Health Insurance

News & Analysis as of

State Issues Healthy PA Program RFA to Insure 500,000+

The Corbett administration’s efforts on the Healthy PA initiative continue to move forward. Late last week, the Department of Public Welfare issued a Request for Application (RFA) for private market health plans to provide...more

NY Bill Seeks to Strip Insurers of Discretion When Substance Abuse Services Should Be ERISA Preempted

The New York State Senate is considering passing Bill No. 4326 which seeks to address an epidemic of heroin and prescription drug abuse by requiring insurers to provide in-patient treatment to addicts. Publicity over the...more

The Check’s in the Mail - Who Is Responsible for Payment in a Delegated-Network System?

In today’s healthcare system, reimbursement issues involve not only prompt pay statutory provisions but also various risk-shifting arrangements included in a delegated-network system of managed care. When the insolvency of...more

Two Federal Circuits Find Health Insurance Claims Outside Scope Of Arbitration Clauses

Because courts apply a presumption of arbitrability when they analyze whether particular claims fall within the scope of an arbitration clause, and arbitration clauses are generally drafted very broadly, I don’t usually get...more

New Model COBRA Notices

To coordinate information about the new marketplace/exchange coverage that may be available under the Affordable Care Act, today the U.S. Department of Labor, in conjunction with the IRS and U.S. Department of Health and...more

Dr. Dettling Talks About Shoulder/Knee Work Injuries

Orthopedic surgeon James Dettling, M.D. specializes in shoulder and knee injuries. About half his patients are injured workers treating under a Nevada workers' comp claim. He and long-time medical assistant, Patrick...more

COBRA Coverage Too Expensive? Consider ACA Coverage Instead, Obama Administration Says

On Friday, the Obama administration announced a proposed rule (the “Proposed Rule”) that will require that notices sent to workers regarding Consolidated Omnibus Budget Reconciliation Act (“COBRA”) health insurance coverage...more

Supreme Court Grants Certiorari to Review Sixth Circuit’s Pro-Union Inference in Retiree Health Insurance Benefits Cases

The Supreme Court of the United States has agreed to resolve a circuit split about how courts should interpret collective bargaining agreements that provide for health insurance benefits for retired employees in M&G Polymers...more

Legislation Permitting Healthcare Providers to Negotiate Jointly with Health Insurers Introduced in Congress

Legislation was recently introduced by Representative John Conyers (D-Michigan) that would permit healthcare providers to negotiate jointly with health insurers concerning contract terms without running afoul of the antitrust...more

Insurance Antitrust Legal News - May 2014 • Volume 3, Number 3

In This Issue: - LEGISLATION PERMITTING HEALTHCARE PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS INTRODUCED IN CONGRESS: Legislation was recently introduced by Representative John Conyers (D. Michigan)...more

Minimum Necessary and the Breach Standard

When the new HITECH rules came out OCR specifically said, “...uses or disclosures that impermissibly involve more than the minimum necessary information...may qualify as breaches.” But what exactly is the minimum necessary...more

New Data Shows Higher Healthcare Costs in Second Half of 2013 – Is this A Result of the Affordable Care Act?

Will insurance expansion and industry consolidation result in higher healthcare costs, at least in the short term, and further stress the economy and the healthcare industry? That highly political question is being asked now...more

Health Care Reform Implementation Update - April 21, 2014

On April 14, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) reported their findings that show a smaller rise in insurance premium costs under the Affordable Care Act (ACA) than previously...more

It’s Not Too Late: You May Still Qualify for ACA Coverage

March 31 was the last day to enroll in a health insurance plan through the federally-facilitated health care exchange. However, like many other Affordable Care Act (“ACA”) deadlines, the March deadline was a soft deadline, as...more

FTC Commissioner Criticizes Proposed Legislation That Would Permit Health Providers to Negotiate Jointly with Health Insurers

In a February 26 speech before the Connecticut Bar Association, Federal Trade Commissioner Maureen Olhausen expressed strong opposition to proposed legislation that would create an antitrust exemption for collective...more

ACA Pay Or Play: Is Your Dependent Coverage Compliant?

Now that the IRS has issued final regulations under Section 4980H, the so-called “pay or play” provision of the Affordable Care Act, employers are deciding how to determine whether employees are full-time (30 hours or more a...more

HHS to Health Insurers: Same Treatment for Same-Sex Couples

A release and a blog post from the Department of Health and Human Services (“HHS”) on Friday announced that starting in 2015, health insurance companies will be required to offer coverage to same-sex spouses if they offer...more

Filing From Home, and Health Insurance Reporting on W-2s

According to an IRS release last week, the number of taxpayers electronically filing their own returns from home has increased compared to last year at this time by approximately 6%. Overall, the IRS has received about the...more

March 31: ACA Deadline or Just Another Monday?

March 31, 2014 is the open enrollment deadline for individuals who want to buy health insurance through the Health Insurance Marketplace (also known as the “Exchange”). Or is it?...more

The Waiting is the Hardest Part: Final Regulations on the PPACA’s 90-Day Waiting Period Released

On February 24, 2014, the Internal Revenue Service (IRS), the Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL), and the U.S. Department of Health and Human Services (HHS) jointly released...more

Hearing Held on Pennsylvania’s Novel “Any Willing Insurer” Legislation

On December 18, 2013, the Pennsylvania House Health Committee held a hearing on Pennsylvania House Bills 1621 and 1622, two bills that would require that any health provider in the state that operates as part of an integrated...more

Insurance Antitrust Legal News - March 2014 • Volume 3, Number 2

In This Issue: - FTC COMMISSIONER CRITICIZES PROPOSED LEGISLATION THAT WOULD PERMIT HEALTH PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS: In a February 26 speech before the Connecticut Bar Association,...more

Healthcare Legal News - February 2014 • Volume 4, Number 1

In This Issue: - CMS ISSUES FINAL RULE ON DIRECT ACCESS OF LAB TEST RESULTS BY PATIENTS: On February 3, 2014, the Centers for Medicare and Medicaid Services (CMS) released a final rule that permits patients or...more

Unprecedented HIPAA Fine May Mean Increased Scrutiny and Penalties

Triple-S Management Corp. (“Triple-S”), a Puerto Rico-based health insurer, has been fined $6.8 million by the Puerto Rico Health Insurance Administration (“PRHIA”) following a Health Insurance Portability and Accountability...more

Affordable Care Act – Portions of Employer Mandate Postponed

In July 2013, the employer mandate was pushed back until January 1, 2015 for all employers covered by the Act (i.e., those with 50 or more employees, including full-time equivalents (FTEs)). On February 10, the Department of...more

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