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Looking Forward/Looking Backward – Day 1 Notes from the JPMorgan Healthcare Conference

A large amount of wind, much discussion about the U.S healthcare, and the public getting soaked again – if you were thinking about Washington, DC and the new Congress, you’re 3,000 miles away from the action. This is the week...more

What Does a Trump Presidency Mean for the Affordable Care Act?

President-elect Trump has stated repeatedly that one of his initial goals is to repeal and replace the Affordable Care Act (the "ACA"). Because the Republicans control both houses of Congress, it seems likely that a repeal...more

Researchers see ways Obamacare helped to cut costs, improve patient care

As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the...more

Q&A with Paula Williams: Guidelines allow voluntary employer wellness programs

Guidelines allow voluntary employer wellness programs - Q: A federal court recently heard a case involving a corporate wellness program. What was the basis for the Equal Employment Opportunity Commission (EEOC) lawsuit...more

Cures Act Lets Small Employers Reiumburse Premiums

On December 13, 2016, President Obama signed into law the 21st Century Cures Act, which allows small employers to maintain health reimbursement arrangements (HRAs) for the purpose of reimbursing employees for the cost of...more

Small Employers Have New Health Reimbursement Option Under Cures Act

The 21st Century Cures Act (Cures) signed by President Barack Obama on Dec. 13, 2016, contains a smorgasbord of health-related provisions, from reforming federal mental health policies to increasing funding for medical...more

The ERISA Litigation Newsletter - December 2016

This month Richard Zall, Chair of Proskauer's Health Care Department, explores developments likely to occur with respect to the Affordable Care Act as a result of the new administration. In our Rulings, Filings and...more

Will the ACA Stay or Will it Go?

After surviving two Supreme Court cases and numerous repeal efforts, the Affordable Care Act (“ACA”) is in jeopardy again. Despite the law’s uncertainty, employers may want to continue their compliance efforts because: (1)...more

Issue 104: Departments Issue FAQs on the Mental Health Parity and Addiction Equity Act and Request Comments on Tobacco Cessation...

On October 26, 2016, the Departments of Health and Human Services, Labor and Treasury (the Departments) published issue 34 of their series of FAQs on the Affordable Care Act, found here. The FAQs discuss the Mental Health...more

ACA Tax Reporting Extensions

The IRS has once again extended the deadline for furnishing to employees the applicable tax forms required by the Affordable Care Act (ACA), and will continue to provide employers with penalty relief if they make good-faith...more

Employment Law This Week®: FLSA Overtime Rules, NYS Overtime Laws, National Origin Discrimination, Foreign Workers [Video]

We invite you to view Employment Law This Week® - a weekly rundown of the latest news in the field, brought to you by Epstein Becker Green. We look at the latest trends, important court decisions, and new developments that...more

Employers Need To Be Aware Of Potential Pitfalls Of Providing Opt-Out Incentives To Company Health Insurance

In recent proposed regulations, the Internal Revenue Service (IRS) addressed how the Affordable Care Act (ACA) impacts the use of employer opt-out incentives, which are payments to employees who decline an employer’s group...more

Issue 102: ACA Post-Election Outlook

This is the one hundred and second issue in our series of alerts for employers on selected topics on health care reform. This series of Health Care Reform Management Alerts is designed to provide an in-depth analysis of...more

Reminder: November 15 Transitional Reinsurance Program Filing Deadline is Fast Approaching

To help stabilize the individual insurance market, Section 1341 of the Affordable Care Act introduced the Transitional Reinsurance Program (TRP), which includes the collection of a TRP fee from “contributing entities” for...more

Entities that are subject to the Affordable Care Act’s Nondiscrimination Rules must post notice by October 17, 2016 and implement...

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

Dealing with Long-Winded Out-of-Network Provider Nuisance Letters

Over the past couple years, more and more of my clients with self-funded plans have received letters from out-of-network providers appealing denied claims. The letters are usually 20 to 30 pages long, not very specific, and...more

HIPAA Compliance – Not Just an Issue for Health Care Providers

Many people believe that compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is solely an issue for health care providers and their affiliates. However, nothing could be further from the...more

Check Your Neutral Policies: The EEOC Joins the ACLU’s Challenge to Dignity Health’s Exclusion of All Care Related to Sex...

The ACLU filed a complaint against Dignity Health, claiming that the total exclusion of care related to “sex transformation surgery” in Dignity’s employee health insurance plan is unlawful sex discrimination. Now the EEOC...more

What is Telemedicine? A Cool Benefit or a Hot Mess?

We’ve had numerous inquiries lately about telemedicine benefits. My clients most typically ask either “is this a group health plan?” or “is it just access to another provider?” Clearly, there is much confusion surrounding...more

Hospital and Fixed Indemnity Policies; Excepted Benefits; Supplemental Coverage under Recently Proposed Treasury Regulations; and...

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Michigan Health Insurance Claims Assessment Act is Not Preempted by ERISA

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

Health Plan Case Managers Entitled to Overtime Pay

Managed care companies help insurers and government programs coordinate healthcare plans by making coverage determinations for participants. In many situations, case managers conduct utilization reviews to determine the...more

Proposed Changes to Form 5500 Would Significantly Increase Reporting Obligations for Health and Welfare Plan Sponsors

Summary - On July 11, 2016, the Department of Labor (DOL) and Internal Revenue Service (IRS) announced a proposal to implement significant changes to the forms and regulations that govern annual employee benefit plan...more

ERISA: 2nd Circuit — Mental Health Provider Lacks Standing to Challenge ERISA Benefit Denial

Who can challenge an ERISA benefit denial? Does a physician have standing to challenge the denial of a patient’s coverage? It depends....more

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