Qualified Health Plans

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Health care providers, health plans, business associates, and other entities affected by the federal HIPAA privacy and security regulations are quickly running out of excuses for not having a robust HIPAA compliance program...more

CMS Identifies Key Priorities for 2014 Compliance Reviews of Qualified Health Plans in the Federally Facilitated Marketplace

At a Centers for Medicare & Medicaid Services ("CMS") teleconference titled "Compliance Reviews in the Federally-Facilitated Marketplace" ("FFM"), which was held on April 10, 2014, CMS representatives discussed the agency's...more

April and May 2014 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

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

CMS Now Requiring Qualified Health Plans To Accept Premium Payments From Certain Third Parties

As previously reported on November 13, 2013 and February 20, 2014, the Centers for Medicare and Medicaid Services ("CMS") has attempted to provide guidance as to when it is appropriate for issuers of "qualified health plans"...more

March and April 2014 Filing and Notice Deadlines for Qualified Retirement and Health and Welfare Plans

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

Appeals Court Sides With Hospitals, Rejects Health Plan’s Demand for Refund

The United States Court of Appeals for the Seventh Circuit recently affirmed a Wisconsin district court’s grant of summary judgment in favor of two Wisconsin hospitals, ruling the hospitals were not obligated to repay $1.7...more

HHS Allows Third-Party Premium Payments By Tribes And Non-Profits

We previously reported that the U.S. Department of Health and Human Services ("HHS") has discouraged hospitals and other third parties from paying patients' premiums or cost-sharing. HHS stated in its November 4, 2013 FAQ...more

Health Law Alert - February 2014: Medicare Advantage Terminations: Thinning The Herd Of Qualified Participating Providers

"Thinning the herd" is the process of removing from the population, by any means necessary, those who cannot or should not survive. Emblem, United Healthcare and other major health insurers, have undertaken a corporate...more

CMS Issues Draft Letter with 2015 Affordable Care Act Plan Certification Requirements

On February 4, 2014, CMS released a Draft Letter containing guidance for issuers seeking to offer Qualified Health Plans (QHPs) in Federally-Facilitated Marketplaces (FFMs). The Draft Letter offers operational and technical...more

Another Benefits Grab Bag of Guidance and Reminders – Health and Retirement Plans

Preventive Care Expansion for Calendar Plan Year 2015 for Non-Grandfathered or Non-Exempt Plans - The preventive care coverage requirements were updated in September 2013 to include a requirement that there must be...more

ACA Proposed Rule to Require Health Insurers to Certify Compliance with HIPAA Electronic Transaction Requirements

The U.S. Department of Health and Human Services issued a proposed rule to implement the ACA requirement that health insurers and other HIPAA-covered health plans certify compliance with the standards and operating rules for...more

HHS Issues Proposed Rule Requiring Health Plans to Demonstrate Compliance with HIPAA Electronic Transaction Standards and...

On January 2, 2014, the U.S. Department of Health and Human Services (HHS) published a proposed rule that would require “controlling health plans” (CHPs) to demonstrate compliance with certain electronic transaction standards...more

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

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

Health Reform + Related Health Policy News - November 2013 - Issue 1

In This Issue: - Top News ..HHS Gives Mixed Messages Regarding Federal Health Care Program-Status of Qualified Health Care Plans (QHPs) ..HHS Issues Health Insurance Marketplace Enrollment Report...more

Employee Benefits Update: 2013 Year End Plan Tasks

As we approach the end of the year, employers and plan sponsors of qualified retirement plans and health and welfare plans should take time to meet various upcoming deadlines. Failure to comply with the deadlines may result...more

Healthcare Complexity: Do Exchange Plans Qualify as Federal Healthcare Programs

As the healthcare community readies itself for patients securing health coverage through the exchanges, various techniques are being considered to encourage and facilitate patient enrollment in a health plan. One question...more

HHS's Mixed Messages: Identifying a Federal Healthcare Program When You See It

Recent seemingly contrary determinations by the U.S. Department of Health and Human Services (HHS) have fueled industry speculation regarding whether qualified health plans (QHPs) available on the health insurance exchanges...more

May Providers Pay Health Insurance Premiums for HealthCare.gov Plan Enrollees?

Following last week's declaration that Qualified Health Plans (QHPs) on HealthCare.gov are not "Federal health care programs," and thus are not subject to the federal Anti-Kickback Statute, CMS released additional guidance...more

CMS Creates Clarity and Confusion on Application of Fraud and Abuse Laws to Qualified Health Plans

On October 30, 2013, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to U.S. Representative Jim McDermott stating that HHS does not consider qualified health plans (QHPs) sold...more

HHS Says Qualified Health Plans Are Not ‘Federal Health Care Programs’

The Department of Health and Human Services (HHS) recently announced that qualified health plans (QHPs) established by the Affordable Care Act (ACA)—which include federally-facilitated insurance exchanges and federal...more

Dodging the AKS: Marketplace Plans Are Not "Federal Health Care Programs"

In an October 30th letter addressed to Congressman Jim McDermott, the Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, left little to interpretation: Qualified health plans (QHPs) purchased through...more

Sebelius: "Qualified Health Plans Are Not Federal Health Care Programs"

In a letter to Rep. Jim McDermott dated Oct. 30, 2013, Department of Health and Human Services Secretary Kathleen Sebelius clarified that qualified health plans (“QHPs”) available on the health insurance exchanges under the...more

CMS Declares Third Party Payment of QHP Premiums Not OK

On the heels of HHS’s recent announcement that qualified health plans (QHPs) purchased through the Affordable Care Act (ACA) insurance exchanges are not “federal health care programs” for purposes of the federal anti-kickback...more

HHS Clarifies that ACA Qualified Health Plans are Not Subject to Federal Anti-Kickback Statute; Expresses Concern about Providers...

The U.S. Department of Health and Human Services recently announced that Qualified Health Plans (sold on and off the Exchanges) are not “Federal health care programs” for purposes of the federal anti-kickback statute. The...more

Marketplace Plans Not Subject to Anti-Kickback Statute

On October 30, 2013, the Secretary of the Department of Health and Human Services (“DHHS”), Kathleen Sebelius (“Secretary”), released a letter to Congressman Jim McDermott (D-WA) answering the question of whether qualified...more

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