Health Insurance

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Transitioning to Coverage: Three Things to Know About the New Transgender Healthcare Regulations

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act. As we discussed in our March 30, 2016 blog, the rule...more

DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over...more

Manatt on Medicaid: CMS Revises Process for Determining MMC Payments

In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more

OIG Releases Report on Washington State’s Health Benefit Exchange

The OIG recently released findings that Washington’s Health Benefit Exchange (the “Washington Exchange”) needs to be improved to fully comply with federal requirements and to protect personally identifiable information (PII)....more

Data Security Safeguards Can Help Healthcare Employers Withstand Cyberattacks—and Government Audits

The last couple of years have brought a steady rain of bad news for the healthcare industry when it comes to data security: Insurers faced with massive data breaches affecting thousands of health plans and millions of...more

Connecticut Health Law Legislative Update

Current law permits a hospital, health system, or medical school to organize and become a member of a medical foundation, which can practice medicine through its employees or agents who are physicians, chiropractors,...more

Contractual Prohibitions on Health Insurers Steering Policyholders to Lower Cost Providers Draws Antitrust Challenge

The United States Department of Justice has filed an action seeking to enjoin a hospital from enforcing provisions in its contracts with health insurers that prohibit the insurers from steering policyholders to lower cost...more

New York Legislation to Require Payment Parity for Telehealth Services

New York introduced a new bill designed to ensure commercial health plans pay for telehealth services at the same rate the plans pay for in-person services. The legislation, SB 7953, comes on the heels of New York’s...more

U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance...

On June 9, 2016, the Antitrust Division of the United States Department of Justice (“DoJ”) filed a complaint against the Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Health Care System (“CHS”) in the United...more

Insurer Held to Have Duty to Defend Allegations that Patients’ Medical Records Were Accessible Via Google Search

The Fourth Circuit Court of Appeals recently held that an insurer had a duty to defend an insured against class action allegations that the insured posted confidential medical records on the Internet. Two patients at Glen...more

Manatt on Health Reform: Weekly Highlights - June 2016#3

CMS targets short-term insurance plans in efforts to stabilize the individual market risk pool; Illinois mandates Medicaid coverage for opioid addiction treatment; and Michigan seeks to restructure State Medicaid financing....more

Hospital and Fixed Indemnity and Disease-Specific Policies in the Cross Hairs: Tri-Agency Proposed Rule Portends Some Disruption

On June 10, the Departments of Treasury, Labor, and Health and Human Services (The “Departments”) issued a set of proposed regulations dealing with expatriate health plans, excepted benefits, lifetime and annual limits, and...more

Health Law Insights Newsletter - Issue 10 - June 2016

McCarter & English, LLP’s Health Care Group presents Issue 10 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Drug Diversion Case Raises Red Flags for...more

Summary: Final Rule on Nondiscrimination in Health Programs and Activities

Section 1557 of the Affordable Care Act (“ACA”) establishes a broad prohibition on discrimination on the basis of race, color, national origin, sex, age or disability in health programs and activities. After almost 3 years of...more

Manatt on Medicaid: CMS Clarifies Medicaid Managed Care Prescription Drug Access

Editor’s Note: This “Manatt on Medicaid” is the fifth in a series of updates focused on CMS’s new Medicaid/CHIP managed care regulations. In the coming weeks Manatt will continue to explore key provisions of the regulations...more

DOJ and NC File Antitrust Suit Challenging Anti-Steering Restrictions in Payor Contracts

A popular weapon used to contain health care expenditures is the creation by payors and employers of tiered provider networks, which by differentiated co-pays attempt to steer insureds to less expensive choices. In...more

IREG Update - Global pandemic emergencies: the insurance industry tackles a seemingly unmanageable risk

Global pandemic emergencies: the insurance industry tackles a seemingly unmanageable risk - On May 21, 2016, the World Bank Group announced the Pandemic Emergency Financing Facility (PEF), a new global financing...more

Health Net Payments Trickle in to Addiction Treatment Centers as CA Regulators Investigate Insurer

As we have previously detailed, Health Net began directing a great deal of attention toward addiction treatment providers in early 2016. The payor (which has subsequently been acquired by Centene Corp.) started aggressively...more

New IRS Enforcement Interpretation Takes Aim At Tax Status Of Certain Wellness Program Payments

Employers have plenty on their plates to think about on the subject of wellness plans these days. New EEOC regulations and new court decisions will keep employers on their toes in evaluating their current wellness plan...more

Manatt on Health Reform: Weekly Highlights - June 2016#2

Arkansas’ Governor requests to transition to a “State-based Marketplace on the Federal Platform;” Louisiana launches Medicaid expansion with SNAP fast-track enrollment; and study shows 2016 premium increases are lower for...more

Why Arizona’s New Telemedicine Law Sends an Important Message

Arizona Governor Doug Ducey signed a bill (S.B. 1363) into law, on May 17, 2016, requiring private health plans to pay for telemedicine services across the whole state rather than only services received in rural areas of the...more

False Claims Act Penalties Moving Full Steam Ahead

By August 1, 2016, all federal agencies must adjust their civil monetary penalties, including penalties required by the False Claims Act (“FCA”), to account for inflation. Last month, the Railroad Retirement Board, which...more

HHS Finalizes ACA Nondiscrimination Protections for HHS Programs

The Department of Health and Human Services (HHS) has published a final rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age,...more

Ohio Prepares Medicaid Waiver Request

Ohio is preparing a Section 1115 Medicaid demonstration waiver application that, if approved, would require most of the members enrolled in Ohio’s Healthy Ohio Program to pay premiums and copayments for their health care...more

HHS Releases HIPAA Privacy and Security Audit Guidelines as it Starts its Second Round of Audits and Continues Enforcement Efforts

During April 2016 the Department of Health and Human Services (“HHS”) posted lengthy audit guidelines for HIPAA Privacy and Security on its website (over 400 pages). As HHS starts its audits of health care providers, health...more

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