News & Analysis as of

Manatt on Health Reform: Weekly Highlights: January 2015 #3

This week, leadership changes at CMS continue, Montana’s Governor introduces Medicaid expansion legislation, and the California Marketplace allows new health plan entrants into the individual and SHOP Marketplaces for the...more

BCBSNC Release of Data

After objecting to the release of hospital reimbursement rates mandated under North Carolina’s Health Care Cost Reduction and Transparency Act of 2013 (NCGS Section 131E-214.5), Blue Cross Blue Shield of North Carolina...more

New York Passes Telemedicine Reimbursement Legislation

New York became the 22nd state to sign into law legislation that will require commercial and Medicaid plans to provide coverage of telehealth and telemedicine services. The law, originally intended to take effect on January...more

News from the Health Law Gurus™:

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every week for the latest health law news stories....more

Benesch Health Care Market Intelligence - Physician/Hospital Summary Report 2014

In this Report: - Key Findings - Industry Trends – Hospitals - Industry Trends – Physician Practices - Government/Regulatory – Ohio - Government/Regulatory – U.S. -...more

Health Care Update - January 2015

In This Issue: - SGR Already Strong Focus of 114th Congress: - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional Initiatives - Other Health...more

New York Passes Telehealth Bill

New York Governor Andrew Cuomo signed a Bill late last week, which will take effect as of January 1, expanding telehealth coverage in New York. This law does three things which are on the leading edge of telehealth coverage....more

Texas Adopts Standard Prior Authorization Form

In an effort to reduce the number of different prior authorization forms with which providers must contend, the Texas Department of Insurance (TDI) has adopted a single, standard form for requesting prior authorization of...more

California Insurance Commissioner Issues Emergency Regulations Affecting Narrow Provider Networks

On January 5, 2015, Commissioner Dave Jones issued emergency regulations affecting health insurers with respect to access to provider networks in response to consumer complaints that appointments with physicians are hard to...more

Challenges Physicians Can Expect in 2015

Reimbursement for medical services continues to decline. Continuing uncertainty about the Affordable Care Act persists. Government regulations create burdensome paperwork, busywork, and compliance headaches. Technology costs...more

Warning: Don’t Lose your Right to Contest Medical Treatment

Newly implemented rule (04 NCAC 10A.1001 [Rule 1001]) requires, among other things, that you immediately respond to requests for authorization for surgery and hospitalization. Under this rule, you have only seven days to...more

A Quick Look at Healthcare Issues Expected to Make News in 2015

As we look into our crystal balls, we do not expect a lot of new issues in 2015. Rather, we believe that most of the significant issues will be a continuation of issues that arose in 2014 or earlier. ...more

Lordy, Lordy, Look Who’s Forty: A Review of Our 40-Year-Old Stalemate in Health Care Reform

Well, folks, it is official. I am “over the hill.” Yup. My birthday is today, January 7, 1975, and I was born 40 years ago. Instead of moping around, I have decided to embrace my 40s. For starters, let’s take a look...more

Excepted Benefits: Final regulations provide guidance on dental, vision and employee assistance plans

The Departments of Labor, the Treasury, and Health and Human Services (the “Departments”) have recently published final regulations related to when limited scope dental and vision benefits and employee assistance programs...more

Effects of the New Federal Spending Package on the Health Sector

In mid-December, President Obama signed into law a $1.1 trillion spending bill known as the “Consolidated and Further Continuing Appropriations Act, 2015” or “Cromnibus.”[1] This post explores provisions that relate to the...more

States Doubling Down on Delivery and Payment Reform Efforts

Although health care reform implementation via the Affordable Care Act (ACA) has focused mostly on federal changes to the health care marketplace, individual States are getting some much needed help to design and implement...more

9 Health Care Legal Issues to Follow in 2015

Cost sharing, consumerism, price transparency, patient engagement, value-based purchasing, affiliations, consolidation, access, community partnerships, narrow networks, cost containment, post-acute care, talent...more

Health Headlines: Also in the News - December 2014 #3

ONC Issues New Federal Health IT Strategic Plan –On December 8, 2014, the Office of the National Coordinator for Health Information Technology (ONC) released its Federal Health IT Strategic Plan 2015-2020 (Plan). The Plan...more

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

The Future of MassHealth: Five Priority Issues for the New Administration

Executive Summary - The past decade marked an era of seismic change in the Massachusetts health care market and one in which the Commonwealth led the nation in coverage and delivery system reform. In 2006,...more

New Rule Permits CMS to Revoke Medicare Billing Privileges for Providers/Suppliers with “Pattern or Practice” of Denied Claims

On December 5, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule titled “Requirements for Medicare Incentive Reward Program and Provider Enrollment” (“the Rule”). The Rule implemented several...more

Health Alert (Australia) - December 8, 2014

In This Issue: Judgments and Reports. Excerpt from Reports: Australia. Department of Social Services - 4 December 2014 - 2014 Aged Care Approvals Round (ACAR) results. Senator Mitch Fifield,...more

Reminder: Amendments needed to reflect $2,500 limit on Health FSA contributions by year end

As mentioned in a prior Alert, beginning in 2013 employees’ salary reduction contributions to a health flexible spending account (health FSA) may not exceed $2,500 per plan year. This limit is to be indexed for inflation in...more

Florida, No Grants For You!

In November 2014, the federal government’s Distance Learning and Telemedicine (DLT) program awarded over $10 million in grants to support telemedicine and rural health research. The list of 65 DLT grant recipients included...more

"New Preventive Services Under the Affordable Care Act"

The Affordable Care Act (ACA) requires non-grandfathered group health plans to provide benefits for items or services recommended by the U.S. Preventive Services Task Force (USPSTF). These benefits must be provided without...more

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