News & Analysis as of

Qualified Health Plans

Stable or Fable: Will the Trump Administration Proposed Rule Save the Exchanges or Hasten Their Demise?

by Nossaman LLP on

A proposed rule intended to stabilize the individual and small group insurance markets was issued on February 17, 2017, only a week after the Senate confirmed Tom Price as the Secretary of the U.S. Health and Human Services...more

CMS Issues Proposed Changes to ACA Healthcare Exchanges

by King & Spalding on

On February 15, 2017, CMS issued a proposed rule which the Trump administration contends will reform and stabilize the individual and small group health insurance market exchanges created pursuant to the Affordable Care Act...more

Trump Administration Takes First Steps to Support Exchanges, but Key Questions Remain

by McDermott Will & Emery on

In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a...more

President Trump Props Up the ACA: A Summary of the New Administration's ACA Market Stabilization Regulation

by Faegre Baker Daniels on

On February 15, President Trump and new Department of Health and Human Services (HHS) Secretary Tom Price released their first proposed regulations addressing the Affordable Care Act (ACA). While remaining committed to...more

News from the Vermont State House - An analysis from DRM's Government & Public Affairs Team - February 2017

by Downs Rachlin Martin PLLC on

The Agency of Transportation has submitted a proposal to the House Transportation Committee that would allow the agency to seek damages from a utility that fails to move or adjust a utility line that is in a state or local...more

Another Challenge to U.S. on Risk Corridor Payments

by Faegre Baker Daniels on

Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the Affordable Care Act’s “risk corridor” program. According to Molina’s 84-page complaint filed Jan. 23,...more

Hawai’i Receives Approval for the First State Innovation (Section 1332) Waiver

by Foley & Lardner LLP on

The federal Department of Health and Human Services and Department of Treasury (the Departments) agreed that certain small employer health insurance coverage provisions of the Affordable Care Act (ACA) would be waived for the...more

Risk Corridors Update: DOJ Says US Does Not Have to Pay – House Agrees

by Freeborn & Peters LLP on

Readers of this blog may recall that on September 9, 2016, the federal Department of Health and Human Services (HHS) – through its Centers for Medicare and Medicaid Services (CMS) – announced that it is open to discussing...more

Washington Healthcare Update

by McGuireWoods LLP on

1. Congress - Senate - FDA Supports Expanded Authority Over Cosmetics - In an Oct. 5 letter to Senator Dianne Feinstein (D-CA), the Food and Drug Administration (FDA) says its current legal authority over...more

Washington Healthcare Update

by McGuireWoods LLP on

This Week: Congress remains in recess, but members write letters on Mylan’s EpiPen…CBO says repealing Part B Demo would cost $395 million…CMS releases data on hospice utilization and finds spending and utilization vary in...more

Now, About Those Settlements? – House Committee Asks

by Freeborn & Peters LLP on

The U.S. House of Representatives Committee on Energy and Commerce (Committee), which oversees the Department of Health and Human Services (HHS), recently sent a strong letter to HHS Secretary Sylvia Matthews Burwell after...more

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

Study finds that Marketplace premiums are lower than employer-based premiums, even without federal subsidies; New York regulators move to shield insurers from outsized federal risk adjustment payments; and Missouri will seek...more

Washington Healthcare Update

by McGuireWoods LLP on

1. Congress - House of Representatives - House Energy and Commerce Committee Republican Leaders Send Letter to HHS OIG Concerning NIH Grant on Traumatic Brain Injury - On Sept. 15, Republican leaders of the...more

The Risk Corridors End Game

by Freeborn & Peters LLP on

Since the first cases were filed earlier this year, we have been following nationwide litigation seeking full risk corridors payments to qualified health plans (QHPs) providing coverage on the Affordable Care Act (ACA)...more

California Court Finds That Discretionary Clauses in Health Insurance Policies Are Enforceable

In 2011, the California legislature passed Insurance Code Section 10110.6 which bans the use of discretionary clauses in any policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not...more

What Does the CMS Notice of Benefit and Payment Parameters Mean for Providers?

by BakerHostetler on

The Centers for Medicare & Medicaid Services (CMS) recently issued its proposed Notice of Benefit and Payment Parameters for 2018 (Proposed Rule) a couple of months earlier than in the past - one of the administration’s many...more

Manatt on Health Reform: Weekly Highlights - September 2016

The national uninsurance rate hits a record low; Georgia’s Chamber of Commerce outlines three Medicaid expansion proposals; and California legislation targets surprise medical bills. FEDERAL AND STATE MARKETPLACE...more

United Behavioral Health v. MIHS

Medicare Part C, 42 U.S.C. §§ 1395w-21 et seq., permits enrollees to obtain Medicare-covered healthcare services from private healthcare organizations and their third-party contractors. The Employee Retirement Income Security...more

2016 Draft Instructions For 1094-B and 1095-B

by Balch & Bingham LLP on

Last week, the IRS released draft 2016 instructions for the 1094-B and 1095-B (the “B” Forms). The release of the draft instructions is just weeks after the IRS released the draft instructions for the 1094-C and 1095-C...more

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

CMS targets Medicaid managed care pass-through payments; California proposes “California Qualified Health Plans” for the undocumented; and a new study finds out-of-pocket costs were reduced by nearly a third for Medicaid...more

Transparency's Opaque Beginning: CMS Starts Implementing ACA Transparency Requirements

by Faegre Baker Daniels on

Based on QHP Certification instructions issued on July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) will collect administrative and performance data from health insurers that participate in the federally-run...more

Focus on Land of Lincoln

by Freeborn & Peters LLP on

Land of Lincoln Mutual Health Insurance Company, one of the Consumer Operated and Oriented Plans (CO-OPs) set up under the Affordable Care Act (ACA) and intended to provide an alternative to traditional insurers and foster...more

Update – More Risk Corridors Lawsuits Filed

by Freeborn & Peters LLP on

To update our recent post, “Exchange Players File ACA Lawsuits Against CMS,” two new suits were filed by Qualified Health Plan (QHP) issuers selling coverage on the Affordable Care Act (ACA) exchanges. As described in our...more

Exchange Players File ACA Lawsuits Against CMS

by Freeborn & Peters LLP on

The Affordable Care Act (ACA) has been the impetus for extensive litigation since it was enacted in 2010. The Supreme Court has heard oral argument in four cases, and scores of other cases have been filed in the lower courts....more

Judge rules HHS can't pay cost-sharing subsidies to QHPs, but allows funding to continue

by Dentons on

More than six years after the Affordable Care Act (ACA) was enacted, legal challenges continue to thread their way through the judicial system. In a May 12, 2016 decision, US District Court Judge Rosemary M. Collyer, an...more

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