The Centers for Medicare and Medicaid Services (CMS) announced on August 18 that states have until September 24 to request an extension of the enhanced Federal Medical Assistance Percentage (FMAP) – the federal government’s share of Medicaid funding. read more
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Earlier this month, the Massachusetts Division of Insurance (the “Division”) struck a deal with Health New England to settle a dispute over rate increases. In the winter of 2009, Health New England, a Springfield, Massachusetts health insurer, attempted to increase its health insurance premiums by a range of 11.5% to 21.3% for about 21,000 customers. The Division denied this increase on April 1, 2010, along with other insurers who sought double-digit increases. read more
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CMS PROPOSES CHANGES TO “36 MONTH RULE” FOR HOME HEALTH: In late July, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for the Medicare Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year 2011. As anticipated, the proposed rule promulgates changes to the so-called “36 month rule” for home health agencies (HHAs) that went into effect in January 2010. read more
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Last week, the Massachusetts legislature passed House Bill No. 4935, An Act relative to insurance coverage for autism ("H. 4935"), which requires that benefits be provided on a nondiscriminatory basis for the diagnosis and treatment of Autism Spectrum Disorders. H. 4935 prohibits dollar or unit of service limitations on coverage for the diagnosis and treatment of autism that are lower than dollar or unit of service limitations applicable to the diagnosis and treatment of physical conditions. read more
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In response to the Centers for Medicare and Medicaid Services’ (CMS’) proposed hospital inpatient rule for FY 2011, lawmakers urged the agency to reconsider payment reductions in a July 12 letter. The following week, the agency released its proposed rules for home health and skilled nursing facilities. In other news, the Department of Health and Human Services (HHS) issued final rules for achieving “meaningful use” of electronic health records. read more
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The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, the "Affordable Care Act") require group health plans and insurers that provide dependent coverage to extend health care coverage to adult children until they reach age 26. read more
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In late June, two Members of Congress requested that the Centers for Medicare and Medicaid Services (CMS) expedite the implementation of a Medicare home care demonstration project. In other CMS news, the agency issued a proposed outpatient hospital rule in early July, and during Congress’ July 4th recess, President Obama made the decision to officially appoint his CMS Administrator. read more
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On July 1, the U.S. Department of Health and Human Services unveiled a new website, HealthCare.gov , to provide consumers with information on their rights and benefits under the Patient Protection and Affordable Care Act. The site offers data on U.S. insurance carriers and the products they offer and includes a timeline of when new programs under the new law will begin between now and 2014. read more
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In advance of a June 18 deadline for comments, top hospital groups expressed strong opposition to proposed payment cuts issued by the Centers for Medicare and Medicaid Services (CMS). The following week, President Obama announced a set of regulations that will implement various provisions of the recently-enacted healthcare reform law (Public Law 111-148) relating to pre-existing conditions, lifetime coverage limits and other patient protections. read more
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Effective August 31, 2010, the Rhode Island Office of the Health Insurance Commissioner (“OHIC”) will impose a readability requirement for all health insurance policies to be readable at the eighth grade level measured by the Flesch-Kincade formula. The readability requirement comes in response to Rhode Island’s low adult literacy rate, and is designed to protect consumers by making health insurance policies, which are often complicated, easy to understand. read more
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In July 2010, some of the first money allocated by the new health care reform law will start flowing to states that have elected to participate in the federal temporary high-risk insurance pool program. read more
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In late May, the Centers for Medicare and Medicaid Services (CMS) released a supplemental proposed rule that would result in Medicare payment reductions to hospitals. Meanwhile, questions have begun to arise over the future of the Medicare Payment Advisory Commission (MedPAC), given the upcoming inception of the Independent Payment Advisory Board (IPAB) that was created by the new healthcare overhaul law (Public Law 111-148 and 111-152). read more
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On April 26, 2010, the New York Insurance Department (the “NYID”) proposed a circular letter to provide additional guidance to insurers on the impact of the federal Mental Health Parity and Addiction Equity Act of 2008 (the “Act”). This proposed circular letter is a supplement to Circular Letter No. 20 (2009), and addresses interim final rules issued subsequent to Circular Letter No. 20 (2009) by the United States Department of the Treasury, Department of Labor and Department of Health and Human Services. read more
