Health Insurance

News & Analysis as of

Maryland Co-Op Claims Risk Adjustment Formula Discriminates Against Smaller Insurers

Maryland’s Evergreen Health Cooperative has filed for an injunction against the federal government to halt payment by the Consumer Operated and Oriented Plan (co-op) of the $22 million it owes to CareFirst BlueCross...more

Illinois data breach law amended and includes new twists

Governor Bruce Rauner signed several new provisions into law amending Illinois’ Personal Information Privacy Act, including health insurance and medical information into the definition of personal information that triggers...more

COBRA Notices May Include Additional Information on Exchanges

The Department of Labor (DOL) recently issued an FAQ addressing the inclusion of information about the Health Insurance Exchanges (Marketplace) in COBRA notices. The guidance could be very helpful for employers in directing...more

Transitioning to Coverage: Three Things to Know About the New Transgender Healthcare Regulations

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act. As we discussed in our March 30, 2016 blog, the rule...more

Tribal Employment and Jobs Protection Act Seeks to Exempt Native American Tribes from ACA

The Tribal Employment and Jobs Protection Act (H.R. 3080) could have a big impact on tribes if it becomes law. The legislation, which was passed by the U.S. House Ways and Means Committee June 15, seeks to exempt Native...more

HHS Issues Final Rule on ACA Nondiscrimination in Health Programs and Activities

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers...more

DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over...more

HHS Final Rule Finds Categorical Exclusions for Health Services Related to Gender Transition Are Generally Unlawful

The U.S. Department of Health and Human Services (HHS) recently published its Final Rule implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of, among other grounds, sex in...more

Health Alert (Australia) June 20, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: New South Wales 17 June 2016 - Mace v Justice and Forensic Health Network; The Geo Group Australia Pty Ltd v AAI...more

Data Security Safeguards Can Help Healthcare Employers Withstand Cyberattacks—and Government Audits

The last couple of years have brought a steady rain of bad news for the healthcare industry when it comes to data security: Insurers faced with massive data breaches affecting thousands of health plans and millions of...more

How to Respond to a Notice From the Health Insurance Marketplace That Your Employee Has Qualified for an Advance Premium Tax...

Starting in 2016, the Federal Health Insurance Marketplace (the “Marketplace”) will send notices to applicable large employers whose employees received advance premium tax credits and cost-sharing reductions, if those...more

Healthcare Subsidies for Grad Students: An ACA Conundrum

Colleges and universities historically have provided graduate student employees (e.g., teaching assistants) with a stipend or reimbursement to help defray (or even fully cover) the cost of their medical coverage under the...more

Contractual Prohibitions on Health Insurers Steering Policyholders to Lower Cost Providers Draws Antitrust Challenge

The United States Department of Justice has filed an action seeking to enjoin a hospital from enforcing provisions in its contracts with health insurers that prohibit the insurers from steering policyholders to lower cost...more

New York Legislation to Require Payment Parity for Telehealth Services

New York introduced a new bill designed to ensure commercial health plans pay for telehealth services at the same rate the plans pay for in-person services. The legislation, SB 7953, comes on the heels of New York’s...more

U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance...

On June 9, 2016, the Antitrust Division of the United States Department of Justice (“DoJ”) filed a complaint against the Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Health Care System (“CHS”) in the United...more

Health Law Insights Newsletter - Issue 10 - June 2016

McCarter & English, LLP’s Health Care Group presents Issue 10 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - Drug Diversion Case Raises Red Flags for...more

Summary: Final Rule on Nondiscrimination in Health Programs and Activities

Section 1557 of the Affordable Care Act (“ACA”) establishes a broad prohibition on discrimination on the basis of race, color, national origin, sex, age or disability in health programs and activities. After almost 3 years of...more

RECAP: Highlights from the Sixty-Ninth World Health Assembly in Geneva, May 23rd to 28th

Every year in May, the health ministers from all 194 World Health Organization (WHO) Member States meet at the WHO headquarters in Geneva to attend the World Health Assembly (WHA). As the decision-making body of WHO, the WHA...more

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

Arkansas’ Governor requests to transition to a “State-based Marketplace on the Federal Platform;” Louisiana launches Medicaid expansion with SNAP fast-track enrollment; and study shows 2016 premium increases are lower for...more

Why Arizona’s New Telemedicine Law Sends an Important Message

Arizona Governor Doug Ducey signed a bill (S.B. 1363) into law, on May 17, 2016, requiring private health plans to pay for telemedicine services across the whole state rather than only services received in rural areas of the...more

False Claims Act Penalties Moving Full Steam Ahead

By August 1, 2016, all federal agencies must adjust their civil monetary penalties, including penalties required by the False Claims Act (“FCA”), to account for inflation. Last month, the Railroad Retirement Board, which...more

Workplace Policy Institute Insider Report — June 2016

Littler's Workplace Policy Institute Insider Report details key labor, employment, and benefits news and events at the federal, state, local, and global levels. The June edition of the Insider Report highlights recent federal...more

HHS Finalizes ACA Nondiscrimination Protections for HHS Programs

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

2016 Florida Legislative Post-Session Report

Carlton Fields’s Government Law and Consulting Practice Group released its 2016 Florida Legislative Post-Session Report detailing significant bills that passed during the 2016 Regular Session of the Florida...more

Ohio Prepares Medicaid Waiver Request

Ohio is preparing a Section 1115 Medicaid demonstration waiver application that, if approved, would require most of the members enrolled in Ohio’s Healthy Ohio Program to pay premiums and copayments for their health care...more

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