News & Analysis as of

Health Insurance

Read need-to-know updates, commentary, and analysis on Health issues written by leading professionals.

Tennessee Supreme Court Rejects Efforts to Alter Existing Law on the Collateral Source Rule in Personal Injury Cases

Last month the Tennessee Supreme Court, in Dedmon v. Steelman, affirmed the long-standing collateral source rule in personal injury cases. As long as an injured plaintiff can establish that the medical expenses they incurred...more

CVS Health to Acquire Aetna

On December 3, 2017, CVS Health, a giant in the retail pharmacy industry, announced plans to acquire Aetna. Aetna is one of the largest medical insurers in the nation, servicing approximately 46.7 million people. Under the...more

OIG Advisory Opinion 17-06: Another Medigap/PHO Arrangement Approved

by Baker Ober Health Law on

Advisory Opinion 17-06 joins a long list of opinions approving arrangements between a Medicare Supplemental Health Insurance (Medigap) insurer and a preferred hospital organization (PHO). While this advisory opinion does not...more

Connecticut District Court Provides Interpretation of ACA Provision - Decision Allows Insurers to Circumvent Hospitals in...

by Holland & Knight LLP on

• The ACA does not prevent insurers from declining to directly reimburse out-of-network hospitals for emergency care, and instead adjudicate and administer claims directly with individual patients, the U.S. District Court for...more

Abrupt Closure of SynerMed Shakes Up Medical Management Industry

by Nossaman LLP on

SynerMed, a Southern California-based physician management company, will be shutting down, per an email from its CEO earlier this month. Recently, the company had come under increasing scrutiny by health plans and California...more

Proposed Regulations Issued Implementing Massachusetts Employer Medical Assistance Contribution (EMAC) Supplemental Contribution

In an earlier post, we reported on the passage of H. 3822, “An Act Further Regulating Employer Contributions to Health Care,” (the “Act”), the purpose of which is to shore up the finances of the Commonwealth’s Medicaid...more

Medicaid Forecast: Slower Enrollment Growth and Higher Spending Growth for FY 2017 – 2018: Results from a 50-State Medicaid Budget...

by Baker Ober Health Law on

On October 19, Kaiser Family Foundation and Health Management Associates hosted a joint briefing to release their 17th Annual 50-State Medicaid Budget Survey for state fiscal years (FY) 2017 and 2018. The survey highlights...more

News from Second & State

Weekly Wrap - It was back to business as usual this week in Harrisburg, as the Senate returned for three days of voting session. While not in session, the House of Representatives was also busy, holding some public...more

Opioid Litigation Over Insurance Coverage – Coming to a Jurisdiction Near You

by Nexsen Pruet, PLLC on

A very recent appellate ruling in California provides a roadmap for opioid litigation over insurance coverage that is about to ramp up all over country. In Travelers Prop. Cas. Co. of Am. v. Actavis, Inc. et al, 2017 WL...more

Three Years Later, Foley Survey Reveals Positive Prognosis for Telemedicine

by Foley & Lardner LLP on

When we launched Foley’s inaugural Telemedicine and Digital Health Survey in 2014, it was apparent that health care executives weren’t ready to make telemedicine a significant focus of their business and patient strategies....more

NAIC Working Group Exposes Proposed Revisions to Life and Health Guaranty Association Model Act

by Locke Lord LLP on

On October 27, the NAIC Model Law (E) Working Group released an exposure draft of its proposed revisions to the Life and Health Guaranty Association Model Act (#520), intended to address the financial challenges of Long Term...more

“Who” May Object to the Contraceptive Coverage Mandate, and Why?

by Bryan Cave on

New rules issued by the Trump administration, including both interim final and temporary regulations effective October 6, 2017, significantly expand “who” may object to the Patient Protection and Affordable Coverage Act’s...more

Superior Court Sets Out Rules For Class Certification

by Morris James LLP on

Wilmington Pain & Rehabilitation Center P.A. v. USAA General Indemnity Insurance Co., No. N15C-06-218 JRJ CCLD (October 17, 2017) - This is an important decision became it sets out the most recent rules for determining...more

Big Pharma BI, CBI, and Service Interruption Claims Percolating in Puerto Rico

by Zelle LLP on

As recovery and rebuilding efforts drag on in Puerto Rico, Hurricane Maria’s impact on Big Pharma is radiating across the U.S., and around the globe as the dozens of drugs manufactured in Puerto Rico become scarce. Maria...more

Trump Administration Will No Longer Make Cost-Sharing Reduction Payments to Insurers; States Sue

by King & Spalding on

On October 12, 2017, the White House press office announced that the Trump Administration would no longer make cost-sharing reduction (CSR) payments to insurers, which it referred to as a “bailout of insurance companies...more

Insurer Liable Though Physician Skips Med Mal Trial

by Faegre Baker Daniels on

Lancet Indemnity’s $1 M med mal policy had a standard clause requiring the insured, Dr. Ishtiaq Malik, to cooperate and assist Lancet and appointed counsel in investigating and defending claims. But when the family of...more

President Trump Signs New Executive Order To Loosen Insurance Regulations

by King & Spalding on

Following multiple failed attempts by the Republican-led Congress to repeal the Affordable Care Act (ACA), on October 12, 2017, President Trump took unilateral action signing an executive order aimed at expanding choices and...more

Reaping the Jurisdictional Whirlwind

by Reed Smith on

Literally for decades plaintiffs in mass torts have employed the business model of flooding jurisdictions seen as friendly to them with more solicited plaintiffs than any court system can possibly handle. They have employed...more

Health Reform Rollercoaster

by Winstead PC on

When POTUS signed the most recent executive order related to health care reform, it was only a small incremental step to direct the agencies to loosen some rules on health reform that will eventually impact the coverage...more

BC Healthcare Restructuring Update: R CSR’s O-U-T? Less U.S. Gov’t $$ = More 11s . . . ?

by Bryan Cave on

Ok, if your attention span is anything like ours, all this wonky stuff about the ins and outs of the Affordable Care Act (or “ObamaCare,” as most of us know it) causes your eyes to glaze over and makes your mind wander to...more

Beltway Buzz - October, 2017 #2

Trump Signs New Executive Order Threatening ACA. Following last month’s senatorial defeat on full repeal-and-replace—after which Congress vowed to move on to tax reform and other lower hanging fruit—the Trump administration...more

Trump, by executive fiat, tries to blow up ACA with cheap, skimpy alternatives

President Trump has made good on his promise to try to blow up the Affordable Care Act, aka Obamacare. His latest, twin executive actions seek to gut the national health insurance program that Republicans have reviled but...more

Association Health Plans: What Are They & What’s Changing?

by Nilan Johnson Lewis PA on

What are Association Health Plans? Association Health Plans allow small employers or self-employed individuals to group together to form a larger pool for offering health insurance. An Association Health Plan model can...more

California Enacts Bill on Drug Pricing Transparency

by Ropes & Gray LLP on

On October 9, 2017, California Governor Jerry Brown (D) signed into law what may be the most comprehensive prescription drug pricing transparency bill in the country. The bill, SB-17, is intended to foster transparency in...more

Structuring Clinical Practices to Prevent Pitfalls – Deeply Rooted Corporate Practice Doctrine Remains Strong

by BakerHostetler on

With growing patient demands, advanced technology and payer restraints, healthcare providers are increasingly exploring management agreements with experienced companies to handle the daily operations of their clinical...more

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