Health Insurance

News & Analysis as of

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to Issuers (Letter to Issuers) in the...more

ACA Suit Challenging Reduction in Hours Allowed to Proceed

Many employers are still working to catch up to and understand the new requirements of the Affordable Care Act (ACA) – including the IRS, which has announced automatic extensions to certain reporting requirements for this...more

Compliance With Medicare Secondary Payer Act At Issue In Auto Insurance Case

A recent decision in the District of New Jersey addressed an auto insurer’s obligations to comply with the Medicare Secondary Payer Act. Auto insurers may wish to review their practices and procedures in light of this...more

Masked Man Robs Government; Faces 10 Years

The mask itself didn’t raise any suspicions. After all, the man wearing it—Richard Toussaint–was an anesthesiologist. But like so many other masked men, he turned out to be a thief. That’s why on March 4 he was convicted in...more

Manatt on Health Reform: Weekly Highlights - March 2016

HHS approves waiver extending Medicaid coverage to Flint residents impacted by the water crisis; SCOTUS rules that states cannot require self-insured health plans to provide claims data; and seven insurers sign on to...more

U.S. Supreme Court Reaffirms ERISA’s Preemption Provisions as Applied to State Health Law Reporting Requirements

Recently, the U.S. Supreme Court, in Gobeille v. Liberty Mutual Insurance Co., 2016 U.S. LEXIS 1612, underscored the broad extent to which the preemption language of the Employee Retirement Income Security Act of 1974...more

New ACA Guidance Warrants Another "Checkup" of Employer Health Plans

On December 16, 2015, the IRS issued Notice 2015-87 (the "Notice"), which provides "question-and-answer" guidance regarding how various Affordable Care Act (the "ACA") provisions apply to employer-provided group health plans....more

Supreme Court Holds That ERISA Preempts State Health Care Services Disclosure Law

Preemption is not a foreign concept when dealing with the Employment Retirement Income Security Act of 1974 (ERISA). Preemption arguments frequently and increasingly arise, for example, in the context of claims by health care...more

Health Alert (Australia) - March 7, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: - Victoria 26 February 2016 Inquest into death of Maree Rosalie Jones Ms Jones was admitted...more

US Supreme Court Reaffirms ERISA Preemption Doctrine

The Court finds that ERISA preempts the state law “All Payer” data requirement. In a 6–2 decision issued on March 1, the US Supreme Court affirmed a US Court of Appeals for the Second Circuit decision holding that the...more

Cybersecurity and Data Privacy: Big Win for Self-Insured ERISA Plans at Supreme Court (3/16)

On March 1, the Supreme Court issued a decision in Gobeille v. Liberty Mutual Insurance Company that delivered a big win for self-insured group health plans. The case involved a challenge to a Vermont law that required...more

Supreme Court Restricts State Medical Claims Data Reporting Law

ERISA does not allow a state to compel a self-insured group health plan to compile and report medical claims data for inclusion in a state-wide all-payer health care database, the U.S. Supreme Court has ruled in a landmark...more

Limiting Employee Hours To Avoid ACA Could Violate ERISA, Court Rules

In a first-of-its-kind decision, a federal court recently upheld the right of employees to sue their employer for allegedly cutting employee hours to less than 30 hours per week to avoid offering health insurance under the...more

Supreme Court: ERISA Pre-empts Vermont’s Health Data Collection Law as Applied to Self-Insured Health Plans

In Gobeille v. Liberty Mut. Ins. Co., No. 14-181, 2016 U.S. LEXIS 1612 (Mar. 1, 2016), the U.S. Supreme Court held that ERISA pre-empts Vermont’s “all-payer database” law – to the extent it is applied to self-insured health...more

How Likely Are You to Need Long-Term Care?

Planning for retirement and deciding whether to buy long-term care insurance would be a lot easier if you knew your odds of needing long-term care, as well as at what age and for how long. Unfortunately, there's no definite...more

Supreme Court Decides Gobeille v. Liberty Mutual Insurance Company

On March 1, 2016, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Company, No. 14-181, holding that the Employee Retirement Income Security Act of 1974 (ERISA) pre-empts Vermont’s regulatory scheme requiring...more

Will 2016 Be the Year for McCarran Repeal?

As the second session of the 114th Congress begins to pick up steam, five bills are currently pending in the House that, if enacted, would repeal the McCarran-Ferguson Act’s antitrust exemption for at least some insurers....more

U.S. Supreme Court Rules That ERISA Preempts State Health Claims Reporting Law

Yesterday, in Gobeille v. Liberty Mutual Insurance Company, the United States Supreme Court held that the Employee Retirement Income Security Act of 1974 (“ERISA”) preempts a Vermont state law that requires certain entities...more

DOL Issues Proposed Updates for Summaries of Benefits and Coverage

The U.S. Department of Labor (DOL) has issued an updated template Summary of Benefits and Coverage (SBC), Glossary of Coverage and Medical Terms, and related materials. The revised materials remain in proposed form, but have...more

California Insurance Department Holds Hearing on Centene/Health Net Merger

Since the summer of 2015, a great deal of attention has focused on whether the proposed Anthem/Cigna and Aetna/Humana mergers will be approved by federal and state antitrust regulators. These transactions have been the...more

CMS Releases Proposed Rule and New Tactics Aimed at Strengthening Provider Enrollment Screening

On February 22, 2016, CMS announced on its blog four new enrollment tactics designed to strengthen provider enrollment screening efforts. Just three days later, on February 25, 2016, CMS released a proposed rule that would...more

Employee Benefits Developments - February 2016

IRS Issues Guidance Regarding Application of ACA Fee to Expatriate Health Plans. Section 9010 of the Affordable Care Act (ACA) imposes an annual fee on covered entities engaged in the business of providing health insurance...more

Obamacare in the Courtroom: In the Matter of Double Recovery

The Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare, was drafted to make health care and health insurance more affordable and more available to more Americans as well as to relieve some of the burden on...more

CMS Finalizes Funding Methodology for ACA Basic Health Program for 2017-2018

On February 29, 2016, CMS is publishing its final methodology for determining federal payment amounts to states that elect to establish a Basic Health Program (BHP) to offer health benefits to low-income individuals otherwise...more

CMS, AHIP Release Multi-Payer Physician Quality Measure Sets

CMS and America’s Health Insurance Plans (AHIP) recently released seven sets of physician clinical quality measures as part of a “Core Quality Measures Collaborative” intended to align quality measures among payers and reduce...more

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