Health Insurance

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Manatt on Medicaid: Kentucky Update—Outgoing Governor Beshear Argues for Continuation of Medicaid Expansion and State-Based...

In an impassioned speech on November 13, 2015, outgoing Kentucky Governor Steve Beshear (D) made the case for why Governor-elect Matt Bevin should continue the healthcare reforms enacted in Kentucky under the Affordable Care...more

Second Circuit Reminds Healthcare Providers to Seek Relief from Insurance Companies Under Their Own Contracts, Not the Insureds’...

In Rojas v. Cigna Health and Life Ins. Co., 793 F.3d 253, 258 (2d Cir. 2015), the Second Circuit joined several other circuits in holding that “healthcare providers are not ‘beneficiaries’ of an ERISA welfare plan by virtue...more

A&B Healthcare Week in Review, November 2015

I. REGULATIONS, NOTICES, & GUIDANCE - On November 21, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and...more

Washington Healthcare Update

This Week: Congress tries to put together a tax extender package, which may provide an opportunity for some Affordable Care Act changes... HHS releases final rule on bundled payment for Joint Replacement Comprehensive Care...more

The baby boomer gamblers: Running out of money

As the first of the baby boomers have reached retirement age, the greatest financial threat to the American middle class is silently waiting for them. Most are unprepared for what actuaries call “longevity risk.” The real...more

Manatt on Health Reform: Weekly Highlights - November 2015 #3

Kansas legislators supportive of Medicaid expansion are pulled from committee; Montana’s Medicaid expansion is off to a strong start; and New Mexico sees declines in uncompensated care since ACA implementation....more

HHS Appeals Adverse Decision on Fixed Indemnity Attestations

As expected, on Monday, November 9, 2015, the U.S. Department of Health & Human Services (HHS) filed a Notice of Appeal from the decision issued by Judge Royce Lamberth of the United States District Court for the District of...more

Summary of HUD's LEAN 232 Program Email Blast Office of Residential Care Facilities (ORCF) October 30, 2015

In an effort to summarize the highlights of the LEAN Email Blasts that we receive, and rarely have time to review in a timely fashion, we at Pepper Hamilton are providing this quick synopsis of the latest LEAN update. Our aim...more

Manatt on Health Reform: Weekly Highlights - November 2015

Montana receives approval to expand Medicaid beginning 2016; California’s $6.2 billion Medicaid waiver receives pre-approval; and HHS proposes broadening circumstances under which states receive enhanced federal matching...more

New FAQs on Preventive Services, Wellness Program Rewards and Mental Health and Substance Use Treatment: McGuireWoods Healthcare...

This is the 54th in a series of WorkCite articles concerning the Patient Protection and Affordable Care Act and its companion statute, the Health Care and Education Reconciliation Act of 2010 (referred to collectively as the...more

Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications

On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the...more

Congress Takes Long Look at Proposed Health Insurance Mergers

While the Department of Justice Antitrust Division is responsible for reviewing the proposed Anthem/Cigna and Aetna/Humana mergers for any potential competitive concerns, Congress jumped into the process with both feet in...more

Health Alert (Australia) - November 2, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments Australian Capital Territory 29 October 2015 - In the matter of ER (Mental Health and Guardianship and...more

OCR Audits to Begin in 2016

Beginning in 2016, the United States Department of Health and Human Services’ Office for Civil Rights (OCR) will conduct another round of audits to gauge compliance with privacy provisions in the Health Insurance Portability...more

Health Care Mergers Come Under Scrutiny

In July, 2015, Aetna struck a deal to buy Humana for $37 billion, which would cover 33 million members. Merging with Humana would give Aetna more than one-quarter of the total Medicare Advantage market, analysts say. In...more

New Texas Medical Stop-Loss Rules Drafted by Texas Department of Insurance

Within an environment of increased federal and state regulatory emphasis on health insurance related issues arising due to the passage by the U.S. Congress of the Patient Protection and Affordable Care Act of 2010, the Texas...more

Health Insurance Company Unitedhealth Discussing Possible Merger

In the health care industry, saying competitive and operating efficiently is important for survival, and businesses in this industry need to continually seek to consolidate resources to ensure they are operating in as...more

Insurers May Not Terminate Physicians for Recommending Out-of-Network Providers

Under a new Texas law, effective September 1, 2015, health maintenance organizations (HMOs) and Preferred Provider Benefit Plans (PPO) (collectively referred to as "Insurers") can no longer terminate a physician from their...more

Health Care Update - October 2015

Senate Working Group Pressing Forward on Telehealth - As Congress focuses on bigger picture policy decisions, including broad budget negotiations and raising the debt ceiling, there are some exciting developments on the...more

Manatt on Health Reform: Weekly Highlights - October 2015 #4

HHS announces average premium price increases of 7.5% across; Michigan and Illinois launch the country’s first joint cloud-based, real-time Medicaid information management system; and the Marketplace carrier...more

House Passes Budget Reconciliation Bill with ACA Mandate, Tax Repeal Provisions

On October 23, 2015, the House of Representatives approved H.R. 3762, budget “reconciliation” legislation that includes provisions to repeal of four provisions of the Affordable Care Act (ACA). Specifically, the legislation...more

Manatt Digital Media - October 2015

In this newsletter, we highlight some of the ways digital technologies are transforming healthcare and the opportunities and challenges they present to individuals and businesses. We also introduce you to our team at Manatt...more

IRS Adjusted ACA Fee Amounts for the 2015/2016 Policy or Plan Years and Additional Payment Options

The Patient-Centered Outcomes Research Institute (PCORI) fee was established under the Affordable Care Act (ACA) to advance comparative clinical effectiveness research. The PCORI fee is assessed on issuers of health insurance...more

Health Alert (Australia) - October 19, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments New South Wales (NSW) 12 October 2015 - Klewer v Sydney Children’s Hospital Specialty Network [2015] NSWSC...more

Washington Healthcare Update

Bicameral Bill Introduced to Provide HHS Authority to Reject Proposed Insurance Rates - Before Congress left for its Columbus Day recess, Rep. Jan Schakowsky (D-IL) and Sen. Diane Feinstein (D-CA) introduced the Health...more

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