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Health Care Update - June 2015 #4

In This Issue: - Pathway for Bipartisanship following King v. Burwell - Federal Regulatory Initiatives - Congressional Initiatives - Other Health Care News - Upcoming Congressional...more

King v. Burwell – Supreme Court Upholds Premium Subsidies under Federally-Run Marketplaces; ACA Remains (Mostly) Unfazed

On June 25, 2015, the United States Supreme Court released its much anticipated King v. Burwell decision regarding the validity of premium assistance issued by Federally-run Marketplaces. Chief Justice Roberts, writing for...more

The Supreme Court Upholds The Availability Of Subsidies On The Federal Exchange—Where Do We Go From Here?

One of the most highly anticipated decisions of the term—at least among the Sheppard Mullin Healthcare team—was issued Thursday by the Supreme Court: King v. Burwell. Six of the justices, including Chief Justice Roberts,...more

How Does the King v. Burwell Decision Affect the Affordable Care Act?

The Supreme Court handed the Obama administration a key victory this morning, upholding the tax credits that allow many low-income Americans to purchase health care insurance in states where the federal government is running...more

Under the Dome: Inside the Maine State House

Under the Dome: Inside the Maine State House provides a high-level overview of recent activity at the Maine State House. Legislature Plans Long Day - Early this past Wednesday morning, the Maine House and Senate...more

King v. Burwell: No “Death Spirals”

"Death spirals" were avoided today when the U.S. Supreme Court released its long awaited opinion in King v. Burwell, holding that tax credits are available to subsidize coverage for qualified individuals in all states,...more

King v. Burwell: The Supreme Court Rules in Favor of the Administration and the Affordable Care Act Survives

The U.S. Supreme Court has once again ruled in favor of the Affordable Care Act (ACA). At issue in King. v. Burwell was whether the landmark legislation allows federal subsidies to be given to low-income consumers residing...more

U.S. Supreme Court Upholds Affordable Care Act Subsidies

Today, in King v. Burwell, the United States Supreme Court held that subsidies for coverage under all marketplace health exchanges pursuant to the Patient Protection and Affordable Care Act (the “ACA”) remain available. ...more

How Does King v. Burwell Decision Affect the Affordable Care Act? [Video]

At the core of King v. Burwell is the concern of whether patients will have access to affordable medical care across the country, regardless of how a state chose to implement health care exchanges. In this video, Foley...more

OIG Advisory Opinion 15-07: An Indicator of Clinical Trial Copayment Change?

“You scratch my back, I scratch yours” arrangements are common in business transactions. These agreements are risky in the healthcare space, however, with the potential to implicate civil and criminal sanctions. Whether...more

Thirteen Years of the Same Rules and Now Big Proposed Changes to the Regulation of Medicaid Managed Care Plans

On May 25, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a newly proposed rule that would change the way the agency regulates Medicaid managed care plans, the first regulation of its kind since 2002. ...more

Proposed Managed Care Rules Leave State Obligations for CHIP Largely Unchanged

The Centers for Medicare & Medicaid Services’ (CMS) proposed rule (“Rule”) that updates Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems, leaves state obligations largely...more

The skinny on narrow networks

The insurance exchanges created under Affordable Care Act have facilitated increased competition. Old version managed care models implemented cost-savings measures like pre-authorizations for medical care, hospital length of...more

May Companies Reduce Employee Hours to Avoid ACA Requirements?

The Affordable Care Act (the “ACA”) generally requires that large employers offer health coverage that meets certain requirements to their full-time employees (i.e., employees working 30 hours or more per week) and their...more

Washington Healthcare Update

This Week: Leading Up to the SCOTUS King v. Burwell Decision... House Votes to Repeal the Medical Device Tax... CMS Announces It Will Bolster Transitional Reinsurance Payments... MedPAC Releases June Report to Congress....more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

Providers Await Result on Affordable Care Act Challenge

Challenging a holding by the Fourth Circuit Court of Appeals before the U.S. Supreme Court in King v. Burwell, counsel Michael Carvin argued that the Affordable Care Act does not allow the federal government to issue tax...more

China Issues New Guiding Opinions for Public Hospital Reform

Recently, the General Office of the State Council published the Guiding Opinions on Pilot Comprehensive Reform of Urban Public Hospitals, which took effect on 6 May 2015. The Guiding Opinions give directions for the ongoing...more

Health Care Update - June 2015 #3

In This Issue: - Post- King v. Burwell Strategy is TBD - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Other Health Care News - Upcoming...more

Health Alert (Australia) - June 22, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: Victoria. Inquest Into the Death of Baby Chloe Lee Kellett - The Victorian Coroner investigated an infant's death from...more

Alert: Health Plan Update on Out-of-Pocket Limitations

The Affordable Care Act (the “ACA”) established limitations on the annual out-of-pocket costs that a health plan may impose on a participant. The U.S. Department of Health and Human Services, Department of Labor and the...more

Health Alert (Australia) - June 15, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: New South Wales. O'Sullivan v Medical Council of New South Wales [2015] NSWCATAD 113 The New South Wales Civil and...more

EEOC Guidance: Redesigning Wellness Programs to Comply with the ADA

Although the Equal Employment Opportunity Commission (EEOC) has been actively taking legal action against employers over wellness programs that it considers coercive under the Americans with Disabilities Act (ADA), companies...more

New York Governor Andrew Cuomo names Anthony Albanese Acting Superintendent of Financial Services

Bloomberg reported last week that Anthony Albanese, Chief of Staff to Departing Superintendent Ben Lawsky, has been named to head the New York Department of Financial Services on an acting basis. He will lead the Department...more

King v. Burwell – Will the Supreme Court Tip the ACA Dominos? Part 2

In our previous blog post, we evaluated the legal issues at stake in King v. Burwell. We will now examine some of the ramifications of a Supreme Court decision that goes against the Obama Administration, assuming such were to...more

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