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CMS Takes Action Against Network Transparency While New Jersey Legislation Hits a Snag

Just as the Centers for Medicare & Medicaid Services (CMS) began holding federal health care plans accountable for their provider network transparency obligations, the New Jersey legislature stalled in its bid to pass a law...more

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

CMS details requirements for Kentucky's transition to HealthCare.gov; a new special enrollment period is established for subsidy-eligible individuals who failed to file their 2014 taxes; and President Obama sends his final...more

Do Your Assignment of Benefits Clauses Need a Check-up? Recent Southern District of Florida Decision Highlights the Importance of...

A frequently litigated issue in reimbursement cases brought by in- and out-of-network healthcare providers against insurers under the Employee Retirement Income Security Act of 1974 (“ERISA”) is provider standing. Because...more

The Societal Impacts of a Pandemic Outbreak [Video]

From the 2015 PLUS Conference session “Coming to America: PLI Exposures from Ebola & Other Pandemics,” David Lakey, M.D. (Texas Department of State Health Services) discusses the potential community and health issues that...more

Health Care Outlook for 2016

In 2016, the Affordable Care Act will continue to be a contentious issue involving opposing legislative efforts and presidential debates. It has already been a major talking point in the campaigns of multiple 2016...more

Senate Bill Would Strengthen Mandate That People With Disabilities Be Integrated in the Community

Senator Charles Schumer (D-NY) recently introduced the Disability Integration Act of 2015 (DIA) in the U.S. Senate. If passed, the bill would require states and health insurers to provide services to people with disabilities...more

Is This The Year Florida Recognizes Direct Primary Care?

Florida House Bill 37 and Florida Senate Bill 132, similar bills aiming to expressly authorize and regulate direct primary care medical home plans in the State of Florida (“DPCs”) and both stating that DPCs are not...more

Manatt on Health Reform: Weekly Highlights - February 2016

Virginia submits a $1 billion DSRIP application; Michigan's Governor will request authority to extend Medicaid coverage to Flint residents aged 21 and under; and Hawaii reinstates small business tax credits in its updated...more

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

Louisiana's Governor pushes ahead on Medicaid expansion, while expansion is blocked by Wyoming's Legislature; Massachusetts plans to submit a 1332 waiver application to preserve its merged markets; and CBO lowers its 2016...more

US Policy Scan 2016

Virtually the only certain political outcome of 2016 is that voters will select a new president to enter the White House in 2017. Against this backdrop, the legislative and electoral outlook in Washington, DC, remains steeped...more

Drug Costs, Risk Adjustment Drive Q2 Health Insurance Rate Increases

The Massachusetts Division of Insurance (DOI) recently held a two-day hearing on rate changes proposed by Massachusetts health insurance plans to be effective for the second quarter of 2016 (Q2). Presentations by carriers, in...more

SURPRISE!!! The NJ Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act Goes Forward and...

On November 17, 2015, New Jersey lawmakers forged ahead with the controversial legislation that addresses, among other things, “surprise” medical bills from out of network providers. According to its sponsors, the purpose of...more

Medical Malpractice and Healthcare Quarterly - Winter 2015-2016

DELAWARE MOVES TO MAKE TELEMEDICINE MORE ACCESSIBLE - On July 7, 2015, Governor Jack Markell signed into law House Bill No. 69 (DE LEGIS 80 (2015), 2015 Delaware Laws Ch. 80 (H.B. 69)), which amends various provisions of...more

Redial: 2015 TCPA Year In Review – Analysis Of Critical Issues And Trends

The Litigation Group of Sutherland Asbill and Brennan LLP has published REDIAL: Redial: 2015 TCPA Year In Review – Analysis Of Critical Issues And Trends. This publication reflects our in-depth analysis of significant...more

eCommerce Regulation, Bitcoin, Anti-Money Laundering, Shadow Insurance, 401(k) Litigation [Expect Focus – Vol. IV, Fall 2015]

IN THE SPOTLIGHT - - California Passes Life and Annuity Electronic Transactions Law LIFE INSURANCE - - Under a Spotlight, "Shadow Insurance" Lawsuit Fails Scrutiny - NAIC Evaluates Insurer’s Use of Variable...more

Check--and Double Check--to Avoid Professional Liability in New Jersey

A recent New Jersey Supreme Court decision warns that health-care facilities that fail to do appropriate due diligence before granting privileges to physicians could face potential liability for that failure. In Jarrell v....more

2015 – The Health Law Year in Review

With 2015 in the books, we are pleased to reflect on some of the major developments over the past year in the field of health law. The year was marked by changes in Medicare payment models—from government pronouncements...more

Cadillac Tax Effective Date Postponed (and Three Other 2015 Year End Health and Welfare Benefits Legislation Highlights)

While Americans everywhere were busy eating turkey and drinking eggnog last November and December, our government was hard at work attending to budget matters. Tucked among the appropriations were several fairly significant...more

CMS approves $25 billion California Medi-Cal 2020 Demonstration Project

On December 30, 2015, the Centers for Medicare and Medicaid Services (CMS) approved a new Section 1115 Demonstration Project for California which could total $24.8 billion over a five year period to serve the uninsured and...more

HHS and Treasury issue guidance on 1332 waivers

While the Affordable Care Act (ACA) created a multitude of new requirements centered around the subsidies to individuals in the new Marketplaces, it also created a potential safety valve for states to make adjustments to the...more

States Launch Hearings on Major Insurance Company Mergers

This summer, in the space of only a few weeks, Aetna announced an intention to acquire Humana, followed by an announcement by Anthem that it was planning to merge with Cigna. As was widely reported at the time, if...more

Solicitors Argue to U.S. Supreme Court That Vermont Health Care Reporting Law Is Not Preempted By ERISA

The Supreme Court will soon consider whether, as applied to self-insured health benefit plans or their third-party administrators, ERISA preempts a Vermont law requiring health care payers to report claims and other data to a...more

Medicare Data Not Indicative of Overall Healthcare Spending Costs

In December 2015, a  research team at Carnegie Mellon published a paper titled “Examining the Variation in Health Spending and in Hospitals’ Transaction Prices” after receiving access to insurance claims data from Aetna,...more

Whether Naughty or Nice, Recovery Audit Contractors Are Coming to Medicare Advantage

During the holiday season lull, the Centers for Medicare and Medicaid Services (CMS) issued a weighty document. The agency put out a draft statement of work to procure Recovery Audit Contractors (RACs) for the Medicare...more

Manatt on Medicaid: CMS Approves Michigan’s Waiver Amendment to Implement Reforms to ACA Medicaid Expansion

On December 17, 2015, the Centers for Medicare and Medicaid Services (CMS) approved Michigan’s request to amend its Healthy Michigan Section 1115 demonstration, through which the State provides coverage for more than 594,000...more

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