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The past two weeks brought several notable healthcare developments, as the Department of Health and Human Services (HHS) continued preparations for implementation of the new healthcare reform law – Public Law (PL) 111-148. read more
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The Health Care and Reconciliation Act (the “Act”), signed into law on March 30, 2010, imposes a tax on annuity income to help pay for the multi-billion dollar reform package set forth in both the Act and the Patient Protection and Affordable Care Act, signed into law on March 23, 2010. Specifically, the Act imposes a 3.8% Medicare contribution tax on individuals who earn more than $200,000 a year, and couples who earn more than $250,000 a year. read more
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The New York Insurance Department has issued a proposed regulation that would prohibit life and health insurers from issuing policies that contain discretionary clauses (the “Proposed Regulation”). read more
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After weeks of uncertainty, Congress finally cleared a federal program extension bill last week that will prevent Medicare physician payment cuts. read more
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On April 9, 2010, Iowa’s governor Chet Culver signed measures (Senate File 2201) designed to create greater transparency and disclosure of health insurance premiums, and to expand the rights of consumers prior to any rate increases by insurance companies. read more
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As Members of Congress returned home last week to discuss the new healthcare reform law with their constituents, President Obama put the finishing touches on the process by signing a package of healthcare corrections into law. Meanwhile, Health and Human Services (HHS) Secretary Kathleen Sebelius wasted no time in announcing her department’s intent to clarify potentially confusing language in the new law. read more
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Healthcare reform’s long and often bumpy journey through Congress came to a close last week, as President Obama signed into law the 2,000+ page legislation that will overhaul the nation’s healthcare system. Simultaneously, the Senate worked to clear a package of corrections to the new law via the budget reconciliation process, changing it ever so slightly and sending it back to the House for one final vote. read more
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After another week of fine tuning and vote counting, House leaders released the final text of their healthcare bill on Thursday, in addition to official cost estimates from the Congressional Budget Office (CBO). These steps set the wheels in motion for a weekend vote on the measure, and after a frenzied race to secure the necessary 216 votes for passage, the House approved its final healthcare reform efforts in a historic Sunday night vote. read more
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Healthcare negotiations steadily moved forward last week, as details emerged on a potential timeline for completing action on a final bill in the coming weeks. Despite optimistic endgame statements from Democratic leaders on both sides of the Capitol, legislative language remained in the final stages of negotiations by the week’s end, as leaders continued to count votes and await final cost estimates. read more
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According to the Statistics on China Insurance Business for 2009 recently published by the China Insurance Regulatory Commission (CIRC), total insurance premiums in China received in 2009 amounted to RMB 1.11 trillion, up 13.8% from 2008. read more
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Democrats moved steadily forward last week on their reinvigorated efforts to enact comprehensive healthcare reform, as the White House specified its procedural preferences and Congressional leaders continued to hammer out policy provisions. However, given the various complications that stand in their way, it remains to be seen whether Democrats will be able to finalize legislation before the end of the month – their new self-imposed deadline. read more
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The White House released its own healthcare reform bill last week, in preparation for Thursday’s marathon healthcare summit. Despite its bipartisan billing, that six hour session did not yield tangible progress, leaving Democrats exactly where they were before the summit – faced with the question of how to move comprehensive healthcare reform forward without any help from the minority party. read more
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The Centers for Medicare & Medicaid Services ("CMS") has revised the timeline for non-group health plan ("NGHP") reporting under the Medicare secondary payer reporting provisions of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 ("Section 111"). read more
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On Monday, February 22, Representatives Tom Perriello (D-Va.) and Betsy Markey (D-Colo.) introduced H.R. 4626, the Health Insurance Industry Fair Competition Act, to repeal the McCarran-Ferguson Act antitrust exemption for the business of health insurance. read more
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New requirements making the HIPAA privacy and security rules applicable to business associates of healthcare entities became effective on February 17, 2010. However, the new requirements, under the the Health Information Technology for Economic and Clinical Health (“HITECH”) Act, may not be enforced immediately. read more
