Health Insurance

News & Analysis as of

The Affordable Care Act—Countdown to Compliance for Employers, Week 2: Explaining the Look-Back Measurement Method to Employees

Many applicable large employers—i.e., employers that are subject to the Affordable Care Act’s (ACA) employer shared responsibility rules—have a pretty good sense of what these rules are, how they work, and what they plan to...more

Labor & Employment E- Note - December 2014

In This Issue: - SCOTUS Says Firms Don't Have to Pay for Security Screening Time - EEOC Saw Decline in Discrimination Settlements, Number of Cases - HHS Closes Loophole Allowing Employers to Cut Hospital...more

Illinois Supreme Court Agrees to Decide Whether Pension Board's Disability Finding is Preclusive in Employee Benefits Act...

In the closing days of its November term, the Illinois Supreme Court agreed to decide whether a pension board’s finding that an officer is disabled for pension purposes is preclusive of the employer’s liability for health...more

Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender...more

With a New Year Rolls in a New OIG Work Plan

Recently, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) released its Work Plan for Fiscal Year 2015 (“Work Plan”). The OIG protects the integrity of HHS programs by identifying...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

Should Employers Drop Domestic Partner Dependent Coverage?

Over the past decade, many employers extended dependent coverage under their group medical insurance plans to employees’ domestic partners. For many employers, this change was made in order to allow gay employees to add their...more

Cigna Health and Life Ins. Co. v. Audax Health Sol’ns, Inc., C.A. No. 9405-VCP (Del. Ch. Nov. 26, 2014)

In this action seeking a declaratory judgment regarding the validity of certain provisions in a merger agreement and related contracts, the Court of Chancery granted in part plaintiff’s motion for judgment on the pleadings,...more

CMS Proposes Changes to 2016 Star Rating Calculations - Medicare Advantage and Medicare Part D Prescription Drug Plans May Be...

The Centers for Medicare and Medicaid Services (CMS or the Agency) released a memorandum requesting comments regarding proposed changes to the 2016 star ratings systems for Medicare Advantage Plans (MA Plans) and Medicare...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

Employer Cash Payments To Reimburse Employees For Health Insurance Costs – No!

Many employers offer or provide cash to employees to reimburse them for the cost of purchasing an individual health insurance policy. Others offer employees with high claims risk a choice between enrolling in the company’s...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

PPOs and Other Non-HMO Products Now Require Approval and Periodic Reviews of Network Adequacy in New York

The New York Legislature recently enacted legislation that will require all health insurance plans that issue policies that provide for the use of a provider network to obtain network adequacy certification. The new...more

HHS Broadens Federal Controls Over Private Health Insurance Benefits and Operations

On November 21, 2014, the Obama administration released two proposed rules affecting health insurance issuers’ offering of private health insurance products both inside and outside of the public insurance exchanges...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

Ninth and Tenth Circuits Address Removal Under CAFA's "Mass Action" and "State Action" Provisions

In Corber v. Xanodyne Pharmaceuticals, the Ninth Circuit – on rehearing en banc –examined the applicability of the “mass action” provision of CAFA, which provides federal jurisdiction for any civil action in which monetary...more

The National Association of Insurance Commissioners Weigh in on Issues of Network Adequacy

Network adequacy—a health plan’s ability to provide timely access to a sufficient number in-network providers—has become a matter of increased scrutiny during these early years of ACA implementation; Many consumer and...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

View From McDermott: A New Type of ERISA-Based Hold-Up—The Rise of Out-of-Network Provider Suits Against Self-Funded Health Care...

Over the past decade, there has been a significant increase in the number of physicians who have dropped out of Preferred Provider Organization (‘‘PPO’’) and Health Maintenance Organization (‘‘HMO’’) networks and attempted to...more

Manatt on Health Reform: Weekly Highlights: December 2014

This week, a federal Issuer Bulletin describes how issuers in the Federally Facilitated Marketplace will identify their existing enrollees who are switching plans for 2015 coverage. The Exchange Board in New Mexico proposes a...more

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

Quirky Question #247, An Update on Wellness Programs

Question: Our company has been considering implementing financial incentives for employees to participate in biometric screening as part of an employee wellness program. Are there legal issues we should be...more

Health Care Update - December 2014

In This Issue: - FDA Releases Menu Labeling Rule - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Upcoming Congressional Hearings - Excerpt from FDA...more

348 Results
|
View per page
Page: of 14