannini joined Witherspoon Kelley 22 years ago, working closely with K. Thomas Connolly, a principal of the firm, who, she says, was one of the first health-care attorneys in Spokane.

Today, Witherspoon Kelly is Spokane's largest law firm, with 42 attorneys, eight of whom are most involved in providing services to health-care clients. Largely as a result of the Affordable Care Act, the practice group includes a recently hired employee-benefits attorney.

Others attorneys at the firm work with the group as their expertise is needed on issues ranging from antitrust to tax concerns, she says.

Group Health Cooperative, the Seattle-based health care system that's the second largest health-plan provider in Eastern Washington, isn't looking at increasing its legal staff, says Mary Weiler, associate general counsel for the cooperative.

"The Affordable Care Act has added numerous additional regulatory requirements at the federal level, along with the implementation of a new state-based exchange, and regulation by the (Washington state) Office of the Insurance Commissioner," says Weiler, whose Seattle-based office provides counsel throughout the Group Health system.

Assessing requirements of the act and how they interact will be a vital task for health-care attorneys, she says.

"We have been looking at legal, regulatory, and compliance issues in a new way—fully utilizing the strengths of our legal, regulatory, and compliance staff in a more collaborative manner because of the complexities of the Affordable Care Act," Weiler says.

Giannini says lawyers here might expect to handle as many questions from care-provider clients as from employers as the Affordable Care Act is further implemented.

Compliance will be a big issue as the Affordable Care Act focuses on fraud-and-abuse prevention, Giannini says.

One Witherspoon Kelley attorney, who specializes in white-collar defense, will handle health care cases involving "mistakes, accidents, and occasional screw-ups regarding health-care regulations," she says.

New rules under the Health Insurance Portability and Accountability Act are tied in with objectives of the Affordable Care Act to ensure privacy of the information.

"More and more issues are coming up about privacy and health care information," Giannini says. "It's turning into a significant practice area."

Under the act, the provider is obligated to inform the federal government and the patient whenever there is a breach of data.

"If there's a breach in the physician's office, it has to be reported," Giannini says. "Not surprisingly, we've got thousands of reports of breaches."

She says the U.S. Department of Health and Human Services is making efforts to educate providers before imposing heavy sanctions.

"The first round of audits is recognizing deficiencies and recommending what to do about them," she says, adding that government auditors "tend not to be so lenient when it's clear that the provider hasn't developed policies or trained staff or not exhibited concerns" about HIPPA compliance.

In addition to hospitals and physicians, nursing care and mental health providers also are concerned about the future of federal and state reimbursement policies, she says.

"A lot of providers are trying to figure out where they fit in if reimbursement changes," she says.