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With Congress in recess last week, the White House worked behind the scenes to craft a healthcare reform bill that will be used as a basis for moving forward during the bipartisan healthcare summit scheduled for this week. Meanwhile, more and more Democratic Senators formally voiced their support for reviving the controversial public option and using the budget reconciliation process to pass a final bill. read more
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The two major snowstorms that struck Washington, DC last week brought business on Capitol Hill to a near standstill, as the House cancelled all votes for the week and the Senate conducted limited business. As a result, Democrats headed into the first congressional recess of 2010 with little progress to report on their retooled jobs agenda, and no substantive breakthroughs on their stalled healthcare reform efforts. read more
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As the White House and Congress focused their attention on the release of President Obama’s FY 2011 Budget and the new jobs agenda, healthcare reform efforts took a back seat last week. Despite the priority shift, off the record chatter and closed door meetings continued, as speculation grew over if and how Democrats would be able to revive their stalled priority in the coming months. read more
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Healthcare reform efforts remained in flux last week, as President Obama sought to repackage his party’s priorities in the wake of the shocking Republican victory in Massachusetts on January 19. read more
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Last Tuesday’s stunning Republican victory in Massachusetts left the future of healthcare reform legislation uncertain, at best. After the game-changing Senate special election, Democrats spent the week assessing the damage and working to figure out a path forward on their top legislative priority. read more
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The House returned to session last week, as intense negotiations continued behind the scenes on an agreement that will reconcile the differences between the House- and Senate-passed healthcare reform bills. On Thursday, a compromise was reached on one of the Senate bill’s more controversial provisions, smoothing a possible path toward a final agreement in the coming weeks. read more
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Though both the House and Senate were officially in recess, several notable occurrences took place last week as key players moved ahead on the difficult task of how to reconcile the differences between the two chambers’ healthcare reform plans. read more
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U.S. House Representatives Peter DeFazio, (D-OR) and Gene Taylor (D-MS) drafted a letter to House Speaker Nancy Pelosi (D-CA) in support of repealing the antitrust exemption under the McCarran Ferguson Act for health insurers and medical liability insurers. read more
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On November 21, 2009, the Genetic Information Nondiscrimination Act (GINA), which prohibits genetic information discrimination in health coverage and employment, took effect. read more
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On December 19, 2009, President Obama signed into law an extension to the COBRA premium subsidy, extending both the period of eligibility for, and the length of, the premium subsidy. read more
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After a prolonged floor debate that kept Senators in session through weekends for 25 consecutive days, the Senate completed its work on healthcare reform legislation in the early morning hours on Christmas Eve. The vote on final passage of the Senate’s bill – H.R. 3590 – came at 7:00 a.m., when it passed by a tally of 60-39. read more
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Privacy and data breaches are part of every company's nightmare of what can go wrong. There is no company in any industry that is not exposed to risks and liabilities related to unauthorized access to personal information of individuals. The risk of data breaches, and the regulations governing company obligations to secure data, and to provide notification in the event of a breach, are increasing dramatically. read more
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Healthcare reform efforts were marked with uncertainty and skepticism in the Senate last week, as Democratic leaders continued their scramble to reach a consensus on the controversial bill before Christmas. Those efforts continued behind the scenes into the weekend, and a compromise was finally unveiled on Saturday. read more
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Debate on healthcare reform legislation continued on the Senate floor last week, while behind the scenes a tentative agreement was reached among Democrats on the controversial public insurance option. As a result, further consideration of the Senate healthcare reform bill is temporarily on hold, as Democratic leaders await cost estimates on the new public option compromise. read more
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The Senate returned from Thanksgiving break last week and resumed consideration of its healthcare reform bill in earnest, debating and voting on several amendments to the legislation. However, despite slow but steady progress and a seven day work week, agreements on the more controversial aspects of the 2,000+ page bill remained elusive. read more
