Health Insurance

News & Analysis as of

CMS’s Proposes Rule On Mental Health Parity to Strengthen Access to Medicaid and CHIP Plans

On April 6, 2015, CMS announced a proposed rule intended to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposed rule...more

Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care...

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study...more

Competition & Regulation Update: Harper Review - Implications For The Private Health Insurance Industry

On 31 March 2015 the final report of the Competition Policy Review Panel chaired by Professor Ian Harper (Harper Review) was released. The Harper Review Panel (Panel) has completed the most comprehensive review of Australia's...more

Medicaid Expansion Leads to Economic Benefits While Improving Access to Coverage

The Affordable Care Act provides states with a powerful incentive to expand Medicaid to adults with incomes up to 133% of the Federal Poverty Level, paying for 100% of Medicaid coverage through 2016, and eventually phasing to...more

Healthcare Legal News Volume 5 Number 2

According to a recent study by Accenture, by 2017 approximately 18 percent of the American public will purchase insurance through exchanges versus relying on traditional employer healthcare coverage or foregoing insurance...more

Data breach class action suit against Horizon Blue Cross dismissed

Late last week, a federal court judge in New Jersey dismissed a putative class action lawsuit against Horizon Blue Cross for a data breach involving two unencrypted laptops that were lost in 2013. The case alleged that close...more

IRS Clarifies That After-Tax HRAs and Other Individual Health Insurance Payment Arrangements Generally Violate the Affordable Care...

Any employer who offers an arrangement that reimburses employees (or pays directly) for premiums or other medical costs of individual health insurance coverage, including a health reimbursement account ("HRA") provided in...more

Small Retailers Again Face Increased Health Insurance Costs

The owners of small retail businesses in Massachusetts have come to expect to pay higher health insurance costs than their counterparts in the rest of the country, and unfortunately last year was no exception. ...more

Meet the ACA’s Employer Mandate

After several delays, the Affordable Care Act’s "employer mandate" has begun to take effect. Under the mandate, employers with more than 50 fulltime employees (Large Employers) must offer affordable, minimum essential...more

King v. Burwell: Setting the Tone for Health Care Politics

In 2015, the Affordable Care Act (ACA) will face new challenges in a Republican-controlled Congress, and continued challenges in the courts. The Supreme Court recently granted a writ of certiorari to review a Fourth Circuit...more

Another Health Plan Hit By Massive CyberAttack and Class Actions Follow

Coming fresh off the heels of the Anthem data breach Premera Blue Cross announced on March 17th that it was the victim of a “sophisticated” cyberattack that may have exposed the personal information of approximately 11...more

New York’s Surprise Medical Bill Law Goes into Effect

New York’s Emergency Medical Services and Surprise Bills law went into effect yesterday, which means consumers who receive out of network (OON) emergency services will no longer have to pay more than their usual in-network...more

Summary of California Appellate Decisions - March 2015

HOW TO USE THIS CASE SERVICE - When you receive your summaries, each page will have an alphabetical letter located in the upper right-hand corner. Each alphabetical letter corresponds to a separate subject matter...more

Health Care: Out-of-Network Provider Coverage, Notice, Disclosure, and Dispute Resolution (3/15)

New York State has adopted legislation to address consumer complaints related to health insurance coverage and "surprise bills" for health care services performed by out-of-network physicians and providers....more

New York – Emergency Medical Services and Surprise

The Emergency Medical Services and Surprise Bills Law (the "New Law"), which goes into effect March 31, 2015, increases protection of New York consumers from "surprise bills" received for medical services performed by certain...more

Multiple class action lawsuits filed against Premera Blue Cross for data breach

Days following Premera Blue Cross’s public announcement that it had experienced a data breach affecting approximately 11 million, it has been sued five times (as of the time of this writing) in proposed class action lawsuits...more

OIG Warns Lab “Pull-Through” Arrangements May Be Illegal

In an important advisory opinion, the U.S. Department of Health and Human Services Office of Inspector General (OIG) gave a thumbs-down to a proposed clinical laboratory “pull-through” arrangement even though the patients in...more

Is Your Company Ready to Comply with Encryption of Individually Identifiable Health Information?

New Jersey’s new data privacy standard, signed into law as S. 562 by Gov. Chris Christie on January 9, requires health insurance carriers that are authorized to issue health benefit plans in New Jersey to protect individually...more

Another Health Plan Hit By Massive CyberAttack and Class Actions Follow

Coming fresh off the heels of the Anthem data breach Premera Blue Cross announced on March 17th that it was the victim of a “sophisticated” cyberattack that may have exposed the personal information of approximately 11...more

Hospital Wins First Round Against Largest Rival in Antitrust Suit Alleging Illegal Exclusive Dealing Agreements with Insurers

The waves of change affecting health care providers include reimbursement and funding developments, the impact of the Affordable Care Act, technological and medical advances, provider network design transformations imposed by...more

US Supreme Court to Consider ERISA’s Tracing Requirements

On March 30, the U.S. Supreme Court announced it would review Bd. of Trustees of Nat. Elevator Indus. Health Ben. Plan v. Montanile, 593 F. App’x 903 (11th Cir. 2014)....more

Blog: HIPAA FAQ Series: Does HIPAA Permit Communications via E-mail with PHI Subjects?

Last week, we introduced a new series to this blog that will cover frequently asked questions regarding the Health Insurance Portability and Accountability Act (HIPAA). This week, the series continues by delving into a hot...more

Colorado Passes “Full Parity” Telemedicine Law, Although Some Gaps Remain

On March 20, 2015, Colorado Governor John Hickenlooper signed into law HB 15-1029, which requires that insurers operating in Colorado reimburse health care providers for telehealth services in all of Colorado’s counties,...more

HIPAA Breach Affects Many Western New York School Districts

Recently, a national BlueCross BlueShield affiliate, Anthem, Inc., discovered that its information technology systems was hacked. The information believed to have been accessed includes names, member ID numbers, dates of...more

The ERISA Litigation Newsletter - March 2015

Editor's Overview - This month's newsletter discusses how to avoid liability under ERISA through plan design, including statute of limitations provisions, venue provisions, and anti-assignment provisions. Courts have...more

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