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California’s Surprise Medical Bill Statute: Part 2: Comparison to New York’s Emergency Medical Services and Surprise Bills Law

Executive Summary - On September 23, 2016, the California Legislature passed, and Governor Jerry Brown signed, Assembly Bill 72 (“the Law”), creating a new regime for the regulation of “surprise bills.”...more

California’s Surprise Medical Bill Statute: Part 1: Implications and National Trends

I. Executive Summary - On September 23, 2016, the California Legislature passed, and Governor Jerry Brown signed, Assembly Bill 72 (“the Law”), creating a new regime for the regulation of “surprise bills.” Surprise bills...more

HHS Sets New Requirements to Limit Surprise Medical Bills from Out-of-Network Providers

The U.S. Department of Health and Human Services (“HHS”) recently released a final rule titled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] that sets...more

Doing the Cha-Cha on Exchange Rules: CMS Moves Forward on Standardized Plan Offerings but Steps Back from Instituting Minimum...

On March 8, 2016, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule titled “Patient Protection and Affordable Care Act; CMS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] setting...more

The Impact of Health Insurance Co-Op Liquidations on Providers

A growing number of health insurance co-ops or “consumer operated and oriented plans” created under the Affordable Care Act (“ACA”) are shutting down on their own initiative or on orders of state regulators because of their...more

CMS Issues Broad-Reaching Proposals to Better Align Medicaid Managed Care with the Commercial and Medicare Markets

On May 26, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) containing the first proposed revisions to the Medicaid managed care (“MMC”) program’s regulations in more than...more

Why Providers Should Think About the Impact of ICD-10 on Managed Care Reimbursement Now

ICD-10 implementation has been delayed by Medicare until October 2015. Many believe it may be delayed again and are putting off thinking about its impact until it is clear that the updated code set will be implemented by...more

New York’s “Emergency Medical Services and Surprise Bills” Law

Earlier this year, the New York Legislature enacted, and Governor Cuomo signed, legislation that will impact billing and reimbursement for some out-of-network health care services, require new disclosures from providers...more

HEALTH REFORM: New York Issues "Invitation to Participate in the New York Health Benefit Exchange," Clarifying Application Process...

The New York Department of Health's Office of the New York Health Benefit Exchange issued the long-awaited "Invitation to Participate in the New York Health Benefit Exchange" (the "Invitation") on January 31, 2013. The...more

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