News & Analysis as of

Healthcare Qualified Health Plans

Manatt, Phelps & Phillips, LLP

FY 2025 Executive Budget Women’s Health Highlights

Earlier this week, Governor Kathy Hochul released her Executive Budget proposal totaling $233 billion for State Fiscal Year 2025. The budget proposes several initiatives targeted at improving access to, quality of, and...more

Arnall Golden Gregory LLP

Mental Health Crisis: Unmasking Ghost Networks

As the United States continues to grapple with a growing mental health crisis, millions are finding it increasingly difficult to access and afford mental health treatment. Recent investigations conducted by the New York...more

Groom Law Group, Chartered

CMS Proposed Rule Would Leverage Technology and Interoperability to Improve Prior Authorization

On Tuesday, December 13, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“New Proposed Rule”) to improve the prior authorization process and advance interoperability for Medicare Advantage...more

King & Spalding

CMS Proposes Rule to Require Certain Health Plans to Electronically Share Data with Providers Regarding Prior Authorization...

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On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more

Manatt, Phelps & Phillips, LLP

CMS Revives Standardized Plans and Federal Network Adequacy Review

The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Notice of Benefit and Payment Parameters (NBPP), the annual rule outlining key policies for the individual and group health insurance markets for plan...more

Nossaman LLP

Understanding the HHS 2023 Proposed Rule

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The Department of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for the 2023 Proposed Rule on Wednesday, January 5th 2022. ...more

McDermott Will & Emery

Qualified Plans & Health And Welfare Plans

McDermott Will & Emery on

QUALIFIED PLANS - Student Loan Repayment Benefits - ? Qualified plan benefit tied to student loan debt repayment ? Special rules apply to these benefits when they are connected to the 401(k) plan ? IRS Private Letter...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - October 2015 #3

Arizona seeks Medicaid Waiver to implement new coverage restrictions for Medicaid expansion enrollees and delivery system reform; Tennessee’s uninsured rate continues to drop; and Louisiana gubernatorial candidates line up...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - October 2015

Congress passes a bill to give states greater flexibility in defining “small businesses”; South Dakota seeks to offset Medicaid expansion costs in part with increased use of the fully federally-funded Indian Health Service;...more

Manatt, Phelps & Phillips, LLP

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

The Massachusetts Marketplace takes steps to ease consumer confusion by reducing choice among QHPs; North Carolina appears poised to pass Medicaid reform legislation; and bipartisan support is gaining for defining businesses...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - September 2015 #2

Colorado’s uninsured rate is down 9 percentage points in four years; Michigan requests increased cost-sharing for its Medicaid expansion population above the federal poverty line; and, HHS’s proposed guidance strengthens...more

Manatt, Phelps & Phillips, LLP

Health Update - July 2015

Lessons From the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace - Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - July 2015 #3

In quick succession, governors in Alaska and Utah announce Medicaid expansions this week; Iowa is transitioning its expansion away from the Marketplace to Medicaid managed care, for now; and, HHS extends its exception to...more

Foley & Lardner LLP

The Biggest Obstacle to Value-Based Care

Foley & Lardner LLP on

In this video, Foley Partner Lawrence Vernaglia discusses the biggest obstacle to realizing a value-based system of health care, and what realistically can be done in the industry by taking "measured steps."...more

Mintz

How New York’s Emergency Medical Services and Surprise Bills Law Impacts Providers and Plans

Mintz on

Last year New York passed legislation known as the “Emergency Medical Services and Surprise Bills” law, a much-heralded consumer protection law primarily intended to guard against surprise bills for out of network (OON)...more

Epstein Becker & Green

CMS Announces Key 2015 Compliance Priorities for Federally Facilitated Exchange Plans

Epstein Becker & Green on

The Centers for Medicare & Medicaid Services (“CMS”) recently announced its 2015 key priorities for compliance reviews of qualified health plans (“QHPs”) offered in the federally facilitated marketplaces (“FFMs”). Through a...more

Epstein Becker & Green

CMS Releases Key Proposals for the 2016 Qualified Health Plan Application Process

Stakeholders received insight on the Obama administration’s expected approach to the certification and oversight of qualified health plans (“QHPs”) on December 19, 2014, with the release by the Centers for Medicare & Medicaid...more

Epstein Becker & Green

New York’s “Emergency Medical Services and Surprise Bills” Law

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Earlier this year, the New York Legislature enacted, and Governor Cuomo signed, legislation that will impact billing and reimbursement for some out-of-network health care services, require new disclosures from providers...more

Epstein Becker & Green

CMS Cost Sharing Reduction Reconciliation Reporting for QHPs

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Qualified Health Plans (“QHPs”) and other stakeholders have until October 27, 2014, to comment on CMS’s proposed cost sharing reduction payment reconciliation reporting process. On Friday, September 26, 2014, CMS released...more

BakerHostetler

The Sliding Scale of Health Coverage: Finding the Intersection of Cost, Access and Quality

BakerHostetler on

While not a new concept, the use of narrow networks has become a lightning rod for the controversy surrounding qualified health plans (QHPs) offered on the insurance exchanges created under the Affordable Care Act (ACA) and...more

Cooley LLP

HHS Delays ICD-10 Implementation Requirements

Cooley LLP on

On August 4, 2014, the United States Department of Health and Human Services (HHS) issued a final rule delaying the compliance date for health care providers, health plans, and health care clearinghouses to transition to the...more

King & Spalding

August and September 2014 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

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Employers and plan sponsors must comply with numerous filing and notice deadlines for their retirement and health and welfare plans. Failure to comply with these deadlines can result in costly penalties and excise taxes. To...more

Buchalter

Risk Taking in the Provider World: Is a Knox-Keene Plan a Good Strategic Move For You?

Buchalter on

Reimbursement for health care services in California continues its shift toward capitation, resulting in health care providers increasingly forming their own health plans under the Knox Keene Health Care Service Plan Act (the...more

Epstein Becker & Green

CMS's Final Exchange and Insurance Market Standards Impact Qualified Health Plan Filings for 2015 and Beyond

On May 16, 2014, the Centers for Medicare & Medicaid Services ("CMS") released a final rule titled "Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond" ("Final Rule")...more

Cozen O'Connor

Health Care Reform Implementation Update - May 2014

Cozen O'Connor on

Congress held several hearings last week ranging from Sylvia Burwell’s nomination for Secretary of the Department of Health and Human Services (HHS), to Medicare payment oversight, to post-acute care in Medicare. The Centers...more

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