News & Analysis as of

Health Insurance

Read need-to-know updates, commentary, and analysis on Health issues written by leading professionals.

Stabilizing the Exchanges: CMS Issues Final Rule

by Bass, Berry & Sims PLC on

On April 18, 2017, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register a final rule (the "Final Rule") aimed at stabilizing the individual and small group health insurance markets...more

Employer Shared Responsibility: Have Penalties Been—or Will Penalties Ever Be—Assessed?

by Perkins Coie on

Are you an Applicable Large Employer (ALE) that has received rejected Forms 1095-C from the IRS? If so, you are not alone. ...more

California Advances PBM Licensing and “Transparency” Law

Last week, the California Assembly Committee on Business and Professions voted in favor of Assembly Bill 315. AB 315 seeks to amend the California Business and Professions Code: (a) to require PBMs to obtain licensure from...more

Full Steam Ahead: IRS Moves Forward to Collect Affordable Care Act Penalties

by Snell & Wilmer on

As efforts to reform the Affordable Care Act (the “ACA”) stall in Congress, a recent government report suggests that the Internal Revenue Service is preparing to identify and collect employer shared responsibility penalties....more

Health Care Weekly Preview from ML Strategies – April 2017

Welcome back everybody. While the momentum around an American Health Care Act (AHCA) comeback is unclear, there’s no discounting that efforts are ongoing to reach a consensus among House Republicans with significant pressure...more

A Spring Cheat Sheet to Congressional Health Care Policy

Welcome back, friends. While the next stretch likely won’t have the drama of the American Health Care Act (AHCA), there will be plenty happening. There are deadlines that require decisive action on behalf of stakeholders and...more

Darwinian Insurance

by BakerHostetler on

This case demonstrates the need for providers to know and follow the notification provisions set forth in their insurance policies in order to avoid an inadvertent loss of coverage. Once again, the terms of a hospital’s...more

Congress returns with Trump pressing anew for ACA repeal/replace, but with what?

Welcome back, Republicans in Congress. When you went home for spring break, constituents made raucous complaints, if you held town halls, about the GOP’s failure to repeal and replace the Affordable Care Act, aka Obamacare....more

Proving Utility, Demonstrating Value: How to Align the Moving Parts in Personalized Medicine Reimbursement

by Foley & Lardner LLP on

Of the many business, operational, legal, regulatory and clinical obstacles standing in the way of widespread delivery of personalized medicine, the single greatest challenge may lie in solving the reimbursement puzzle....more

Fate Uncertain for HHS’s Extension of ACA Discrimination Protections to Abortion & Gender Transition

by Genova Burns LLC on

In May 2016 HHS issued a final rule implementing the Affordable Care Act’s Section 1557 nondiscrimination provision, which applies to recipients of funding from HHS. The rule prohibits discrimination on the basis of gender...more

Recovery of Medical Bills: Once Is Enough

by Faegre Baker Daniels on

Strange as it sounds, Missouri state law allowed federal workers to recover medical bills twice: once under their federal health insurance plan and again from the person (or person’s insurer) responsible for their injuries. ...more

WARNING: New York Percentage Billing Arrangements Under Attack. Medicaid Frad Unit Is Seeking Recoupment from Providers Using...

New York’s Medicaid Fraud Control Unit (“MFCU”) has sent demand letters seeking recoupment from certain healthcare providers in New York State who have percentage of collection arrangements with their outside billing...more

Supreme Court says lawyer's referral of client to a doctor for treatment is attorney-client privileged communication, and out of...

The Florida Supreme Court declared that the attorney-client privilege shielded a motor vehicle accident plaintiff from being required to disclose that her attorney had referred her to a doctor for treatment. In Worley v....more

HHS Finalizes Rule Aimed at Stabilizing ACA Individual Marketplace

by Baker Ober Health Law on

On Thursday, April 13, the Department of Health and Human Services finalized a long-awaited regulation intended to stabilize the Affordable Care Act (ACA) individual health insurance marketplace. The final rule tracks closely...more

CMS Issues Final Rule to Stabilize ACA Insurance Markets, While Emphasizing Marketplace Woes

by Reed Smith on

The Centers for Medicare & Medicaid Services has published a final rule intended to help improve the risk pool and stabilize the Affordable Care Act (ACA) Insurance Exchanges for 2018 – even as CMS contends that consumers...more

NJ Out-Of-Network Update

Increased Focus on the NJ Surprise Bills Legislation - As you know, New Jersey legislators have been considering laws regulating surprise bills by out of network providers for over 8 years. Recently, activity has...more

House Amends the American Health Care Act: Where Will It Lead?

by Perkins Coie on

On the last day before the U.S. Congress began its spring recess, the U.S. House of Representatives amended the now consolidated bill H.R. 1628, known as the American Health Care Act (the AHCA). We previously discussed the...more

Second Circuit Affirms Dismissal of FCA Cases

by Jones Day on

The Second Circuit affirmed the dismissal of two False Claims Act ("FCA") cases brought by private relators against insurance and other companies based on the alleged failure to reimburse the Centers for Medicare & Medicaid...more

GOP made Obamacare popular, and polls show party’s responsible for it now

Republicans in Congress are heading home to their districts for a spring break. Will they hear again from angry constituents—but this time from zealous supporters angry that they failed to fulfill their seven-year promise to...more

House Passes Bill Blocking Federal Regulation of Stop-Loss Insurance

by Clark Hill PLC on

The U.S. House of Representatives passed the Self-Insurance Protection Act (H.R. 1304), on April 5, 2017, in an effort to preclude federal regulation of stop-loss insurance. This Act would not alter regulation of the current...more

Medicaid Reform Beyond the AHCA

While we continue to monitor Congressional efforts to repeal and replace the ACA, we are also monitoring CMS’s efforts to implement the administration’s Medicaid program goals without Congressional action. The future of the...more

News from Second and State

Weekly Wrap - Only the House of Representatives were in session this week, but it was a pretty busy week nonetheless. Topics from the budget to mandatory minimum sentences were all up for review and debate. The...more

Health Care Newsmakers J. Bradley Wilson & Michael M. Dudley

by Williams Mullen on

We are fortunate to have two industry leaders, J. Bradley Wilson, President and CEO, Blue Cross and Blue Shield of North Carolina, and Michael M. Dudley, President and CEO of Optima Health and Senior Vice President of Sentara...more

Issues to watch at the Denver NAIC Meeting

by Dentons on

As we head to the NAIC Spring National Meeting in Denver this weekend, here are just a few of the issues the Dentons IREG team will be engaged in...more

House Overwhelmingly Approves Insurance Antitrust Reform Legislation

by Reed Smith on

The House of Representatives has approved HR 372, the Competitive Health Insurance Reform Act of 2017, which would repeal the antitrust exemption for health insurance companies provided under the McCarran-Ferguson Act...more

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