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News & Analysis as of

The 2016 Election and Your Healthcare System: What’s at Stake?

Regardless of the 2016 general election outcome, a new administration will have to respond to pressing policy issues that will shape continued transformation of the U.S. healthcare system. What are the issues and where do...more

Manatt on Health Reform: Weekly Highlights - October 2016 #3 consumers begin previewing 2017 coverage options as HHS projects a 9% enrollment increase over last year and an average 22% benchmark premium increase; Oregon study finds increased primary care spending in...more

Manatt on Health Reform: Weekly Highlights - October 2016 #2

Kentucky receives final approval from CMS to transition its Marketplace to the platform; Ohio puts a prescription drug price ceiling on its November 2017 ballot; and a new study links Medicaid expansion to...more

Manatt on Health Reform: Weekly Highlights - August 2016 #5

A federal report finds that Marketplace premiums are lower in expansion states; Massachusetts and Pennsylvania launch prescription drug monitoring systems; and Kentucky submits a slightly modified Medicaid expansion waiver to...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

Manatt on Health Reform: Weekly Highlights - June 2016#2

Arkansas’ Governor requests to transition to a “State-based Marketplace on the Federal Platform;” Louisiana launches Medicaid expansion with SNAP fast-track enrollment; and study shows 2016 premium increases are lower for...more

Are You Still Reimbursing Premiums For Your Employee's Individual Healthcare Insurance? Then You'd Better Read This!!

In the past, many employers (especially smaller companies) have offered to pay their employees’ premiums for individual healthcare insurance instead of sponsoring their own group health plans. With the advent of the...more

CMS Finalizes 2017 Requirements for ACA Marketplace Plans

CMS has published its annual Notice of Benefit and Payment Parameters, which governs participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017. The sweeping rule addresses protection of consumers...more

Drug Costs, Risk Adjustment Drive Q2 Health Insurance Rate Increases

The Massachusetts Division of Insurance (DOI) recently held a two-day hearing on rate changes proposed by Massachusetts health insurance plans to be effective for the second quarter of 2016 (Q2). Presentations by carriers, in...more

Manatt on Health Reform: Weekly Highlights - December 2015

CMS concludes no QHPs can be certified as comparable to CHIP coverage; California's Marketplace plans to connect consumers to vision coverage issuers; and states react to CMS's proposed user fee....more

Automatic Enrollment for Health Plans Has Been Repealed

Budget legislation signed into law by President Barack Obama on November 2, 2015, the Bipartisan Budget Act of 2015, repeals the controversial automatic enrollment provision under the Affordable Care Act (ACA). Section 18A of...more

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

HHS announces average premium price increases of 7.5% across; Michigan and Illinois launch the country’s first joint cloud-based, real-time Medicaid information management system; and the Marketplace carrier...more

Manatt on Medicaid: Arizona Releases Draft Waiver Request for Approval to Implement Reforms to ACA Medicaid Expansion

Overview - On August 18, 2015, Arizona released the Modernizing Arizona Medicaid proposal for a new 1115 waiver to implement coverage and delivery system reforms in its Medicaid program, the Arizona Health Care Cost...more

Manatt on Health Reform: Weekly Highlights - September 2015

CMS permits states to use income information from other means-tested benefit programs for Medicaid eligibility determinations; Alaska’s Medicaid expansion is given the green light to launch today; and Washington State submits...more

The Affordable Care Act’s Reporting Requirements for Carriers and Employers (Part 4 of 24): Highlights from the Draft 2015...

The IRS recently issued draft 2015 Instructions for Forms 1094-C and 1095-C (“2015 Instructions”). These are the forms that employers with 50 or more full-time employees (including full-time equivalent employees) in the...more

Will § 4980H Require Judicial Amendment Too?

Absent applicable transitional relief, most of which vanishes after 2015, an ACA Applicable Large Employer that fails to offer Minimum Essential Coverage to at least 70% of its 2015 full-time employees and their dependents...more

Hospitality Businesses Should Consider “Play and Pay” for the ACA

A hospitality industry professional recently asked me if I thought most hotels would stop offering group health insurance coverage to their employees and have them purchase their own policies from Covered California.  My...more

Health Care Update - July 2015

In This Issue: - Medicare Releases Set of Payment Rules, Physician Fee Schedule on Deck - Implementation of the Affordable Care Act - Federal Regulatory Initiatives - Congressional Initiatives - Other...more

Congressional Health Policy Hearings - June 2015 #2

A House Ways and Means Subcommittee on Oversight hearing recently reviewed the effects of the Affordable Care Act (ACA) on health insurance premiums. In addition, a House Energy and Commerce Health Subcommittee hearing...more

Stripping the ACA of Both the Carrot and the Stick: Sticking it to Consumers On and Off the Federal Exchange

Even as we write and you read, the Supreme Court in King v. Burwell is considering whether qualifying (often low income) individuals and families who have an opportunity to purchase healthcare coverage through the Affordable...more

Quirky Question #247, An Update on Wellness Programs

Question: Our company has been considering implementing financial incentives for employees to participate in biometric screening as part of an employee wellness program. Are there legal issues we should be...more

Manatt on Health Reform: Weekly Highlights: November 2014 #4

In this week’s highlights, new proposed guidance from the feds would allow default renewals to lower cost plans and bring enhanced transparency to Qualified Health Plan rate increases; open Enrollment hits its stride –...more

Don't Forget! Preparing for the Affordable Care Act Employer Mandate

With 2015 just a few weeks away, employers with 100 or more full-time and full-time equivalent employees should be gearing up for the implementation of the Affordable Care Act (“ACA”) employer mandate, which subjects...more

Employer Reimbursement of Employee’s Individual Medical Insurance May Subject Employer to Penalty

IRS Notice 2013-54 provides that an employer’s reimbursement of healthcare insurance premiums paid by an employee on an individual health insurance contract of the employee on a pre-tax basis (an “employer payment plan”) may...more

U.S. Court of Appeals for the District of Columbia Circuit to Rehear ACA Subsidy Challenge

On September 4, 2014, the D.C. Circuit vacated a panel decision in Halbig v. Burwell (Civ. No. 14-5018) striking down the federal government’s provision of premium subsidies to individuals purchasing coverage through the...more

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