Health Insurance

News & Analysis as of

Form 1095-C and I-9 Compliance: How to handle "mismatches"

Employers complying with the Affordable Care Act (“ACA”) by filing Form 1095-C increasingly face another question: Are they in compliance with their I-9 obligations? The Affordable Care Act (ACA) requires employers with...more

New N. Calif. Report Suggests High Cost of Giving Birth Linked to Increased Health System Consolidation

Childbirth is the leading indication for hospital admission in California, with roughly 500,000 deliveries in the state each year. This is particularly challenging for health plans serving Northern California, the most...more

Valuing Medical Expenses for a Plaintiff without Health Insurance.

Woodland Hills personal injury lawyer Barry P. Goldberg must value cases based at least in part on the value of the plaintiff’s past medical bills and the value of future medical expenses. Plaintiff trial lawyers struggle in...more

No Health Insurers Need Apply: Health Plan Can’t Recover Medical Costs From NY No-Fault Insurer

Under no-fault laws, automobile policies typically must cover the cost of certain medical services provided to policyholders who have been injured in covered accidents. New York’s insurance laws also permit those costs to be...more

DOJ Challenges Health Insurance Merger

On July 21, 2016, the Department of Justice, Antitrust Division (the “DOJ”) announced that it, along with several state attorneys general, would sue to block two multi-billion dollar health insurance mergers between Aetna and...more

Rhode Island’s New Law Requires Health Plans Cover Telemedicine Services

Rhode Island marks the 31st state to enact a telemedicine commercial reimbursement statute. The Telemedicine Coverage Act (HB 7160B) was signed into law by Rhode Island Governor Gina Raimondo on June 28, 2016, representing a...more

DOJ Seeks to Block Two Major Health Insurance Mergers

The United States Department of Justice (DOJ) is suing to block two proposed mergers between major health insurance companies, claiming that the deals violate antitrust laws and would lead to increased health care costs for...more

Manatt on Health Reform: Weekly Highlights - July 2016 #3

Massachusetts’s Marketplace eliminates cost-sharing for addiction treatment in subsidized QHPs; Montana cuts its uninsurance rate in half; and a Kaiser report identifies the 50 most costly drugs for Medicaid....more

Appellate Division Finds c.78 Health Benefits Contributions Requirements Do Not Apply to Public Sector Disability Retirees

Last month, in Brick Twp. PBA Local 230 v. Twp. of Brick, the Appellate Division of the Superior Court of New Jersey confirmed that N.J.S.A. 40A:10-21.1, P.L. 2011, c. 78, § 42, more commonly known as Chapter 78, does not...more

Paying Employees to Opt Out of Insurance? BEWARE

Seyfarth Synopsis: That “win-win” in contract negotiation wherein employees are paid to opt out of employer insurance has become much more complicated thanks to the IRS. Basically, if bargaining parties do not follow new IRS...more

No More Surprises: Florida Ends Certain Medical Balance Billing

"Surprise medical billing" occurs when a patient receives care at a facility and receives treatment from a provider, such as an anesthesiologist or radiologist, who is not contracted with the patient’s health insurance plan....more

Recent Congressional Hearings

Congressional committees held hearings on a wide variety of on health policy issues this month before going on summer recess. Notable hearings include the following...more

CMS Issues Medicare Physician Fee Schedule Proposed Rule

On July 7, 2016, CMS issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017 (Proposed...more

Addressing the Opioid Crisis

Following the July 13 U.S. Senate's passage of Comprehensive Addiction and Recovery Act (CARA), providers, families and communities should evaluate the act's impacts. The reform, S. 524, is viewed as a comprehensive approach...more

Health Alert (Australia) July 18, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: South Australia 13 July 2016 - Inquest into the death of Geoffrey Scott Noakes Mr Noakes was a 43 year old with a...more

Client Alert: Florida: What the New Balance Billing Law Means for Physicians

This year two bills became law in Florida that are intended to equip Floridians with tools to make health care decisions based on cost and to protect them from significant unanticipated medical bills. The first (HB1175)...more

DC Circuit strikes down HHS regulation regarding fixed indemnity plans

On July 1, 2016, in the case of Central United Life Insurance Company v. Burwell (No. 15-5310), the US Court of Appeals for the District of Columbia Circuit ruled that the US Department of Health and Human Services (HHS)...more

IRS Proposes Restrictions on Employer Opt-Out Payments for ACA Coverage Waivers

In early July the IRS issued proposed regulations addressing the effect that employer payments to employees who waive employer-sponsored health coverage, known as Opt-Out Payments, have on determining whether an ACA-covered...more

ColoradoCare Stands to Significantly Alter Health Care Services

In November, Colorado voters will cast ballots on Amendment 69, also known as ColoradoCare. ColoradoCare is an ambitious, far-reaching plan to amend the Colorado constitution which would establish a statewide universal...more

Alaska Enacts New Telemedicine Law: What Providers Should Know

Alaska Governor Bill Walker signed SB 74 into law on June 21, 2016, expanding the use of telemedicine in the Last Frontier state. Specifically, SB 74 removes Alaska’s previous in-state presence requirements for prescribing...more

Best in Law: Beware of In-Lieu-Of Payments to Employees

Employers who allow their employees to opt for taxable cash payments in lieu of health benefits must consider the value of the payments when calculating overtime rates, a federal appellate court has ruled. Originally...more

New Federal Proposal May Make Health-Related Travel Insurance an Excepted Benefit Under ACA

For companies selling travel insurance products, there is major news out of Washington D.C. The Obama administration is seeking to curb short-term, limited duration health policies, which includes insurance products now...more

Time for a Wellness Check on your Wellness Program? New EEOC Regulations Could Diagnose Need for Change

In light of new rules from the Equal Employment Opportunity Commission (EEOC), employers should examine their wellness programs now (and during open enrollment for next year) to determine the potential impact of the final...more

The State of Telehealth - Policy and Reimbursement Q&A

Foley Partner Nathaniel Lacktman, head of the firm’s telemedicine and virtual care practice, participated in a comprehensive Q&A discussing the challenges and opportunities facing the telehealth market with Healthcare...more

More Clarity on Expatriate Health Plans and the ACA

Expatriate health plans have been surprisingly difficult to reconcile with the Affordable Care Act (ACA). Proposed regulations set to take effect in 2017 provide some useful guidance to U.S. employers that sponsor expatriate...more

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