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Senator Patrick Leahy (D-VT) filed an amendment to the Patient Protection and Affordable Care Act (H.R. 3590) (the “PPACA”) on December 1, 2009, that would repeal the exemption from federal antitrust laws for the health insurance and medical malpractice insurance industries. read more
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The Insurance and Reinsurance Department of Edwards Angell Palmer & Dodge invite you to join them for the following complimentary webinar: "The Continuing Nightmare of Data Breach and Privacy Risks and Regulations: Increasing Risks, New Regulations, and Changing Deadlines." read more
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Healthcare reform efforts headed into another weekend showdown, as the Senate kicked-off consideration of its legislation with a key procedural vote on Saturday evening. The timing of that vote was solidified once Democratic leaders released their merged healthcare reform bill last Wednesday – ending weeks of negotiations and speculation over what shape the bill would take. read more
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Following the House’s November 7 vote on healthcare reform, the Senate now faces increasing pressure to vote on a bill this year, as evidenced by the words of both the current President and a former President last week. In the House, Members spent the week in their congressional districts, in recess for Veterans Day. read more
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The House passed its $1 trillion healthcare reform bill over the weekend, following a week-long flurry of behind the scenes activity by Democratic leaders, as they worked to line up the 218 votes necessary for passage. Across the Capitol, the Senate remained in a holding pattern, and many Senators have begun to acknowledge that a vote on healthcare reform may not occur in their chamber before the end of the year. read more
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Governor Time Pawlenty (R-MN) recently outlined a set of proposed healthcare reforms to be considered during Minnesota's 2010 legislative session. read more
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This week, Wisconsin Governor Jim Doyle announced an emergency rule (the “Rule”) interpreting and implementing Section 632.895 (12m) of the Wisconsin Statutes which mandates that insurers and self-insured health plans provide coverage for the treatment of autism spectrum disorders.
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Vice President Joseph Biden spoke yesterday at the NAIC Fall meeting taking place near Washington DC, and he used the opportunity to seek the support of state insurance commissioners for the Government's proposals for national healthcare reform. read more
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The Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499) (the “Act”), signed into law on December 29, 2007, contains a new mandatory reporting requirement for insurers covering medical expenses. This advisory focuses on liability insurers, no-fault insurers, and workers’ compensation insurers. read more
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The New Jersey Department of Banking and Insurance (the “Department”) released a draft rule, N.J.A.C. 11:17B-4 (PRN 2009-242) (the “Proposed Rule”), setting forth the specific requirements of N.J.S.A. 17:22A-41.1. N.J.S.A. 17:22A-41.1, which became effective on January 5, 2008, requires that insurance producers selling, soliciting or negotiating health insurance policies provide the purchaser with written notification of “the amount of any commission, service fee, brokerage, or other valuable consideration” received.
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Today, Senate Judiciary Committee Chairman Patrick Leahy introduced legislation to eliminate the federal antitrust exemption for health insurance and medical malpractice insurance companies. read more
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Edwards Angell Palmer & Dodge's Insurance and Reinsurance Department recently published its latest Newsletter, Insurance & Reinsurance Review - September 2009, which contains nine articles about various topics in the insurance and reinsurance industry. read more
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The first half of the month-long congressional recess has significantly dimmed hopes for a bipartisan agreement on healthcare reform in the Senate, due to contentious, rancorous town hall meetings and new polls suggesting eroding public support for the Democrats’ healthcare reform proposals. read more
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On August 10, 2009, New York Governor David Patterson signed legislation continuing the freeze on medical malpractice rates. In addition to the premium rate freeze, the legislation also suspended an anticipated surcharge. The Legislature projected that without the freeze, medical malpractice rates would have increased by as much as 30% for some physicians. read more
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In Washington, DC, two new laws were enacted this month that will impact insurance coverage eligibility in same-sex marriages performed out-of-state. The Jury and Marriage Amendment Act of 2009, effective July 6, 2009, provides that “marriages legally entered into in another jurisdiction between two persons of the same sex shall be recognized as a marriage in the District.” read more
