SHOP Program

News & Analysis as of

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

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

CMS’s risk adjustment program data signals an improving risk pool while the agency announces plans to modify the program; California enrolls 134,000 undocumented immigrant children into Medicaid; and Oregon approves increases...more

Manatt on Health Reform: Weekly Highlights - August 2016

Oregon’s hospitals see improved financial performance following the ACA; CMS denies Indiana’s request for an additional lockout period in the Medicaid expansion program; and a new Manatt Health report details Medicaid funding...more

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

Funding for Arkansas' Medicaid expansion hangs in limbo; Tennessee's House Speaker appoints Medicaid reform task force in light of public groundswell; and CMS delays requirement for State-based SHOP online enrollment....more

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

Oklahoma seeks federal approval for premium assistance program targeted to American Indians/Alaska Natives; Louisiana estimates $100 million in net savings from Medicaid expansion; and Vermont becomes the first state to...more

Manatt on Marketplaces: Vermont Posts State Innovation Proposal to Waive SHOP Requirement

Vermont posted a draft 1332 waiver proposal for public comment on February 8, 2016. Vermont proposes to eliminate the ACA requirement that small employers enroll through a Small Business Health Options Program (SHOP) web...more

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

Alabama receives federal approval for its Medicaid transformation waiver, while Michigan's Governor submits a Medicaid waiver on behalf of Flint residents; CMS announces $7.7 billion in reinsurance payments; and Vermont seeks...more

Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications

On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the...more

End of Year Issues Impacting Employer Health Plans

With the end of 2015 fast approaching, employers should be aware of certain issues under the Patient Protection and Affordable Care Act (“ACA”), the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and...more

Issue 94: PACE Act Signed into Law

This is the ninety-fourth issue in our series of alerts for employers on selected topics in health care reform. This series of Health Care Reform Management Alerts is designed to provide an in-depth analysis of certain...more

A&B Healthcare Week In Review, September 2015

On September 25, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System”. This proposed rule would...more

The ERISA Litigation Newsletter - September 2015

Editor's Overview - It has been a little more than one year since the U.S. Supreme Court altered the legal landscape for litigating ERISA breach of fiduciary duty claims relating to the investment in employer stock...more

Manatt on 1332: Hawaii Posts Nation's First State Innovation Waiver Proposal

Overview - On September 9 Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's waiver proposal is focused on the state's unique 40-year-old employer mandate, the 40-page...more

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

The GAO reports an increase in choice of plans both on and off Marketplaces; Hawaii submits the first 1332 waiver application, with a focus on substituting the employer mandate and SHOP provisions with pre-existing State...more

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

Ohio’s Medicaid expenditures came in $2 billion below estimates despite enrollment growth after Medicaid expansion; California extends full Medicaid benefits to more pregnant women; and nearly one million have enrolled in...more

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

Montana’s Medicaid expansion waiver seeks monthly premiums and a “third party administrator”; Rhode Island’s Medicaid working group recommends pursuing a DSRIP waiver; and Utah’s Medicaid expansion discussions are put on hold...more

Employer Paid Individual Health Insurance Policies Create the Potential for Significant Penalties, But Limited Relief Is Available

Despite guidance from the Internal Revenue Service (“IRS”), the Department of Labor (“DOL”) and the Department of Health and Human Services (“HHS”) indicating the prohibition of the practice under the Affordable Care Act...more

Manatt on Health Reform: Weekly Highlights: December 2014

This week, a federal Issuer Bulletin describes how issuers in the Federally Facilitated Marketplace will identify their existing enrollees who are switching plans for 2015 coverage. The Exchange Board in New Mexico proposes a...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

Manatt on Health Reform: Weekly Highlights: November 2014 #3

With the 2015 Open Enrollment Period (OEP) officially launched as of November 15, this week’s news highlights Marketplaces’ preparation for and tracking of outreach and enrollment – including 100,000 applications submitted on...more

Health Care Reform Implementation Update

Over the past several days, the second open enrollment period through the Affordable Care Act’s (ACA’s) health insurance exchanges began; Republican lawmakers, now with majorities in both the House and the Senate, explored...more

Health Care Update - November 2014 #2

In This Issue: - Smoother Open Enrollment Sets Stage for Shift in Congressional Focus - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional...more

Health care reform reporting requirements: Final rules

The Patient Protection and Affordable Care Act (PPACA) contains requirements for both individuals and employers related to health care coverage. In order to assure compliance with certain of these requirements, PPACA requires...more

Affordable Care Act Redux

Another delay in implementation of the Affordable Care Act (“ACA” or “Obamacare”) has prompted PK Law to update our material on the Act. Here are some points to bear in mind as March 31 approaches...more

The Affordable Care Act’s Employer Mandate: Are You In Compliance?

So, by now, most readers are aware of the postponement of the Affordable Care Act’s (“ACA”) on-line application process to small business under the SHOP (Small Business Health Options Program) marketplace until 2014 for...more

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