The wait is over, and now the work begins for health plan sponsors. Much-anticipated final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) were...more
Effective June 28, 2024, a significant change has been enacted through L. 2024, A4705 (c. 21), which increases the annual assessment rate for Health Maintenance Organizations (HMOs). This new legislation raises the HMO...more
Is Medicare Advantage really a Disadvantage for seniors and taxpayers? Our nation is graying rapidly. Every day, 10,000 baby boomers, members of one of the largest generations in U.S. history, hit the traditional...more
Applicants for a health maintenance organization (HMO) certificate of authority (COA) in Florida must use a new application form effective January 28, 2024. After rule development by the Florida Office of Insurance...more
On May 26, 2023, the Governor of Minnesota signed into law Minnesota bill HF 402 to increase government oversight of health care transactions that occur in Minnesota or involve Minnesota-based health care entities....more
The Louisiana Insurance Department (“Department”) recently revised and reissued Bulletin 07-01 to make all insurers, Health Maintenance Organizations (“HMO’s”) and Third Party Administrators (“TPA”) and provided updated...more
For those participating in corporate development in the health plan space in Florida, the question may arise: “What is a provider service network?” This Article provides the definitional traits of a provider service network...more
A California federal district court, applying California law, has held that an insolvency exclusion in a bankers’ professional liability policy did not bar coverage for a lawsuit filed by a receiver against a bank, finding...more
In 2019, Texas enacted the corporate governance annual disclosure (“CGAD”) annual filing requirement for all Texas domestic insurers and HMOs. CGAD requires disclosure by insurers or insurance groups about the corporate...more
The COVID-19 pandemic continues to demonstrate the importance and effectiveness of telemedicine as a means of providing patients with access to safe and quality medical care through the use of technology... Originally...more
Anyone who interacts with third party payors encounter acronyms on a regular basis. While acronyms are intended to facilitate efficient communication, their use often instead leads to confusion. This blog is intended to...more
The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a Letter of Interest (LOI) for a new geographic model option within the Direct Contracting portfolio. The geographic model would transfer full...more
On Monday, June 8, 2020, the Treasury Department (“Treasury”) and the Internal Revenue Service (“IRS”) released Proposed Regulations addressing the tax treatment of amounts paid for two unique types of medical arrangements –...more
During the last legislative session, Texas enacted Insurance Code Chapter 831 to adopt the corporate governance annual disclosure (“CGAD”) annual filing requirement for all Texas domestic insurers and HMOs. The purpose of the...more
... Massachusetts House Bill 4134 includes several provisions aimed at expanding access to treatment for mental health and substance use conditions in the Massachusetts Commonwealth. Most notably, the Bill would require...more
Massachusetts Governor Charlie Baker has restarted the discussion on health care cost containment in the Commonwealth with a proposed bill that contains a raft of initiatives. This is the first in a series of blog posts to...more
Seyfarth Synopsis: The DOL’s ARB rejected an employee’s SOX retaliation claim where he inadvertently provided information to his employer and only “hinted” that he was filing a SOX-protected complaint. The ARB seems unwilling...more
The U.S. healthcare industry remains at a crossroads. The healthcare reform legislation passed under President Barack Obama in 2010, officially called the Patient Protection and Affordable Care Act (ACA) but widely referred...more
California’s Department of Managed Health Care, which licenses and regulates HMOs and certain PPOs in California, is promulgating a new regulation that will require healthcare providers that enter into certain types of risk...more
Things are heating up in the Minnesota legislature for nonprofit health care entities. Here are breakdowns of local bills that may affect these types of businesses should they become law....more
On September 7, 2018, Governor Jerry Brown signed into law Assembly Bill No. 595, A.B. 595, which amends the California Health and Safety Code to increase oversight by the California Department of Managed Health Care (“DMHC”)...more
Telemedicine providers can sell their services in a number of ways. Consumers, self-funded health plans, and health insurance companies are all important and growing customers for many telemedicine providers. Telemedicine...more
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
To protect patients from receiving an unexpected surprise bill when they seek care at in-network facilities from out-of-network providers, Governor Brown signed AB 72: California’s surprise out-of-network law. The new law...more
California became the first state to set limits on how long HMO patients must wait to see a physician when the California Department of Managed Health Care (“DMHC”) adopted certain “timely access” regulations in 2010, based...more