Health Law Advisor

EBG Introduces Interactive National Rate Review Scorecard

by Jesse M. Caplan and Lynn Shapiro Snyder

On May 23, 2011, the Center for Consumer Information & Insurance Oversight (CCIIO), in the Centers for Medicare & Medicaid Services (CMS) of the United States Department of Health and Human Services (HHS) published its Final Rule implementing Section 2794 of the Public Health Service Act (PHSA).  This Section requires HHS to establish a process for the review of “unreasonable” health insurance premium rate increases in the individual and small group markets.  The Final Rule ...

by Lynn Shapiro Snyder,  Shawn M. Gilman,  Adam C. Solander, and Constance A. Wilkinson

On June 16, 2011, the Office of Personnel Management (“OPM”) released the Request for Information (“RFI”) regarding Section 1334 of the Affordable Care Act, which requires OPM to contract with health insurers to offer multi-state qualified health plans (“MSQHPs”). The purpose of the RFI is to provide OPM with information that will allow it to better understand the “interests and capabilities” of health insurance issuers that will offer MSQHPs through Health Insurance ...

by Patricia M. Wagner and Ross K. Friedberg

Among the criteria that the “Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program” (“Proposed Statement”) uses to evaluate an accountable care organization’s (“ACO’s”) risk of an antitrust challenge is the ACO applicant’s “market share” within each of its service lines. The market share is a measure of the share of services an ACO participant provides in its Primary Service Area (“PSA”) relative to other ...

by Patricia M. Wagner and Ross K. Friedberg

On April 19, 2011, the “Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program” (“Proposed Statement”) was published in the Federal Register. As noted in the Proposed Statement, the antitrust enforcement agencies (the Department of Justice Antitrust Division and the Federal Trade Commission issued the Proposed Statement in response to a perceived preference by potential accountable care organization (“ACO”) participants to ...

by Lynn Shapiro Snyder, Clayton J. Nix, and Lesley R. Yeung

The U.S. Department of Labor (“DOL”) released a survey report on April 15, 2011, that is being used to satisfy a requirement in the Patient Protection and Affordable Care Act (“ACA”) that the Secretary of Labor “conduct a survey of employer-sponsored coverage” as a condition precedent to the development of the “essential health benefits package” by the Secretary of Health and Human Services (“HHS”). This DOL survey is the first step in the process laid out in ACA for establishing the minimum benefits ...

Please join the attorneys of EpsteinBeckerGreen on June 7, 2011, at the National Press Club, as we present eight panels covering labor and employment topics that have increasingly impacted employers in the health care industry.

Our first panel, entitled Significant Labor and Employment Issues that Affect Health Entities, will include representatives from the health care industry, such as a hospitals, skilled nursing facilities, and emergency medical services. These executive panelists will discuss the critical labor and employment issues they are currently experiencing ...

by Lynn Shapiro Snyder and Amy F. Lerman

On April 14, 2011, the U.S. Department of Health and Human Services announced several initiatives that will offer states more flexibility to adopt innovative new practices in order to provide better and more coordinated care for Medicare and Medicaid enrollees who are dually eligible under both of these programs. Under one of these initiatives, 15 states have been awarded $1 million contracts to support the design of state demonstration projects that will aim to improve the coordination of care for dual eligibles. The Centers for Medicare ...

by Ross K. Friedberg, Shawn M. Gilman, and Lesley R. Yeung

On March 31, 2011, the Centers for Medicare & Medicaid Services, the Department of Health and Human Services' Office of the Inspector General, the Federal Trade Commission, the Department of Justice, and the Internal Revenue Service released four separate issuances providing the public with the opportunity to comment on the creation of accountable care organizations eligible for participation in the voluntary Medicare Shared Savings Program ("MSSP"). This alert sets forth a listing of each of the places in which the ...

by Shawn M. Gilman, Douglas A. Hastings, Mark E. Lutes, David E. Matyas, Lynn Shapiro Snyder, Carrie Valiant, Dale C. Van Demark, Patricia M. Wagner, and Lesley R. Yeung

On March 31, 2011, the Centers for Medicare & Medicaid Services ("CMS") released for public comment a much-anticipated Notice of Proposed Rulemaking implementing the voluntary Medicare Shared Savings Program ("Program") for accountable care organizations ("ACOs"). Also on March 31, the Office of Inspector General, along with CMS, released a Notice with Comment Period to solicit comments regarding proposed ...

by Lynn Shapiro Snyder and Lesley R. Yeung

The Early Retiree Reinsurance Program (“ERRP”) was created by the Patient Protection and Affordable Care Act to provide financial assistance to employers, unions, and state and local governments to help them maintain health insurance coverage for early retirees age 55 and older. A report published by the Department of Health and Human Services on March 2, 2011, states that almost 5,500 plan sponsors have been approved to participate in the ERRP and that $535 million in ERRP reimbursement payments have been made to date. It is important ...