Enrollment

News & Analysis as of

Recent Decisions Applying the Covalt and Hartwell Test

Two California Courts of Appeal recently reviewed decisions involving the California Public Utilities Commission in a pair of cases that build on the principles established by the California Supreme Court in Covalt and...more

Employers’ Guide to the Ontario Retirement Pension Plan

The Ontario Retirement Pension Plan (the ORPP), will be a provincially-managed plan that, like the Canada Pension Plan, will be funded by equal co-contributions from both employers and employees. It will come into effect as...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

CBO’s Budget Forecast and the Silver Tsunami

This week, the Congressional Budget Office (CBO) released a projection that shows Medicare enrollment will grow by more than 30 percent in the next decade alone, and the number of seniors will steadily grow from 55 million...more

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

Minnesota's Task Force recommends maintaining their State-based Marketplace while Oregon considers bringing back theirs; CMS narrows the criteria for special enrollment periods; and President Obama seeks an extension of full...more

CMS Issues Final Rule on Enhanced Funding for Certain Medicaid Eligibility & Enrollment Systems

On December 4, 2015, CMS published a final rule that extends enhanced federal funding for the design, development, installation, or enhancement of Medicaid eligibility and enrollment systems. The rule also updates standards...more

Manatt on Health Reform: Weekly Highlights - December 2015 #2

A flurry of support for Medicaid expansion this week…with Virginia hospitals backing a provider assessment, Wyoming's Governor putting forth a budget initiative, and Arkansas announcing plans to extend its waiver. Meanwhile,...more

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

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

Manatt on Medicaid: Medicaid at 50—The Program’s Evolution and Future

Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more

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

Arizona seeks Medicaid Waiver to implement new coverage restrictions for Medicaid expansion enrollees and delivery system reform; Tennessee’s uninsured rate continues to drop; and Louisiana gubernatorial candidates line up...more

Manatt on Health Reform: Weekly Highlights - October 2015

Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more

Medicaid at 50: The Program’s Evolution and Future

Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs to the nation’s largest health insurer. The occasion of Medicaid’s 50th birthday is a fitting time to...more

Only One Short Bite of the Apple: Change in the Medicare Enrollment Appeals Process

In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an...more

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

Ohio’s Medicaid expenditures came in $2 billion below estimates despite enrollment growth after Medicaid expansion; California extends full Medicaid benefits to more pregnant women; and nearly one million have enrolled in...more

GAO Examines Medicare Provider Eligibility Verification Safeguards

The Government Accountability Office (GAO) has issued a report examining the extent to which CMS’s enrollment screening procedures are designed and implemented to prevent enrollment of ineligible or potentially fraudulent...more

CMS Again Extends Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS has announced another 6-month extension of its current temporary enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs), subunits, and branch locations in designated metropolitan areas....more

CMS Extends Enrollment Moratorium on Home Health Agencies

The Centers for Medicare and Medicaid Services (CMS) announced that it will once again extend the moratorium on the enrollment of new home health agencies, branch locations and subunits in certain metropolitan areas of...more

What Does the Supreme Court's Same-Sex Marriage Ruling Mean for Employee Benefit Plans?

On June 26, 2015, the U.S. Supreme Court ruled in Obergefell v. Hodges that states must license and recognize a marriage between two people of the same sex. Despite being a landmark decision affecting same sex couples whose...more

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

CMS offers a special enrollment period for HealthCare.gov enrollees whose incomes were miscalculated due to system error; California Marketplace announces two new insurers; and Connecticut’s budget reduces eligibility levels...more

GAO Releases Report on Improving Eligibility Verification of Providers and Suppliers

On July 21, 2015, the Government Accountability Office (GAO) released a report titled “Additional Actions Needed to Improve Eligibility Verification of Providers and Suppliers” examining the implementation of four of CMS’s...more

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

In quick succession, governors in Alaska and Utah announce Medicaid expansions this week; Iowa is transitioning its expansion away from the Marketplace to Medicaid managed care, for now; and, HHS extends its exception to...more

Dentists Who Write Prescriptions Must Make a Decision: Enroll in Medicare or Opt-Out

If you are a dentist who writes prescriptions to Medicare beneficiaries for drugs covered under Medicare Part D, this article contains important information for you and your patients regarding your new enrollment requirements...more

Manatt on Health Reform: Weekly Highlights - March 2015 #2

King v. Burwell speculation has been rampant since the Supreme Court heard oral testimony on Wednesday. All eyes are on Justices Kennedy and Roberts, who are likely to wield the deciding votes. In other news, CMS approved a...more

Advisors Advantage - March 2015

In This Issue: - Human Emotional Mistakes A Retirement Plan Provider Should Avoid - The White House wants a new fiduciary rule - Fighting the Fiduciary Rule Before It's Been Even Proposed - When you get fired,...more

Seller Beware: Eighth Circuit Finds Insurer Potentially Liable for Enrollment Mistakes of Employer

In Silva v. Metropolitan Life Insurance Company, 762 F.3d 711 (8th Cir. 2014), the Eighth Circuit joined a number of other circuits in recognizing equitable remedies of reformation and surcharge based on a breach of fiduciary...more

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