Health Insurance

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South Carolina Legislative Update

The House and Senate returned last week from Easter recess with vigor. The House considered and adopted, among other pieces of legislation, a comprehensive infrastructure/road plan and revisions to domestic violence...more

Limited Relief for Certain Employer Health Plan Premium Payments or Reimbursements

Under so-called “employer payment plans” (“EPPs”), an employer pays or reimburses an employee for substantiated premium costs under individual health plan insurance coverage (i.e., nonemployer individual health plan...more

Innovation Waivers: An Opportunity for States to Pursue Their Own Brand of Health Reform

Abstract - States have long been the testing ground for new models of health care and coverage. Section 1332 of the Affordable Care Act, which takes effect in less than two years, throws open the door to innovation by...more

Challenges Facing “Narrow” Provider Networks on the ACA Health Care Insurance Exchanges

In This Issue: - The Driving Forces Behind the Trend Toward Narrower Networks - The Trade-Off - Regulatory, Legislative and Litigatious Responses to Narrower Networks Across the Nation - Judicial and CMS...more

Washington Healthcare Update

This Week: Energy and Commerce Health Subcommittee Explores Post-Acute Bundling…CMS Releases First-ever Hospital Compare Star Ratings…Fiscal Year 2016 Proposed Inpatient and Long-term Care Hospital Policy and Payment Changes....more

CMS Fines Insurer for Misleading Medicare Part D Beneficiaries

The federal agency that oversees Medicare’s prescription drug program has alleged that a major U.S. insurance company misled beneficiaries about the pharmacies included in the company’s drug plan, and imposed a $1 million...more

Illinois joins growing list of states to adopt anti-markup legislation; statute impacts all payors

After three years of negotiations between several constituencies, including pathologists, dermatologists and other specialist associations, Illinois has joined 25 states that have enacted laws addressing the practice of some...more

Locke Lord QuickStudy: Doc Fix Statute Contains a Lot More than SGR Repeal

On April 16, 2015, the President signed the Medicare Access and CHIP Reauthorization Act of 2015, commonly known as the “Doc Fix.” As has been extensively reported, the Act repeals the Sustainable Growth Rate or (SGR)...more

Competition & Regulation Update: Harper Review - Implications For The Private Health Insurance Industry

On 31 March 2015 the final report of the Competition Policy Review Panel chaired by Professor Ian Harper (Harper Review) was released. The Harper Review Panel (Panel) has completed the most comprehensive review of Australia's...more

Medicaid Expansion Leads to Economic Benefits While Improving Access to Coverage

The Affordable Care Act provides states with a powerful incentive to expand Medicaid to adults with incomes up to 133% of the Federal Poverty Level, paying for 100% of Medicaid coverage through 2016, and eventually phasing to...more

[Event] Massachusetts Employment Law Summit - May 13, Boston, MA

Employers and their HR departments are faced with a host of new issues and challenges. When you’re not navigating new state, federal, and local laws and making sure systems are in place to comply with them, you’re busy...more

Trademarks in Cuba, Successful Whistleblowers, Big Data, Health Care Encryption, Jury Instruction Tips [Expect Focus – Vol. 1,...

IN THE SPOTLIGHT · Is your Company Ready to Comply with Encryption of Individually Identifiable Health Information? LIFE INSURANCE · STOLI Schemers Must Make Good on Damages Caused · At the State Level, Is a Fixed-Index...more

Another Health Plan Hit By Massive CyberAttack and Class Actions Follow

Coming fresh off the heels of the Anthem data breach Premera Blue Cross announced on March 17th that it was the victim of a “sophisticated” cyberattack that may have exposed the personal information of approximately 11...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

Insurance Recovery Law - April 2015

Legal Issues Not Proper Expert Testimony - Why it matters: As a good reminder concerning the boundaries for admissibility of expert opinions, a federal court in Texas recently granted a policyholder’s motion to strike an...more

New York’s Surprise Medical Bill Law Goes into Effect

New York’s Emergency Medical Services and Surprise Bills law went into effect yesterday, which means consumers who receive out of network (OON) emergency services will no longer have to pay more than their usual in-network...more

CMS Discusses Medicare Implications of FDA Approval of First Biosimilar Product

CMS has issued an educational article on “Food and Drug Administration Approval of First Biosimilar Product,” and the implications for Medicare coverage. CMS states that its policies “will ensure Medicare beneficiaries will...more

House and Senate Approve Budget Resolutions with Medicare, Medicaid, ACA Provisions

On March 25, 2015, the House of Representatives approved (with no Democratic votes) H.Con.Res. 27, a budget resolution providing instructions to Congressional committees on the federal spending framework for FY 2016. Among...more

Manatt on Health Reform: Weekly Highlights - March 2015 #5

This week, Medicaid expansion gains traction in Montana, California submits its waiver application to renew DSRIP and to propose several new delivery system transformation and alignment initiatives, and the Supreme Court...more

Medigap Deductible Discount Proposal Approved by OIG

The Office of Inspector General (OIG) recently issued Advisory Opinion 15-03 and concluded that a licensed provider (the Requestor) of Medicare Supplemental Health Insurance (Medigap) would not be sanctioned under the civil...more

Hospital Wins First Round Against Largest Rival in Antitrust Suit Alleging Illegal Exclusive Dealing Agreements with Insurers

The waves of change affecting health care providers include reimbursement and funding developments, the impact of the Affordable Care Act, technological and medical advances, provider network design transformations imposed by...more

Recent Federal Court Ruling on Application of Texas Prompt Pay Laws to Self-Funded, Medicaid and Out-of-State Plans and Their...

What's new? A Dallas federal district court recently ruled that the Texas Prompt Pay Law does not apply to employer-funded health plans, Medicaid plans, or out of state patients that use Texas providers, or to a Third Party...more

Colorado Passes “Full Parity” Telemedicine Law, Although Some Gaps Remain

On March 20, 2015, Colorado Governor John Hickenlooper signed into law HB 15-1029, which requires that insurers operating in Colorado reimburse health care providers for telehealth services in all of Colorado’s counties,...more

Blog: Class Action Following Health Information Data Breach

As we discussed in our previous post, Premera Blue Cross (Premera) recently revealed that it suffered a massive data breach potentially exposing the personal data of 11 million customers. ...more

Federal Court Allows Hospital’s Antitrust Claims to Proceed on Narrow Market Definition

Winning an antitrust lawsuit hinges on defining the “relevant market,” and this case may prove the point. Methodist Health Services Corporation notched the first win in its battle against Saint Francis Medical Center as a...more

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