The Centers for Medicare & Medicaid Services (CMS) has issued guidance on how health insurers must report and rebate recoveries obtained from the federal government under the Supreme Court’s 8-1 decision in Maine Community...more
Cost-Sharing Reduction (CSR) Payments Take Effect. Under Section 1402, the Affordable Care Act (ACA) implements a plan for reducing the amount of out-of-pocket costs, such as deductibles and co-payments, that lower-income...more
On April 27, 2020, the U.S. Supreme Court decided Moda Health Plan, Inc. v. United States, holding that the Affordable Care Act requires the federal government to compensate insurers for significant losses their health plans...more
4/29/2020
/ Affordable Care Act ,
Appropriations Bill ,
Court of Federal Claims ,
Damages ,
Government Payments ,
Health Insurance ,
Insurance Industry ,
Land of Lincoln Mutual Health Insurance Co. v. United States ,
Maine Community Health Options v. United States ,
Moda Health Plan Inc. v. United States ,
Reimbursements ,
Remand ,
Repeal ,
Reversal ,
Risk Corridors Statute ,
SCOTUS ,
Tucker Act
In December 2018, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a declaratory judgment finding that the individual mandate provision of the Affordable Care Act (ACA) was no longer...more
A federal judge has ruled that health insurers under the Affordable Care Act are entitled to unpaid cost-sharing reduction (CSR) payments from the government. Insurers sued following the Trump administration’s October 2017...more
A federal district court in Fort Worth, Texas struck down the entire Affordable Care Act (ACA) last Friday in a ruling that’s prompting questions about whether its legal reasoning will withstand further scrutiny, and whether...more
On October 12, 2017, the Trump administration announced that it would immediately stop making cost-sharing reduction (CSR) subsidy payments under Section 1402 of the Affordable Care Act (ACA). CSRs allowed — and in fact...more
In a crowded courtroom on January 10, the U.S. Court of Appeals for the Federal Circuit held oral argument on appeals of two Risk Corridors decisions from the Court of Federal Claims. The two cases, Land of Lincoln and Moda,...more
On November 13, 2017, the Centers for Medicare & Medicaid Services (CMS) announced its Risk Corridors payment and charge amounts for the 2016 benefit year. This event is significant in that it both acknowledges and quantifies...more
On October 25, 2017, in the case State of California v. Trump, the U.S. District Court for the Northern District of California denied a motion brought by 17 states seeking to order the Trump administration to resume...more
On October 12, 2017, the Trump administration announced that it will immediately stop making cost-sharing reduction (CSR) subsidy payments, which allow health insurers to defray out-of-pocket costs to insure low-income...more
Amid assertions that the Affordable Care Act (ACA) should be allowed to fail, the Trump administration has indicated that it may stop paying subsidies that are central to ACA markets. At the core of these subsidies are...more
For health insurers concerned about when they may receive government payments through the Affordable Care Act’s (ACA) risk corridor program, court decisions have provided little clarity. An April 18 decision by Judge Griggsby...more