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ColoradoCare Stands to Significantly Alter Health Care Services

In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more

Supreme Court Exempts ERISA Plans from a State Reporting Law

In Gobeille, Chair of the Vermont Green Mountain Care Board v. Liberty Mutual Insurance Co., decided on March 1, 2016, the Supreme Court held that the Employee Retirement Income Security Act of 1974 (“ERISA”) preempts...more

Gobeille v. Liberty Mutual: The Dog That Didn’t Bark, and the Next Front in the Preemption War

Recently, we reported on Gobeille v. Liberty Mutual, in which the Supreme Court invalidated the Vermont all-payer claims data base law. Applying what appeared to us as a straight-forward application of existing ERISA...more

Supreme Court Rules that ERISA Preempts Vermont Claims Reporting Requirement

The Employee Retirement Income Security Act of 1974 (ERISA) made the regulation of employee benefit plans principally a matter of Federal concern. ERISA broadly and generally preempts—or renders inoperative—state laws that...more

Collecting Another Supreme Win for ERISA Preemption - Court in Gobeille Invalidates Vermont Data Collection Law

The U.S. Supreme Court decided the case of Gobeille v. Liberty Mutual Insurance Co. last week, in which the Court invalidated a Vermont health care data collection law as being preempted by the Employee Retirement Income...more

Manatt on Health Reform: Weekly Highlights - March 2016

HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more

Supreme Court Holds That ERISA Preempts State Health Care Services Disclosure Law

Preemption is not a foreign concept when dealing with the Employment Retirement Income Security Act of 1974 (ERISA). Preemption arguments frequently and increasingly arise, for example, in the context of claims by health care...more

Cybersecurity and Data Privacy: Big Win for Self-Insured ERISA Plans at Supreme Court (3/16)

On March 1, the Supreme Court issued a decision in Gobeille v. Liberty Mutual Insurance Company that delivered a big win for self-insured group health plans. The case involved a challenge to a Vermont law that required...more

Supreme Court: ERISA Pre-empts Vermont’s Health Data Collection Law as Applied to Self-Insured Health Plans

In Gobeille v. Liberty Mut. Ins. Co., No. 14-181, 2016 U.S. LEXIS 1612 (Mar. 1, 2016), the U.S. Supreme Court held that ERISA pre-empts Vermont’s “all-payer database” law – to the extent it is applied to self-insured health...more

Solicitors Argue to U.S. Supreme Court That Vermont Health Care Reporting Law Is Not Preempted By ERISA

The Supreme Court will soon consider whether, as applied to self-insured health benefit plans or their third-party administrators, ERISA preempts a Vermont law requiring health care payers to report claims and other data to a...more

Seventh Circuit Rules ERISA Does Not Preempt State Law Prohibiting Discretionary Clauses

In Fontaine v. Metropolitan Life Ins. Co., No. 14-1984, 2015 U.S. App. (7th Cir. Sept. 4, 2015), the Seventh Circuit affirmed a U.S. District Court for the Northern District of Illinois decision holding that Illinois’s...more

Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on...

What's new. A Texas federal district court has ruled that ERISA does not preempt or prohibit application of the Texas Prompt Pay ("TPP") law to Third Party Administrators ("TPAs") of self-funded benefit plans. Judge Lynn...more

Nation’s Highest Court Schedules Oral Arguments in King v. Burwell

A Supreme Court of the United States (SCOTUS) spokesperson announced on December 22, 2014, that the Court will hear oral arguments in King v. Burwell on March 4, 2015. This means that not only could the highest court soon...more

Health Plans Petition the Supreme Court to Determine Whether FEHBA Preempts State Anti-Subrogation Statutes

The Federal Employees Health Benefit Act (FEHBA) governs federal employee health plans and contains a broad preemption clause comparable to the one found in ERISA.1 Despite the similarity, state and federal courts are split...more

Circuit Court Split on ACA Could Impact Employer Penalties

In conflicting opinions released on July 22nd, two federal circuits split on whether Affordable Care Act subsidies are available under a federally operated health insurance exchange. “Pay or play” penalties apply only if...more

Halbig v. Burwell: A Death Blow for the Affordable Care Act?

On July 22, 2014, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled in Halbig v. Burwell that the Affordable Care Act (ACA) authorizes the issuance of tax credits to assist...more

The Check’s in the Mail - Who Is Responsible for Payment in a Delegated-Network System?

In today’s healthcare system, reimbursement issues involve not only prompt pay statutory provisions but also various risk-shifting arrangements included in a delegated-network system of managed care. When the insolvency of...more

Missouri Supreme Court Holds Federal Act Does Not Preempt Missouri Law Barring Subrogation Of Personal Injury Claims

In essence overruling a previous opinion from the courts of appeal, the Missouri Supreme Court has held that the Federal Employee Health Benefits Act (“FEHBA”) does not preempt Missouri law prohibiting the subrogation of...more

Courts Split On Whether Mandatory Contraceptive Coverage Violates Religious Freedoms Of For-Profit Corporations

Under the Patient Protection and Affordable Care Act’s preventive services mandate, non-grandfathered group health plans must provide 100% coverage of contraceptives for women, subject to exemptions and safe harbors for...more

Hospital’s State Law Claims against Health Plan Held Preempted by ERISA, Rules NJ Appellate Division

Last month a NJ Appellate Division panel held in three consolidated appeals that a NJ hospital’s state law claims that a health care plan must pay full price for medical services the hospital provided to plan participants are...more

Physician Medicare Data: Has the Drought Ended?

After 34 years, a federal district court in Florida has overturned a 1979 injunction which prevented the Centers for Medicare and Medicaid Services (CMS) from releasing to the public Medicare data related to physician billing...more

US District Court Prohibits Enforcement of California 340B Medicaid Mandatory Carve-In Law

The 340B program permits eligible hospitals and other “safety-net” providers (340B Covered Entities) to purchase outpatient drugs from pharmaceutical manufacturers at significant discounts. To address its fiscal woes,...more

Employees Who Smoke (Part II) – The Exception for Health Insurance Plans

So yesterday, I made a convincing case that employees who smoke outside the workplace can’t be treated differently than your non-smokers. ...more

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on “Optional” Medicaid Coverage

In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on...more

Letters of Protection- A Hobson’s Choice for Patient, Doctor and Attorney A Personal Injury Lawyer/ Medical Practice...

A “Hobson’s Choice” is a choice that appears to give you more than one option, but in fact only offers one option. So it is with the Letter of Protection (LOP). You, the patient, doctor or attorney, think...more

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