On February 27, 2014, the D.C. Department of Insurance, Securities, and Banking (DISB) released a bulletin reminding insurers that medically necessary treatment for gender dysphoria, including gender reassignment surgeries, is a mandated benefit in the District of Columbia. This is not the case in every state and serves as a reminder for health insurance plans … Continue Reading
On February 7, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum that adds to the growing library of federal guidance on the permissibility of and limitations for health care providers and other entities paying the premiums of patients covered by qualified health plans (QHPs) in the health insurance exchanges or marketplaces. … Continue Reading
On January 10, 2014, CMS will publish the proposed rule titled Medicare Program: Contract Year 2015 and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). The Proposed Rule propositions extensive reforms to the Medicare Advantage (“Part C”) and Medicare Prescription Drug Benefit Program (“Part D”), partly through … Continue Reading
With approximately two months having passed since the end of the government shutdown, the fundamental question still remains; what exactly did Congress achieve through the contentious shutdown negotiations? The shutdown was spurred in part by certain Congressional Members’ opposition to the funding and implementation of the Affordable Care Act (“ACA”). A centerpiece of these oppositional … Continue Reading
Capping a case that has drawn the attention of healthcare lawyers and hospital executives nationwide, the U.S. District Court for the District of South Carolina has ordered Tuomey Healthcare System, Inc. (“Tuomey”) to pay over $237* million for violations of the Stark Law and False Claims Act arising from certain employment agreements between Tuomey and … Continue Reading
Last Wednesday, September 18, 2013, Walgreen Company (“Walgreen”) announced its plan to move approximately 160,000 employees to Aon Hewitt’s private health exchange (the “Aon Exchange”) in 2014. This move marks a significant decrease in risk for Walgreen as the company will shift to a defined contribution model for funding its employees’ health insurance. Under the … Continue Reading
Last Thursday, September 12, 2013, the Department of Health and Human Services (“HHS”) reported that the rate review provisions (the “Rate Review Provisions”) of the Affordable Care Act (“ACA”) saved an estimated $1.2 billion on health insurance premiums in 2012 for 6.8 million policyholders. The Rate Review Provisions are intended to increase transparency behind premium … Continue Reading
The final rule that will implement the law commonly referred to as the Physician Payment Sunshine Act (Section 6002 of the Patient Affordable Care Act, as amended) will be published soon. On February 1, the Centers for Medicare & Medicaid (CMS) filed the final rule that is scheduled to be published in the Federal Register … Continue Reading
Yesterday, the federal government announced that the federal government will not provide 100% funding for states that do not participate in the full Medicaid expansion contained in PPACA, as described by the Washington Post. Partial expansions will be permitted but will only receive matching federal money at the existing rate, at least for 2014-2017. As we … Continue Reading
After a quiet fall, one of the lawsuits challenging the constitutionality of PPACA has new life. In a brief order, the U.S. Supreme Court has sent the Liberty University v. Geitner case to be heard again by the Fourth Circuit Court of Appeals out of Richmond, Virginia. As the AP mentioned in its piece run by the Washington … Continue Reading
For the second time in a week, the federal government has extended deadlines relating to state insurance exchanges. Today was originally the deadline for each state to submit an application to the federal government if the state would be running its own insurance exchange. For any state that does not set up its own exchange, the federal government … Continue Reading
When facing an incompetent network health care provider and angry members, a managed care organization (MCO), such as a health maintenance organization (HMO), a preferred provider organization, or a physician-hospital organization, must take action to protect its members. How can the MCO terminate the provider’s contract without becoming liable to that provider for damages? In … Continue Reading
The decision we’ve all been waiting for is in — the U.S. Supreme Court has ruled that the statute commonly known as the individual insurance mandate (everyone must have minimum health insurance coverage or pay a penalty) is constitutional under Congress’ taxing power. Because the individual mandate was upheld, the rest of the Affordable Care Act (“PPACA”) has also survived. The … Continue Reading
The U.S. Supreme Court has completed announcing its decisions for today, and still no decision on PPACA (Department of Health and Human Servs. v. Florida (No.11-398) and National Federation of Independent Business v. Sebelius (No. 11-393)). The Court is sitting again on Thursday and will likely announce decisions in the remaining cases from this term … Continue Reading
As we get closer to receiving a decision from the U.S. Supreme Court on the constitutionality of PPACA and its individual insurance mandate, three major insurers have committed to continue some benefits that were required by PPACA. These announcements address some of the uncertainty being experienced by insureds who don’t know what will happen or how quickly changes … Continue Reading
The Affordable Care Act provides for nearly $30 million in grant funding for states to establish and strengthen Consumer Assistance Programs. States must apply for the grants and articulate how they will use the funding to assist their residents with problems and related questions regarding health insurance coverage. Consumer Assistance Programs provide assistance to state … Continue Reading
A long day today at the U.S. Supreme Court for PPACA attorneys. This morning, argument was all about whether any unconstitutional parts of PPACA can be severed from the entire Act or if the whole Act must be stricken. As before, oral arguments are available in audio and transcript on the Court’s website. The afternoon … Continue Reading
Definitely more drama today, as the Supreme Court heard 2 hours of arguments on the constitutionality of PPACA. The general opinion following arguments is that the Justices’ questions indicate they may not view the government’s position favorably. The audio and transcript from today have been posted by the Court, and analysis from Court watchers abounds, including … Continue Reading
Today’s arguments at the Supreme Court were 90 minutes on the issue of whether the Court has jurisdiction to decide the constitutional questions now, or if the challengers must wait until the individual mandate and its associated penalties begin in 2014. The audio and transcript of today’s arguments are now available from the Court. Not a … Continue Reading
Next week, the drama begins — the Supreme Court will hold what promises to be the biggest (an impressive 6 hours) and most important series of oral arguments of the decade, if not the century — to decide the future of Obama’s health care reform, PPACA. The government will be primarily represented by Solicitor General Don Verilli; arguing most … Continue Reading
As described in further detail in SSD’s Sixth Circuit Appellate Blog here and on the ACA Litigation Blog here, the U.S. Court of Appeals for the District of Columbia issued a decision yesterday in Seven-Sky v. Holder that the individual insurance mandate is constitutional. This brings the total to 2 appellate courts for the law (the D.C. … Continue Reading
The recent decision by the 4th Circuit Court of Appeals in the Liberty University case may change the path the PPACA cases take in the United States Supreme Court and could even mean that a definitive decision on the individual insurance mandate wouldn’t come until 2016 or later. Until now, most commentators have assumed that we … Continue Reading
Well, this was a big week for the PPACA lawsuits, with multiple filings in the Supreme Court. These quick moves seem designed to get the case heard this term, which means a decision would come out by June 2012 and be fodder for the November 2012 presidential elections. It remains to be seen whether that decision upholds PPACA, … Continue Reading
Following Friday’s oral arguments about the constitutionality of PPACA’s individual insurance mandate in the Seven-Sky v. Holder case and in anticipation of the government’s filing tomorrow in the U.S. Supreme Court, we thought it might be helpful to recap where the courts are on the issue. So far, the score in the courts of appeals is … Continue Reading
