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Since the Fall of 2017, the Trump Administration has used its executive and regulatory authority to roll back coverage requirements for Affordable Care Act[1] (ACA) health plans and expand access to association health plans that would be offered outside of ACA’s exchanges to small businesses and self-employed individuals. In response…
Read More Medicare Part E for All – An Idea Whose Time, Perhaps, Has Still Not Come

On October 12, 2017, President Donald Trump signed an Executive Order “to reform the United States healthcare system to take the first steps to expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers.”  The Executive Order directs the Secretary of Labor…
Read More Trump Administration Issues Executive Order Regarding Health Coverage and Discontinues Cost-Sharing Reductions Payments

The United States Department of Justice has filed an action seeking to enjoin a hospital from enforcing provisions in its contracts with health insurers that prohibit the insurers from steering policyholders to lower cost providers1. The suit targets the Charlotte-Mecklenburg Hospital Authority, the dominant hospital in Charlotte, North…

Read More Contractual Prohibitions on Health Insurers Steering Policyholders to Lower Cost Providers Draws Antitrust Challenge

On October 6, 2015 California’s Governor Jerry Brown signed into law Senate Bill 575, requiring annual notifications of certain nonforfeiture benefits under long-term care insurance contracts. Under current law, an insurer is required to offer, at the time of application for a long-term care insurance contract, an option to purchase…

Read More California Governor Signs Long-term Care Insurance Bill

On April 16, 2015, the Cybersecurity Task Force of the National Association of Insurance Commissioners adopted 12 principles for effective cybersecurity insurance regulatory guidance. Recognizing that cybersecurity risks pose a significant threat to consumer financial and health information, as highlighted by recent, significant data breaches, the NAIC took steps to…
Read More NAIC Issues 12 Principles for Insurance Regulatory Guidance on Cybersecurity

In it Together: Emerging Joint Venture Structures for Hospitals and Insurers

Following the passage of the Affordable Care Act (the ACA), hospitals and physician practice groups, on the one hand, and health insurance and managed care companies, on the other hand, increasingly have focused on lowering health care delivery costs…
Read More Insights into emerging joint ventures for insurers and hospitals focus of Bloomberg BNA article from Locke Lord

As further analyzed in our QuickStudy, available here, New Jersey has enacted a new law (P.L. 2014, c. 88, codified at N.J. Stat. Ann. §§ 56:8-196 – 56:8-198) effective August 1, 2015, requiring health insurance carriers authorized to issue health benefit plans in New Jersey to encrypt personal information…
Read More Attention, Health Insurers: Unique Encryption Requirements in NJ

CMS to Update the EHR Incentive Program

On January 29, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to propose changes to the Electronic Health Record Incentive Program (“EHR Incentive Program”). According to CMS, the rule will address provider concerns and reflect developments in the industry since…
Read More Healthcare Update: CMS to Update the EHR Incentive Program; HHS Announces Timeline for Medicare Payment Reform; OIG Issues Favorable Advisory Opinion Regarding Patient Assistance Program; HIPAA Settlement Following Breach Caused by Malware

Edwards Wildman’s latest Healthcare Update discusses that the New CMS Guidelines on Telemedicine Reimbursement; that OIG Releases 2015 Work Plan and OCR Issues Bulletin on Privacy in Emergency Situations.
Read More Healthcare Update: New CMS Guidelines on Telemedicine Reimbursement; OIG Releases 2015 Work Plan; OCR Issues Bulletin on Privacy in Emergency Situations

Edwards Wildman’s latest Healthcare Update discusses how OIG issues favorable advisory opinion for Medigap “Preferred Hospital” network arrangement; the FDA issued a draft guidance on stem cell same surgery exception; and the $840 million in grants that are available through new HHS Transformation Initiative.
Read More Healthcare Update: OIG Issues Favorable Advisory Opinion for Medigap “Preferred Hospital” Network Arrangement; FDA Issues Draft Guidance on Stem Cell Same Surgery Exception; $840 Million in Grants Available Through New HHS Transformation Initiative