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Manatt on Health Reform: Weekly Highlights: November 2014 #4

In this week’s highlights, new proposed guidance from the feds would allow default renewals to lower cost plans and bring enhanced transparency to Qualified Health Plan rate increases; open Enrollment hits its stride –...more

National Association of Insurance Commissioners Releases Draft Model Law Updating Managed Care Adequacy Model Act

On November 12, 2014, the National Association of Insurance Commissioners (“NAIC”) released a draft model law updating the NAIC’s Managed Care Network Adequacy Model Act. The NAIC regularly creates model laws to serve as...more

No Private Right to Recoup Funds Based on Corporate Practice of Medicine Violation

The United States District Court for the Western District of Washington ruled recently that the state’s corporate practice of medicine doctrine does not provide a private right of action, either express or implied, and...more

Another Lawsuit Adds to Uncertainty About ACA

On November 21, House Republicans filed a lawsuit to challenge certain provisions of the Affordable Care Act (ACA). The suit disputes two actions by the Obama Administration in implementing the law: a delay in the...more

Manatt on Health Reform: Weekly Highlights: November 2014 #2

With the conclusion of the midterm elections last week and open enrollment just around the corner, this week’s news highlights both renewed pledges from the opposition and a flurry of implementation activity in the states....more

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...more

Manatt on Health Reform: Weekly Highlights: November 2014 #3

With the 2015 Open Enrollment Period (OEP) officially launched as of November 15, this week’s news highlights Marketplaces’ preparation for and tracking of outreach and enrollment – including 100,000 applications submitted on...more

HHS Extends November 17 Deadline to Submit Covered Lives Data under Reinsurance Program

The Health Care Reform Act created the transitional reinsurance program, which requires most self-insured health plans to make contributions to HHS for the 2014, 2015, and 2016 calendar years, in an attempt to stabilize...more

CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up. Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp. Lifespan filed the claim after being ordered...more

Insurance Antitrust Legal News - November 2014 - Volume 3 - Number 6

Plaintiff Files Third Amended Antitrust Claim Against Highmark - A long running antitrust dispute in Western Pennsylvania continued on October 1, when a Pennsylvania hotel (Cole’s Wexford Hotel) filed a third amended...more

Health Care Update - November 2014 #2

In This Issue: - Smoother Open Enrollment Sets Stage for Shift in Congressional Focus - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional...more

The Massachusetts Health Insurance Mandate: Some Good News for Massachusetts Taxpayers

Since 2007, most Massachusetts residents have been required to either obtain health insurance coverage meeting Massachusetts “minimum creditable coverage” standards, or pay a state tax penalty (for 2014, the penalty ranges...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 6: Labor and Treasury Departments Play Whack-a-Mole with...

Last year, the Department of Labor and the Treasury Department/IRS (Departments) issued guidance on the application of certain of the Affordable Care Act’s insurance market reforms to health reimbursement arrangements (HRAs),...more

Supreme Court will hear King v. Burwell

On November 7, the Supreme Court announced it would hear its second significant legal challenge to the Affordable Care Act (ACA). King v. Burwell, expected to be heard this spring and ruled on by the end of June, is a direct...more

California Court of Appeal Rules That California Regulation Section 1300.71(a)(3)(B) Is Not the Exclusive Standard for Valuing the...

Children’s Hospital Central California v. Blue Cross of California (2014) 226 Cal.App.4th 1260, involved a dispute between a hospital and a health plan over the reasonable value of the post-stabilization medical services that...more

California Court of Appeals Holds That the California Mental Parity Act Covers Residential Care for Anorexia Nervosa Even When the...

In Harlick v. Blue Shield of California (9th Cir. 2012) 686 F.3d 699, the Ninth Circuit interpreted the provisions of the California Mental Health Parity Act (Health and Safety Code § 1374.72) and its implementing regulation,...more

CMS Announces Indefinite Delay in Use of HPID

All Actions as to HPIDs Should Stop. With a November 5, 2014 deadline looming for large health plans to obtain a Health Plan Identifier (HPID), the Centers for Medicare & Medicaid Services (CMS), Office of e-Health Standards...more

Supreme Court Grants Review in ACA Tax Subsidies Case

The Supreme Court announced on Friday that it would hear King v. Burwell, a case challenging whether tax subsidies are available to individuals purchasing health insurance through the Federal exchange rather than State...more

U.S. Supreme Court Agrees to Hear Arguments Involving Federal Health Insurance Exchange Subsidies

On Friday, the U.S. Supreme Court announced that it would review the U.S. Court of Appeals for the Fourth Circuit’s decision in King v. Burwell. In that case, the Fourth Circuit held that tax credits for health insurance...more

Supreme Court to Decide Who Is Entitled to the Federal Health Care Subsidy

Are the federal government’s subsidies to purchasers of health insurance available only to those who purchase insurance from state-run exchanges or to those who purchase from federal health care exchanges as well? Was the...more

Employment Law Reporter – November 2014: The Impact of Burwell v. Hobby Lobby

Has the Supreme Court “ventured into a minefield,” by its “decision of startling breadth,” as Justice Ruth Bader Ginsburg wrote in her dissent to Burwell v. Hobby Lobby? In Hobby Lobby, the Court held that the contraceptive...more

Privacy Tuesday – November 2014 – Five Things to Start Your Week

Welcome to Privacy Tuesday – here are five privacy & security bits and bytes to start your week: 1) California AG’s Data Breach Report: Who Is Handling Your Patients’ Confidential Health Information? - The...more

Special Edition Health Care Update - Elections Wrap Up, Lame Duck Preview, and a Changing Congress

In This Issue: - Impact of Midterm Elections - Lame Duck Preview - Ebola Epidemic and Lame Duck Response - Implementation of the Affordable Care Act - Other Federal Regulatory...more

ACA’s Transitional Reinsurance Fee Due for Self-Insured Employers

Self-insured employers need to be mindful of two important Affordable Care Act (ACA) deadlines — the Transitional Reinsurance Fee and the Patient Centered Outcomes Research Institute (PCORI) Trust Fund Fee....more

U.S. Supreme Court Takes Up Major Challenge to Federal Health Reform

Are Employers in the 34 States Without Exchanges Subject to Penalties? - Despite the fact that there is no longer any disagreement in the lower courts, the Supreme Court on Friday, November 7, 2014, made the unusual...more

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