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Late last month, the New Jersey legislature passed A2238/S1651 (the “NJ Act”), which requires group health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders. Specifically, policies must provide coverage for treatments that are deemed medically necessary by the autistic person’s physician including behavioral therapy, physical therapy, speech therapy, and occupational therapy. read more
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In response to recent investigations of reimbursements of out-of-network treatment, New York Governor Paterson announced a proposed regulation that will require health and accident insurers, including health maintenance organizations (collectively, “insurers”), to inform insureds as to the actual reimbursement amount for out-of-network treatment before receiving such treatment. read more
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Last weekend, President Obama proposed $313 billion in new Medicare and Medicaid reimbursement cuts to help pay for healthcare reform. These cuts would be in addition to the cuts that were proposed in the President's budget. The new proposal includes cuts for almost all types of providers, including hospitals, nursing homes and other facilities. read more
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Late last month, the Connecticut legislature passed S.B. 301 (the “Act”), which requires group health insurers to provide coverage for the diagnosis and treatment of autism spectrum disorders. Specifically, policies must provide coverage for treatments that are medically necessary and prescribed by a licensed physician, licensed psychologist or licensed clinical social worker. read more
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The American Hospital Association last week submitted a comment letter to the Senate Finance Committee urging the Committee not to reduce hospitals’ Medicare payments to help fund health care reform. Committee Chairman Max Baucus (D-Mont.) and member Chuck Grassley (R-Iowa) had made that suggestion, among others, on May 18 in a health reform policy paper prepared prior to the Committee taking up the matter this month. read more
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A recent report by Families USA, an advocacy group, said that the average family pays $1,000 a year more for health insurance premiums to subsidize the cost of health care for the uninsured. The average individual pays $370 more per year. This cost-shifting becomes necessary whenever someone who doesn't have medical insurance receives care at a hospital emergency room, clinic or physician's office and then doesn't pay for the care. read more
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The federal government continues to make changes to the Medicare Advantage program, which allows private insurance companies to provide more than 10 million seniors with healthcare coverage. read more
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Last week, the federal government revealed several new ideas in its continuing effort to simplify and reform the country's healthcare system. read more
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H.R. 1253, the Health Insurance Restrictions and Limitations Clarification Act of 2009, was passed on March 31, 2009 in the House of Representatives by a vote of 422 to 3. read more
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As President Obama begins to grapple with sweeping changes to our national healthcare system, he should first turn his attention to the obvious flaws in an existing program. Medicare Part D, the prescription drug benefit for the elderly, came into existence in 2006 amidst much confusion in the marketplace. read more
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Last week, Senator John D. Rockefeller IV, (D-W.Va.) introduced the Preexisting Condition Patient Protection Act of 2009 (S. 623) (the "Bill"). According to Senator Rockefeller, the Bill will address any coverage gaps created in the Health Insurance Portability and Accountability Act of 1996 regarding preexisting condition exclusions by eliminating the use of preexisting condition exclusions in all health insurance markets. read more
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The Medicare, Medicaid, and SCHIP Extension Act of 2007 (S. 2499) (the “Act”), signed into law late last year, contains a new mandatory reporting requirement for insurers covering medical expenses. read more
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Physicians, hospitals and other healthcare providers may not be aware that the federal Red Flag Rules, 16 C.F.R. § 681, may apply to them. The Rules, which become effective on May 1, 2009, require covered entities to formally address the risks of identity theft and develop a plan to prevent such risks. read more
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This week, President Barack Obama nominated Kansas Governor Kathleen Sebelius as Secretary of Health and Human Services. He also appointed Nancy-Ann DeParle "health czar" (a/k/a chief of the White House office on health reform). read more
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As we previously reported here, former Massachusetts Governor Mitt Romney signed a health care bill, known as “An Act Providing Access to Affordable, Quality, Accountable Health Care” (the “Act”), into law on April 12, 2006. The Act became effective on July 1, 2007 and requires that all Massachusetts residents carry health insurance, unless they have a waiver for religious reasons or have a waiver from the Commonwealth Health Insurance Connector Authority (the “Connector”). Individuals that do not have a waiver and do not have health care insurance face fines of more than $1,000 per individual for the 2009 tax year. read more
