News & Analysis as of

Health Insurance Regulatory Reform

Epstein Becker & Green

Affordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False Claims

Epstein Becker & Green on

Stakeholders are continuing to analyze the implications of the mammoth proposed rule on “Medicare and Medicaid Programs: [Calendar Year (CY)] 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B...more

Fenwick & West LLP

The Shifting Regulatory Landscape for Level-Funded Plans: An Alternative for Group Health Insurance

Fenwick & West LLP on

In the constantly changing health insurance landscape, level-funded health plans are steadily gaining ground as a viable middle approach between fully insured health plan and self-funded health plans—arguably offering...more

Polsinelli

Florida Proposes New Pharmacy Benefit Manager Rules

Polsinelli on

On September 18, 2023, the Florida Office of Insurance Regulation (“OIR”) published proposed rules to implement provisions of the Prescription Drug Reform Act (Florida Senate Bill 1550) governing Pharmacy Benefit Managers...more

Cornerstone Research

5 Questions with Erin Trish: Surprise Billing in Healthcare

Cornerstone Research on

5 Questions is a periodic feature produced by Cornerstone Research, which asks our professionals, senior advisors, or affiliated experts to answer five questions. We interview Professor Erin Trish, of the Schaeffer Center...more

Polsinelli

Third Party Administrator & Pharmacy Benefit Manager 2023 Newsletter: TPA & PBM Licensing And Compliance Developments

Polsinelli on

Florida OIR Issues Informational Memorandum OIR-23-04M to PBMs - On July 19, 2023, the Florida Office of Insurance Regulation (“OIR”) issued Informational Memorandum OIR-23-04M (“Memorandum”) to Pharmacy Benefit Managers...more

Polsinelli

CMS Proposes Changes to Medicare Provider Enrollment Rules

Polsinelli on

The Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare Provider Enrollment requirements in the 2024 Medicare Physician Fee Schedule Proposed Rule (the “Proposed Rule”). If finalized,...more

Manatt, Phelps & Phillips, LLP

California Assembly Acts to Streamline Physician Credentialing Process

The California Legislature is considering a bill to simplify the process by which health insurers and plans credential providers. Currently, providers must satisfy the proprietary “credentialing” requirements of individual...more

Holland & Knight LLP

Florida Enacts Comprehensive Pharmacy Benefit Plan Regulation

Holland & Knight LLP on

This legislative session, Florida has joined Arkansas and Oklahoma among the most regulatory-minded states with respect to pharmacy benefit plans and programs as well as pharmacy benefit managers (PBMs). Florida's...more

Venable LLP

Congress Set for Busy Lame Duck Session; To Take Up Expansive Set of Issues, Including Defense, Healthcare, Tax, and More

Venable LLP on

​​​​​​​With the midterm elections now behind us, the U.S. House of Representatives and the U.S. Senate return to Washington this week to kick off the lame duck session, entering the twilight of the legislative year with a...more

Stinson - Benefits Notes Blog

American Rescue Plan Act Contains Many Employee Benefits Related Provisions

On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (the “ARPA”) into law.  Many of the provisions in this sweeping legislation bring changes to the employee benefits world of which employers should...more

Akerman LLP - Health Law Rx

Klobuchar Antitrust Bill Could Have Significant Impact on Healthcare Industry

In early February, Senator Amy Klobuchar, new Chair of the Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights, introduced the “Competition and Antitrust Law Enforcement Reform Act of...more

Cozen O'Connor

Repeal of McCarran-Ferguson Act — Ramifications for Insurance Clients

Cozen O'Connor on

Health insurance companies are now no longer immune from antitrust scrutiny for activities previously found to be “the business of insurance.” Last week, the Competitive Health Insurance Reform Act (CHIRA) was enacted,...more

Nossaman LLP

New Disclosure Requirements for Those that Contract with ERISA Group Health Plans

Nossaman LLP on

Included within the 5539 pages of statutory changes in the Consolidated Appropriations Act, 2021 (the COVID-19 relief bill signed into law at the end of December 2020) are important new “transparency” laws that affect third...more

Hogan Lovells

Congress passes FY 2020 funding bill with tax benefits for energy, health care, and retirement plans

Hogan Lovells on

In a rare display of bipartisanship, after intense last minute negotiations between congressional leadership and the Executive Branch, President Donald Trump signed into law legislation passed last week by Congress to...more

Troutman Pepper

New York and New Jersey Consider Health Insurance Reforms

Troutman Pepper on

Increasing uncertainty and hostility surrounding the federal Affordable Care Act (ACA) have resulted in a burst of health insurance reforms at the state level. For example, Washington recently passed a law creating a public...more

Mintz - Employment Viewpoints

Association Health Plan Perspectives (Part 2): The Look-Through Rule and the Limits of State Regulatory Power

In a summary of the recently issued Association Health Plan (AHP) final regulations, the U.S. Department of Labor (DOL) rightly observed that AHPs are a species of multi-employer welfare arrangements, or MEWAs, that are...more

Ballard Spahr LLP

Final Regulations Expand Availability of Individual Insurance Not Meeting ACA Requirements

Ballard Spahr LLP on

The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued final rules modifying the definition of short-term, limited-duration insurance (STLDI). STLDI provides health coverage that is...more

Bricker Graydon LLP

Association Health Plans: Another tool for small employers to manage health care costs and increase employee access to affordable...

Bricker Graydon LLP on

Following last fall’s Executive Order 13813, which directs regulatory agencies to improve access to affordable employer coverage, the Department of Labor (DOL) recently released the final regulations on small business...more

Ballard Spahr LLP

DOL Releases Final Regulation Expanding Association Health Plans

Ballard Spahr LLP on

The U.S. Department of Labor (DOL) on Tuesday released final regulations modifying the Association Health Plan (AHP) rules to expand their availability for small and large employers and to address their affordability by...more

Stinson LLP

DOL Issues Final Association Health Plan Rule

Stinson LLP on

On June 19, 2018, the Department of Labor (DOL) released a final rule that offers new options for associations to sponsor health plans for their members. These new options allow more small businesses to come together to...more

Littler

Association Health Plans: How Do You Solve a Problem Like a MEWA?

Littler on

On June 19, 2018, the Department of Labor issued its highly anticipated final rule expanding the availability of association health plans (“AHPs”). ...more

Sheppard Mullin Richter & Hampton LLP

Proposed CVS Health-Aetna Acquisition Holds Strong in Congressional Hearing

Last Tuesday, February 27, 2018, representatives of CVS Health and Aetna went before the House Judiciary Committee Subcommittee on Regulatory Reform, Commercial, and Antitrust Law (“Subcommittee”) to argue in favor of CVS...more

BCLP

Deep Dive: Association Health Plans - Part 1

BCLP on

On October 12, 2017, President Trump signed a “Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States” (the “Executive Order”) to “facilitate the purchase of insurance across State...more

Akerman LLP - Health Law Rx

House Judiciary Subcommittee Holds Hearing on Proposed CVS/Aetna Merger

On February 27, the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law held a hearing to consider the implications of the proposed CVS/Aetna merger. The transaction, valued at approximately $69...more

Mintz - Employment Viewpoints

Association Health Plans and the Sale of Group Health Insurance “Across State Lines”

In advance of issuing the Executive Order that culminated in the promulgation by the Department of Labor of proposed regulations expanding the availability of Association Health Plans, President Trump announced that one of...more

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