SHOP Program

News & Analysis as of

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

HHS and IRS Release Updates on the SHOP Marketplace, Fees, Taxes, and Payment Parameters

Before departing for the 2013 Thanksgiving holiday, the Obama administration released several new regulatory announcements and guidance relating to the implementation of the Affordable Care Act (ACA). The new guidance delays...more

Health Care Reform Provisions For 2014 And Beyond

Executive Summary: Earlier this year, the Obama Administration delayed implementation of the employer mandate, a major provision of the 2010 health care reform law (the Affordable Care Act or "ACA"). The delay of the...more

No More Pre-Tax Premiums For Individual Insurance Policies?

Over the years we have seen some employers, particularly small employers, choose to provide health coverage to their employees by paying all or part of the premium for individual insurance policies that the employees have...more

Health Insurance Exchanges: The Facts Behind the Debate

Health insurance exchanges (commonly called the MarketPlace or the Exchanges) are a complex and highly debated part of the Affordable Care Act (ACA). With the looming January 1, 2014, deadline to open the marketplace for...more

Save The Date: Oct. 1, 2013 — ACA Open Enrollment Begins

A fundamental feature of the Patient Protection and Affordable Care Act (“ACA” or “Act”) is the introduction of health care exchanges, or marketplaces, where individuals and small businesses may purchase “affordable” and...more

HHS Publishes Final Rule on Exchanges, SHOPs, and Eligibility Appeals

Final regulations required for October 1, 2013 open enrollment are largely unchanged from the proposed rule. On August 30, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human...more

HHS Releases Proposed Rule Aimed at Oversight of Health Insurance Exchanges

On June 14, 2013, HHS released a proposed rule containing many provisions aimed at oversight of federally-facilitated exchanges (FFEs), state health insurance exchanges (State Exchanges), qualified health plan (QHP) issuers,...more

CMS Proposes Rule for Exchanges and SHOPs Under the Affordable Care Act

New marketing integrity and oversight provisions warrant review and comment. On June 14, the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services (HHS) published its...more

Healthcare Law -- May 21, 2013

Clearing up the Rumors around Health Reform Delays: What Really Happened, What Won’t and Steps Employers and Insurers Can Take Now - Rumors are flying in health policy circles that the Obama Administration might delay...more

Affordable Care Act: Health Insurance Exchanges and Other Issues for Small Employers

The Affordable Care Act (ACA) has a variety of implications for small employers and their employees. Under the Qualified Health Plan and Health Insurance Exchange provisions of the ACA, the term “small employer” is defined as...more

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