Health Insurance Healthcare Hospitals

News & Analysis as of

Washington Healthcare Update

This Week: CMS Releases Guidance on Fast Track Process for 1115 Waivers for Medicaid and CHIP... Healthcare.gov CEO Sends Letter to State Insurance Commissioners Concerning 2016 Premium Decisions... Medicare Board of Trustees...more

Also In The News - Health Headlines - July 2015

CMS Reopens Attestation Period For First-Time Hospitals Until August – CMS recently announced that eligible hospitals participating in the Medicare Electronic Health Record Incentive Program for the first time in 2015 may...more

Health Update - July 2015

Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace - Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...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

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

GAO Recommends Congress Reduce Incentives for Prescribing 340B Drugs

The United States Government Accountability Office (GAO) recently released a report entitled “Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals” (“the...more

Telemedicine Practice and Remote Prescribing in Delaware

Note: This is a companion piece to our parallel article discussing the various Delaware commercial insurance coverage requirements in the Act. Delaware Gov. Jack Merkell signed into law, on July 7, 2015, a bill...more

Health Alert (Australia) - July 6, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgments: Victoria. 26 June 2015 - Northern Health v Kuipers [2015] VSCA 172 - The Victorian Supreme Court has allowed an appeal...more

Connecticut Passes Law Imposing New Burdens On Health Insurance Companies

Public Act 15-146, "An Act Concerning Hospitals, Carriers and Health Care Consumers," was signed into law by Governor Malloy on June 30, 2015 and will have a significant impact on health insurance companies in Connecticut....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 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

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

Health Alert (Australia) - June 9, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: Australia. Fair Work Commission Marr v Western Health [2015] FWC 2970 The Fair Work Commission has held that it was...more

Washington Healthcare Update

This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more

Health Alert (Australia) - May 25, 2015

In This Issue: Judgments; Legislation; and Reports & Publications. Excerpt from Reports: Australian Medical Association (AMA) - 19 May 2015 - $19 billion pharmacy deal sign of skewed health...more

Insurer Wrongfully Passed Sequestration Cuts Through to Providers

A Pennsylvania judge found, on May 6, 2015, that a Medicare Advantage Plan had no right under its participation agreements to pass CMS sequestration reductions through to participating providers. Judge R. Stanton Wettick Jr....more

House Bill Says 23 Years Isn’t Long Enough for Transition to ICD-10

All across the country hospitals have been bracing for the scheduled Oct. 1, 2015, transition from ICD-9 coding to ICD-10. It had been scheduled for Oct. 1, 2014, but the Protecting Access to Medicare Act of 2014 delayed it...more

Washington Healthcare Update

This Week: Energy and Commerce Health Subcommittee Explores Post-Acute Bundling…CMS Releases First-ever Hospital Compare Star Ratings…Fiscal Year 2016 Proposed Inpatient and Long-term Care Hospital Policy and Payment Changes....more

How New York’s Emergency Medical Services and Surprise Bills Law Impacts Providers and Plans

Last year New York passed legislation known as the “Emergency Medical Services and Surprise Bills” law, a much-heralded consumer protection law primarily intended to guard against surprise bills for out of network (OON)...more

Health Alert (Australia) - April 20, 2015

In This Issue: Judgments; Legislation; and Reports. Excerpt from Judgments: New South Wales (NSW) - 13 April 2015 - Sarah White v The Local Health Authority & Anor - [2015] NSWC 417 - The New South...more

Locke Lord QuickStudy: Doc Fix Statute Contains a Lot More than SGR Repeal

On April 16, 2015, the President signed the Medicare Access and CHIP Reauthorization Act of 2015, commonly known as the “Doc Fix.” As has been extensively reported, the Act repeals the Sustainable Growth Rate or (SGR)...more

SGR Law Brings Changes to CMP Prohibition on Gainsharing

On April 16, President Barack Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” ending a perennial struggle over the Medicare reimbursement formula for physicians. Although the law is most...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

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

Fifth Circuit: Hospital Enjoys Standing to Seek ERISA Benefits

The Fifth Circuit ruled that an out-of-network medical provider that was assigned a patient’s rights to health insurance benefits has standing to sue a health plan that underpays its portion of the benefits due even if the...more

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