On July 1, Oregon launched a Basic Health Program (BHP) that offers comprehensive health care coverage, including medical, dental, and behavioral health care, with zero premiums and zero cost-sharing for eligible individuals...more
The Press has announced that the Merger Agreement between UPMC and Washington Health System was approved by the Pennsylvania Attorney General with certain conditions, one of which was that UPMC would honor existing employment...more
In the 118th Congress, the US House of Representatives is keenly interested in healthcare price transparency. Three House committees—Energy and Commerce, Ways and Means, and Education and the Workforce—each approved...more
Question: A health plan that I participate with has sent me a notice stating that it has audited some of the claims I have submitted over the past three years. The health plan believes that some of these claims were improper...more
This legislative session, Florida has joined Arkansas and Oklahoma among the most regulatory-minded states with respect to pharmacy benefit plans and programs as well as pharmacy benefit managers (PBMs). Florida's...more
Mounting evidence indicates that addressing the social and economic factors that drive the majority of health outcomes, often called social drivers of health (DOH), can improve health, promote health equity and reduce costs....more
States have always been the primary regulators of their local health care markets and have increasingly used All Payer Claims Databases (APCDs) as one tool to help them make data-driven policy decisions. Like much state...more
The IRS just released IRS Notice 2022-04 that provides the updated fee for Patient-Centered Outcomes Research Institute (PCORI) paid by fully insured and self-funded health plans for the upcoming tax reporting period...more
On October 8th, 2021, the Governor of California, Gavin Newsom, signed into law Senate Bill No. 510, which requires health care service plan contracts and disability insurance policies that provide coverage for hospital,...more
Since the passage of the Affordable Care Act (the “ACA”) in 2010, Texas has deferred to the federal government with respect to certain aspects of health plan rate review. That’s about to change. On October 19, 2021, the...more
On October 13th our friends over at STAT broke the news [sorry, Paywall] about a “warranty” pilot program from Pfizer that offers both patients and health plans (including Medicare Part D plans) the opportunity to receive a...more
In a New Webinar, Manatt and the Leukemia & Lymphoma Society Share the Obstacles Cancer Patients Face to Receiving Proper Treatment—and the Policies States and Plans Can Implement to Improve Network Adequacy and Access. ...more
Oklahoma child support is regulated by state statutes, enforced by courts and agencies, and often affects employer programs and payrolls. Child support includes parental payment as well as benefits provision. Employer health...more
What New Obligations Do Health Plans and States Face Under the Latest Interoperability Requirements—and What’s the Best Path to Compliance? Learn the Answer at a New Manatt Webinar. Historically, privacy rules have focused...more
Last week, Texas Governor Greg Abbott and the Texas Department of Insurance (TDI) instituted measures to expand the use of telemedicine in response to the COVID-19. A significant part of the federal government’s response to...more
Yesterday, Texas Governor Greg Abbott and the Texas Department of Insurance (TDI) asked Texas-regulated health plans to waive all costs associated with testing and telemedicine visits for the diagnosis of COVID-19. TDI...more
A patient sued her health plan and the plan’s debt collector under various California and federal laws in connection with alleged attempts by the plan to unlawfully collect the balances of the plaintiff’s medical statements...more
On January 30, the Department of Health and Human Services (HHS) released long-anticipated guidance that invites states to pursue capped funding demonstrations for the Affordable Care Act Medicaid expansion population as well...more
The Affordable Care Act (ACA) removed pre-existing condition barriers, defined a broad range of essential health benefits, and improved access to coverage and care for millions of people nationwide. However, the ACA has thus...more
The budget stand-off continued this week. Legislators rolled out a number of mini-budgets this week, but their futures are uncertain. The General Assembly will take a break next week for the Labor Day holiday, so it will...more
Proposed State Health Plan Adjustments - A. PA2019-002, Vitality Senior Living Management, LLC, d/b/a Traditions of Athens, LLC: Proposes to add 32 specialty care assisted living facility beds pursuant to Section...more
On July 8, 2019, the Massachusetts legislature approved changes to the law surrounding orders for health insurance coverage in cases where child support is ordered. The statutes impacted include G.L. c. 208 (the divorce...more
The state budget impasse enters its seventh week today, with no visible progress. Some reports claim communication is almost non-existent between the two sides. While the budget remains in gridlock with Medicaid expansion...more
I. Certificate of Need Program - A. AL2019-004, Fresenius Kidney Care Gadsden Acq, LLC, Gadsden, AL: Proposes to expand the existing ESRD facility by adding two (2) home dialysis training stations, for a total of...more
On April 18, 2019, Arizona Governor Doug Ducey signed a new law expanding insurance coverage for telehealth services, including asynchronous telemedicine and remote patient monitoring. The Arizona Legislature passed, nearly...more