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On November 19, 2008, as part of the 2009 Medicare Physician Fee Schedule regulations, the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (“CMS”), published final rules regarding payment limitations on diagnostic testing and the application of the “anti-markup” rules for diagnostic imaging services (the “2009 Rules”). read more
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This updates our January, 15, 2009 posting. On February 4, 2009, President Obama signed into law the Children’s Health Insurance Program Reauthorization Act of 2009 (H.R. 2) (the “Act”). The Act extends the State Children’s Heath Insurance Program (“SCHIP”) through the 2013 fiscal year and expands SCHIP to cover an estimated 4 million additional children. read more
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The Boston Globe has reported that the Attorney General for the Commonwealth of Massachusetts, Martha Coakley, has launched an investigation into Blue Cross Blue Shield of Massachusetts and Partners HealthCare. Partners HealthCare owns several Massachusetts hospitals, including Massachusetts General Hospital and Brigham and Women’s Hospital. read more
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On January 14, 2009, the U.S. House of Representatives passed the Children's Health Insurance Program Reauthorization Act of 2009 (H.R. 2) (the “Act”) by a vote of 289-139. The Act would expand coverage and extend the effective date of the State Children’s Health Insurance Program (“SCHIP”), which is set to expire at the end of 2009 fiscal year. read more
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On November 21, the New York Insurance Department (the “NYID”) issued Circular Letter No. 27 (the “Circular Letter”), “Recognition in New York of Marriages Between Same-Sex Partners Legally Performed in Other Jurisdictions.” The Circular Letter requires insurers to treat all couples in New York, including same-sex couples who were legally married outside of New York, equally. read more
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Last August, Florida Governor Charlie Crist announced that nine health insurers submitted insurance coverage plans to provide healthcare insurance under the Cover Florida plan. The names of participating insurers were to be announced in early October, but have now been delayed due to scheduling conflicts during negotiations. read more
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On October 7, 2008, the New York Insurance Department and New York Department of Health will be holding a joint meeting to address out-of-network insurance coverage. The hearing will be held in response to numerous consumer complaints regarding bills from specialists whom the consumers did not know were out-of-network. read more
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On June 26, 2008, U.S. Senator Frank Lautenberg (D-NJ) reintroduced a measure intended to ensure that children have access to healthcare. The measure was inserted into the Fiscal Year 2009 Labor-Health and Human Services-Education Appropriations bill (the "Bill"). read more
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Connecticut Governor M. Jodi Rell recently vetoed House Bill 5536, An Act Establishing the Connecticut Healthcare Partnership (the "Bill"), which is intended to achieve savings for Connecticut municipalities, nonprofit groups and small employers with 50 employees or less by allowing them to join the current state employees' health insurance program. read more
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Last week, North Carolina Insurance Commissioner Jim Long issued a news release urging consumers holding long term care insurance policies issued by two subsidiaries of Conseco Inc. (“Conseco”) to be aware of a multi-state settlement (the "Settlement") that could result in adjustments made to past claims. Conseco agreed to a $2.3 million fine, along with an additional $30 million for claims-handling improvements and restitution.
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In Government of the French Community, and Walloon Government v Flemish Government Case C-212/06, ECJ (Grand Chamber), the European Court of Justice (ECJ) determined that Flemish legislation limiting eligibility to a care insurance scheme was contrary to European provisions concerning the right to freedom of movement within the European Community (EC) in so far as the care insurance scheme included a residence requirement that excluded persons who worked in the Flemish region or in the bilingual Brussels-Capital, but who resided in another part of the national territory (ie the French or German speaking region). read more
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Last week, Ohio Governor Ted Strickland signed into law House Bill 125, dubbed by supporters the Healthcare Simplification Act, which sets restrictions on the contracting rights between physicians and health insurers when negotiating reimbursement arrangements. read more
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Earlier this month, Rhode Island’s Lt. Governor, Elizabeth Roberts, proposed the Healthy Rhode Island Reform Act of 2008. Among other things, Part V of the proposed act, commonly known as the “play or pay” proposal, requires employers in Rhode Island to either provide employee health benefits or to contribute to a state fund that will cover the uninsured up to a certain level. read more
