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The Future of MassHealth: Five Priority Issues for the New Administration

Executive Summary - The past decade marked an era of seismic change in the Massachusetts health care market and one in which the Commonwealth led the nation in coverage and delivery system reform. In 2006,...more

HHS to Audit Hospital Reporting of GPO Payments: GAO Report Suggests Further Scrutiny of GPO Shareback with Hospitals

On November 24, 2014, the Government Accountability Office (“GAO”) published a report examining the contracting practices and funding structures of health care group purchasing organizations (“GPOs”) and their potential...more

Insurance Regulator Too 'Aggressive,' Insurers Say

Four insurance companies sued the California Department of Insurance, claiming the agency has become "increasingly aggressive" in its efforts to enforce the state's Unfair Insurance Practices Act....more

Health Care Update - December 2014

In This Issue: - FDA Releases Menu Labeling Rule - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Upcoming Congressional Hearings - Excerpt from FDA...more

New Requirements Regarding Flood Insurance in Massachusetts

On July 23, 2014 , Governor Deval Patrick signed into law “An Act Further Regulating Flood Insurance”, effective November 20, 2014. Links to the Act and to “Frequently Asked Questions” prepared by the Massachusetts Division...more

FIO Focus, No.67 - Hearing on the Impact of International Regulatory Standards

On November 18, 2014, the Housing and Insurance Subcommittee of the House Committee on Financial Services held a hearing on “The Impact of International Regulatory Standards on the Competitiveness of U.S. Insurers, Part II.”...more

Court Rules Disparate Impact Claims Cannot Be Made Under Fair Housing Act

Earlier this week, a federal district court judge struck down a regulation issued by the U.S. Department of Housing and Urban Development (HUD), which would have allowed for claims of housing discrimination to be based on...more

Do Lawyers Professional Liability Policies fall within the “no prejudice” amendments to New York’s Insurance Law for late notice?

The New York State Insurance Department has issued an ambiguous opinion taking the position that the amendment to Insurance Law §3420(a)(5), changing the “no prejudice” rule, applies to all liability policies, which arguably...more

Should the Insurance Commissioner Actually Read the Policy Forms Submitted for Approval?

Dave Jones identifies himself to voters as an activist Insurance Commissioner who champions the insurance consumers’ rights. This is the guy who took on the insurance industry practice of side arbitration agreements in...more

CMS Requests Input on Health Plan Innovation Initiatives

Medicare Advantage (“MA”) plans, prescription drug plans (“PDPs”), and other stakeholders have until November 3, 2014, to provide input into the Centers for Medicare & Medicaid Services’ (“CMS’s”) consideration of potential...more

APRA releases Aid for directors of insurers and ADIs

Directors of Australian Prudential Regulation Authority (APRA) regulated entities have additional obligations placed on them by APRA. In response to feedback received from directors, APRA has today released an Aid for...more

Insurer Sues Department of Insurance Over Multi-Million Dollar Penalty

In suing the California Insurance Commissioner on July 10, 2014, PacifiCare Life Insurance Company sought a writ of mandamus ordering the Commissioner to set aside his Decision and Order imposing a record $173 million penalty...more

Arizona Enacts Limited Privilege For Insurance Self-Audits

Arizona has enacted a privilege applicable to voluntary compliance audits conducted by insurance companies. This “self-evaluative” privilege protects audit documents and testimony in civil and some administrative proceedings....more

If A Tree Falls In The City, Is It Serving A Public Purpose?

Today’s posting has nothing to do with corporate law and everything to do with trees. On November 30 and December 1, 2011, the City of Pasadena experienced an unusually violent windstorm. Wind speeds in excess of 100 miles...more

Florida Court of Appeal Holds Insured’s Death Alone Does Not Trigger Unclaimed Property Law Obligations

In an opinion filed August 5, Florida’s First District Court of Appeal held that Florida’s unclaimed property law does not make life insurance proceeds due and payable at the time of the insured’s death and does not impose an...more

Highmark and UPMC Consent Decree

Highmark and UPMC took a major step toward resolving network participation issues June 27, 2014, by executing a Consent Decree with the Commonwealth of Pennsylvania Departments of Insurance and Health. The Consent...more

Favorable Ruling: Taxability of HMOs Under New York City General Corporation Tax

A New York City Tax Appeals Tribunal Administrative Law Judge (ALJ) recently ruled in favor of Aetna, Inc. (Aetna) on whether a health maintenance organization (HMO) was “doing an insurance business” in New York State,...more

New Washington Rule Clarifies Authority to Issue Penalties Against TPAs

The Washington State Department of Health has promulgated a new rule clarifying the Department's authority to issue civil penalties against health carriers and third-party administrators. This rule, which is outside the...more

The Future of Premium Subsidies under the Affordable Care Act: 'Halbig v. Burwell' and 'King v. Burwell'

Both decisions addressed whether tax credits are available for residents in states that have federally-facilitated health exchanges. The District of Columbia Court of Appeals said “no”; the Fourth Circuit Court of Appeals...more

How Big Is Halbig? The Viability of the ACA’s Employer Mandate Hangs in the Balance

For employers with employees in the 36 states with a federally facilitated exchange, the question arises how the Halbig decision impacts their decision and strategy to provide health coverage to their employees when the...more

A Tale of Two Circuits: D.C. Circuit, Fourth Circuit Split on ACA Subsidies

It was the best of times for ACA subsidies, it was the worst of times for ACA subsidies. On Tuesday, the Court of Appeals for the D.C. Circuit (“D.C. Circuit”) and the Court of Appeals for the Fourth Circuit (“Fourth...more

Harsh Justice

Concerned that its own decision might have "the potential to conflict" with that of the Pennsylvania Insurance Department, a Pennsylvania federal court relied on the primary jurisdiction doctrine to dismiss a putative class...more

High Court allows application for permission to bring judicial review proceedings relating to the jurisdiction of the Financial...

In this case report, Sarah Hitchins, an associate in Allen & Overy LLP’s Banking, Finance and Regulatory Litigation Group, considers the High Court’s decision to allow an application for permission to bring judicial review...more

Proposed Expansion of OIG’s Exclusion Authority

In May, the Office of Inspector General of the Department of Health and Human Services (OIG) proposed a new rule (Rule) that would implement changes included in the ACA. The Rule would expand OIG’s authority to exclude...more

I Can’t Get No SATISFACTION-- In the Eleventh Circuit, Is Discretionary Language Still "Satisfactory to Us"?

Ever since the United States Supreme Court addressed the question of whether a wholesale adoption of the "arbitrary and capricious" standard of review would be appropriate for judicial review of denial of benefit...more

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