To great fanfare by both the leadership of the Republican caucus in the House of Representatives (the House) and President Trump, on May 4, 2017, the American Health Care Act (AHCA), the proposed successor/replacement to the Affordable Care Act (ACA), passed the House by a narrow vote of 217-213. Unsurprisingly, no member of the Democratic Party in the House voted … Continue Reading
The Centers for Medicare and Medicaid Services (CMS) announced its 2018 Medicare Advantage (MA) capitation rates, with an expected increase of .45 percent, slightly higher than proposed in the advance notice. CMS estimates that MA health plans will realize an increase in revenue of 2.95 percent, reflecting increases in coding acuity and risk adjustment payments. CMS emphasized that the policies … Continue Reading
An Affordable Care Act (ACA) provision that is often-overlooked by the media, but has impacted the ability of insurers and their non-insurance related entities, in their role as employers, to take tax deductions for certain compensation paid to their highly paid employees may be ending at the end of the year. If passed, the House Republican’s health care bill repealing … Continue Reading
In the uncertain atmosphere surrounding the process of ‘repealing’ and replacing the Affordable Care Act (ACA), there are some clues as to what we can expect to come next, at least with regard with the health insurance industry. Obviously, one place to look is to President-Elect Trump himself. During his campaign, then-candidate Trump published a seven-point position statement on healthcare … Continue Reading
On implementing significant, new requirements for Medicare-certified dialysis facilities that make payment of premiums for individual health coverage, on December 14, 2016, the Department of Health and Human Services (HHS) published an Interim final rule with comment period. The regulations become effective 30 days after the date of publication – January 13, 2017, and comments regarding the interim must be … Continue Reading
Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.
Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights Medicare itself would have in actions against primary payers for reimbursement of conditional healthcare treatment costs. … Continue Reading
Health insurers and HMOs have a limited time to review the new federal meaningful access rules and amend plan documents accordingly. However, many payors still have not revised their plans to include the required language, and others might not be aware the rules apply to them.… Continue Reading
Amendments to the Florida Disposition of Unclaimed Property Act in 2016 made significant changes to unclaimed property presumptions and insurance company obligations. See § 717.107, Fla. Stat. (2016) (the Act). Among other things, the Act: (a) revises conditions of when certain insurance policies or annuity contracts are deemed matured and the proceeds are due and payable; (b) requires insurance companies … Continue Reading
Biometric data – obviously not in just the movies anymore. It is alive, well, and increasingly being used in our everyday society. But, on September 23, 2015, when the Office of Personnel Management revealed that fingerprint data of nearly six million individuals had been compromised in a cyber-security attack, fear came home to roost. Let’s address the journalistic questions:… Continue Reading
Thursday’s Supreme Court decision in the King v. Burwell case can be seen as a major victory for the Obama Administration, resolving, at least for the time being, the continued implementation of the Affordable Care Act by upholding insurance subsidies for about 6.4 million consumers in over 34 states. Once again, Chief Justice John Roberts, came to the rescue of … Continue Reading
As previously reported on November 13, 2013 and February 20, 2014, the Centers for Medicare and Medicaid Services (“CMS”) has attempted to provide guidance as to when it is appropriate for issuers of “qualified health plans” (“QHPs”) to accept third parties premium payments on behalf of individuals.
On March 19, 2014, CMS reinforced its February 7, 2014 guidance by … Continue Reading
A judge in the United States District Court for the Southern District of Florida has approved a $3 million data breach class action settlement agreement between AvMed, Inc. and plaintiffs. The settlement arises out of a December 2009 theft of unencrypted laptops containing the personal information of individuals who received healthcare coverage through AvMed and for the first time permits … Continue Reading
We previously reported that the U.S. Department of Health and Human Services (“HHS”) has discouraged hospitals and other third parties from paying patients’ premiums or cost-sharing. HHS stated in its November 4, 2013 FAQ that it “has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces.” In other … Continue Reading
The past year was one of the most eventful in recent memory for healthcare policy. As the Affordable Care Act (“ACA”) continued its inexorable, albeit at times wobbly, march towards implementation, the headlines became more and more sensational. 2014 promises to be even more fascinating. We provide for you our prediction, in no particular order, of the biggest healthcare stories … Continue Reading
Current events were top-of-mind last Friday, November 15, 2013, as Akerman LLP’s Healthcare Practice Group and Wells Fargo invited clients and industry professionals to engage in a thoughtful discussion on healthcare reform and the future of the American healthcare system.
The Healthcare Briefing featured a distinguished panel of executives and legal advisors that included Gordon Bailey, Assistant General Counsel, Florida … Continue Reading
There has been much speculation in the health care community that it may be financially beneficial, under certain circumstances, for hospitals and other large providers to purchase health care coverage for their indigent patients. U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently stated that Qualified Health Plans, which are sold on the federal health care Marketplace, are … Continue Reading
What is the “temporary reinsurance fee”? The Affordable Care Act (“ACA”) requires the creation of a transitional reinsurance program for the first three years (2014-2016) of the state health insurance exchanges to help stabilize the exchange premiums. It is intended to shift the risk of covering certain catastrophic medical expenses from the primary insurer to a reinsurer. The funding for … Continue Reading
Pursuant to Section 409.966, Florida Statutes, traditional Medicaid services are to be provided to Florida recipients through a limited number of Managed Care Organizations (“MCOs”) in the 11 Regions of the state. The Agency released Invitations to Negotiate (“ITNs)” for each of the Regions inviting MCOs to submit proposals to provide coverage to Medicaid recipients in that Region. The proposals … Continue Reading
Earlier this year, the Florida Legislature passed a law requiring health insurers to tell consumers how much of any premium increase for 2014 is caused by various requirements of the Patient Protection and Affordable Care Act. See Senate Bill 1842 at section 15, amending section 627.410, Florida Statutes. Last week, the Financial Services Commission adopted a regulation that includes a … Continue Reading
System Upgrade? On July 11, 2013, the Department of Health and Human Services Office of Civil Rights (OCR) announced that it had reached a $1.7 million settlement with managed-care company Wellpoint, Inc., to resolve “potential” violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. The settlement arises out of a computer system upgrade that left … Continue Reading
Health insurance carriers are keenly aware of many provisions of the Patient Protection and Affordable Care Act (“ACA”). But an often-overlooked ACA provision may actually impact the ability of these insurers and their non-insurance related entities, in their role as sophisticated employers, to take tax deductions for certain compensation paid to their executives. This change results from the addition of … Continue Reading
The 2013 Florida Legislature passed a number of healthcare-related bills that may impact your business or practice. The bills make changes to Medicaid and affect healthcare providers, hospitals, health insurers, HMOs, and pharmacies.
The Affordable Care Act (“ACA”) generally limits the maximum length of employer-sponsored group health plans’ waiting periods to no more than 90-days in 2014. In the March 21, 2013 Federal Register, the U.S. Department of Labor, Health and Human Services , and the Internal Revenue Service jointly released proposed regulations to provide guidance to employers on how to implement this … Continue Reading
The interplay between the Affordable Care Act (“ACA”) legislation/interpreting regulations and existing state insurance laws continues to evolve. To further complicate matters, the regulators’ own positions on certain state insurance law issues have themselves changed over time. For example, some state insurance laws permit insurers to require small groups to maintain certain threshold participation or contribution levels, and employers preparing … Continue Reading