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On June 1, 2005, after a jury trial lasting over three weeks, a jury found for Blue Cross Blue Shield of Massachusetts (“BCBS-MA”), Blue Cross Blue Shield of Minnesota (“BCBS-MN”), Federated Mutual Insurance Company (“Federated”), and Health Care Service Corporation (“HCSC”) (collectively “Plaintiffs”) against Mylan Laboratories Inc. and Mylan Pharmaceuticals Inc., Cambrex Corporation, and Gyma Laboratories (“Defendants”) on state law claims – agreement in unreasonable restraint of trade; conspiracy in unreasonable restraint of trade; monopolization; and, attempted monopolization – in the Lorazepam active pharmaceutical ingredient (“API”) market, Lorazepam tablet market and in the Clorazepate API and tablet markets. The jury awarded BCBS-MA $8,430,887, BCBS-MN $1,756,096, Federated $410,878.00, and HCSC $1,448,437.00 in damages. read more
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On two separate occasions during the past few months, President Bush has vetoed proposed extensions to the State Children’s Health Insurance Program (“SCHIP”) and it remains to be seen whether the current legislation, due to expire in 2009, will be extended while President Bush remains in office. read more
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In Zeller v British Caymanian Insurance Company [2008] UKPC 4, Mr Zeller sought indemnification under his employer's health insurance policy in respect of his costs of having major heart surgery. read more
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Congress recently approved a Bill (S. 2499) that empowers federal regulators at the Department of Health and Human Services to ensure that employer health plans pay the medical bills of older employees even after these employees become eligible for Medicare. read more
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Earlier this year, bipartisan sponsors in the Ohio legislature introduced H.B. 170 (Coverage for Autism), which would require health plans to cover autism treatment. Currently, in Ohio, coverage under health plans extends only to diagnosis.
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UnitedHealthcare, a subsidiary of UnitedHealth Group, Inc., entered into a settlement agreement last month whereby it agreed to pay $12 million to the Attorneys General of 36 states and the District of Columbia. This settlement comes after a multi-state investigation by state insurance regulators regarding UnitedHealthcare's claims practices, fee schedules and deductibles. read more
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At the request of Governor Culver in June of this year, the Iowa Division of Insurance conducted a three-month review of issues relating to long-term care insurance. The Governor’s request grew out of concerns at both the state and national level regarding long-term care insurance policies and increasing complaints about pricing, rate increases, denial of claims and questionable market practices. read more
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On September 17, 2007 Presidential candidate Senator Hillary Clinton weighed in with her proposal, "the American Health Choices Plan" ("the Plan"), which according to Senator Clinton "expands personal choice, but keeps costs down." read more
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Senator Grassley, the top republican on the senate finance committee, sent a letter to the nation’s largest providers of long-term care insurance requesting information on claim processing. read more
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On August 1, 2007, New York's Governor Spitzer signed into law S.3986-A, a bill intended to decrease friction between managed care plans and their participating providers on certain sensitive issues. Most significantly, if a health plan requires that certain health care services be preauthorized in order to be covered, then once a service has been preauthorized and performed, the plan may not thereafter deny coverage for the service.
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On January 17, 2007, lawmakers in the House and Senate introduced identical bills ( H.R. 506 and S. 325) aimed at funding innovative State initiatives that expand coverage and access to the uninsured and improve quality and efficiency in the health care system.
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On April 12, 2006, Massachusetts Governor Mitt Romney signed a health care bill, known as "An Act Providing Access to Affordable, Quality, Accountable Health Care (the "Act")", into law. read more
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The Blue Cross and Blue Shield Association, along with a majority of its nationwide affiliated "Blues plans," has reached settlement with a class of approximately 900,000 physicians, to resolve a class action suit brought in the Southern District of Florida. read more
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The Connecticut General Assembly recently enacted legislation (Public Act 07-113), signed into law by Governor M. Jodi Rell on June 12, to prohibit health insurers or HMOs (termed "health care centers" under Connecticut law) from engaging in the practice of "post-claim underwriting." read more
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The National Conference of Insurance Legislators’ (NCOIL) Long Term Care and Health Retirement Issues Committee announced that it will discuss and review potential abuses in the long term care (LTC) insurance market at the upcoming NCOIL meeting in Seattle. read more
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Given the escalating costs of covering legitimate health care services, the last thing the health insurance industry needs is to be paying for services that were never rendered. Fortunately, state and federal laws provide harsh penalties for this sort of fraud. read more
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