Health Insurance

News & Analysis as of

Checklist for Group Health Plan Participant Disclosure Requirements

There has been an explosion of participant disclosure requirements for group health plans in recent years. While health care reform created some of these new requirements, many of them became effective years earlier. For busy...more

Millennium Health to Pay $256 million in False Claims Act Settlement

Millennium Health, one of the nation’s largest urine drug testing laboratories, has agreed to pay the government $256 million to resolve claims that it violated the Federal False Claims Act (“FCA”). The Settlement...more

Automatic Enrollment for Health Plans Has Been Repealed

Budget legislation signed into law by President Barack Obama on November 2, 2015, the Bipartisan Budget Act of 2015, repeals the controversial automatic enrollment provision under the Affordable Care Act (ACA). Section 18A of...more

CMS Proposes Sweeping Changes to Medicare Reimbursement for Clinical Diagnostic Laboratory Tests

First Data Collection Period for Clinical Laboratories Is July 1, 2015 to December 31, 2015 - In the October 1, 2015 Federal Register, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule...more

Bipartisan Budget Deal Includes Provisions Impacting Employers

On Monday, President Obama signed into law a two-year bipartisan budget deal that has several implications for employers. The Bipartisan Budget Act of 2015 (H.R. 1314) suspends the debt ceiling limit until March 2017, and...more

North Carolina General Assembly Week in Review: Health Care Spotlight

On Thursday, after six terms serving in the House, Rep. James H. Langdon (R-Johnston) announced that he would not be running for re-election in 2016. Following his announcement, two Republicans announced their intentions to...more

Health Alert (Australia) - November 2, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments Australian Capital Territory 29 October 2015 - In the matter of ER (Mental Health and Guardianship and...more

Progress, But Also Perpetuated Errors, In The EEOC’s Proposed GINA Rule Regarding Wellness Program Incentives

Today, the U.S. Equal Employment Opportunity Commission (“EEOC”) issued a Notice of Proposed Rulemaking addressing wellness program incentives under the Genetic Information Nondiscrimination Act (“GINA Proposed Rule”) in the...more

EEOC Emitie Regla Proponiendo la Modificación del Título II De Gina

Regla Aclara Incentivos que Pueden Ser Proporcionados para Recibir Información Sobre La Salud de un Cónyuge que Participa en un Programa de Bienestar Patrocinado por el Empleador - WASHINGTON - El Viernes, 30 de octubre...more

Torts – Effect of Howell Decision on Purchased Medical Liens

Anna Uspenskaya v. Clare Meline - Court of Appeal, Third District (October 28, 2015) - Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 was a landmark case in which the California Supreme Court...more

EEOC Proposed GINA Regulations Permit Limited Wellness Plan Incentives In Exchange For Spousal Health Data

The Equal Employment Opportunity Commission (EEOC) issued a Notice of Proposed Rulemaking (NPRM) on October 30, 2015 to amend the federal regulations implementing Title II of the Genetic Information Nondiscrimination Act...more

OCR Audits to Begin in 2016

Beginning in 2016, the United States Department of Health and Human Services’ Office for Civil Rights (OCR) will conduct another round of audits to gauge compliance with privacy provisions in the Health Insurance Portability...more

Health Care Mergers Come Under Scrutiny

In July, 2015, Aetna struck a deal to buy Humana for $37 billion, which would cover 33 million members. Merging with Humana would give Aetna more than one-quarter of the total Medicare Advantage market, analysts say. In...more

New Texas Medical Stop-Loss Rules Drafted by Texas Department of Insurance

Within an environment of increased federal and state regulatory emphasis on health insurance related issues arising due to the passage by the U.S. Congress of the Patient Protection and Affordable Care Act of 2010, the Texas...more

Health Insurance Company Unitedhealth Discussing Possible Merger

In the health care industry, saying competitive and operating efficiently is important for survival, and businesses in this industry need to continually seek to consolidate resources to ensure they are operating in as...more

IREG Update - October 2015 #3

Recent closures demonstrate weakness in ACA CO-OP program - Background - The Affordable Care Act (ACA) was signed into law five and a half years ago, dramatically changing health insurance regulations and creating a...more

Employee Benefits Developments - October 2015

The Internal Revenue Service (IRS), consistent with prior regulations from the Department of Health and Human Resources (HHS), issued supplemental proposed regulations requiring employer sponsored health plans to provide...more

Insurers May Not Terminate Physicians for Recommending Out-of-Network Providers

Under a new Texas law, effective September 1, 2015, health maintenance organizations (HMOs) and Preferred Provider Benefit Plans (PPO) (collectively referred to as "Insurers") can no longer terminate a physician from their...more

Health Care Update - October 2015

Senate Working Group Pressing Forward on Telehealth - As Congress focuses on bigger picture policy decisions, including broad budget negotiations and raising the debt ceiling, there are some exciting developments on the...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 15 of 24): Coding Form 1095-C, Part II for...

As we noted in a previous post, the recently issued final 2015 Instructions for Forms 1094-C and 1095-C changed certain of the rules relating to the reporting for offers of COBRA coverage where the COBRA qualifying event...more

Manatt on Health Reform: Weekly Highlights - October 2015 #4

HHS announces average premium price increases of 7.5% across; Michigan and Illinois launch the country’s first joint cloud-based, real-time Medicaid information management system; and the Marketplace carrier...more

New Affordable Care Act FAQs Issued

On October 23, the U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) jointly issued answers to frequently asked questions regarding the...more

Ohio Judge Stays Bad Faith Action Pending Arbitration In Health Care Payment Row

A district court in Ohio granted defendant Pan-American Life Insurance Company’s (“Pan-American”) motion to stay pending arbitration finding a valid and enforceable arbitration provision within the pertinent group health...more

The ERISA Litigation Newsletter - October 2015

Editor's Overview - This month, we review the Second Circuit's ruling in New York State Psychiatric Ass'n, Inc. v. UnitedHealth Grp. wherein the Second Circuit ruled that: (i) a provider association has associational...more

2016 Cost of Living Increases are Rare

On October 21, 2015, in Information Release 2015-118, the IRS announced cost-of-living adjustments to various dollar limitations under the Internal Revenue Code (the "Code") for pension plans and other related items for the...more

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