News & Analysis as of

Beneficiaries Health Insurance

Seyfarth Shaw LLP

Gone But Not Forgotten: How to Handle Final Pay and Benefits When an Employee Passes Away

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Let’s face it—no one wants to think about what happens when an employee dies. It’s a deeply human moment, and yet, somewhere between the condolences and the memorial service, someone in Human Resources is quietly asking: “So…...more

Troutman Pepper Locke

U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

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The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

Dentons on

Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

Stotler Hayes Group, LLC

Medicaid Application Process: Top Tips for Applying for Medicaid

Applying for Medicaid benefits, particularly long-term care benefits, can be difficult and confusing. Yet, it is a necessary evil for many who rely on Medicaid to ensure that they can afford the room, board, care, and...more

Dinsmore & Shohl LLP

Medicare Telehealth Flexibilities Extended, but Without Promise of Permanent Solution

Dinsmore & Shohl LLP on

Through a recent stopgap funding bill, Congress has extended several telehealth-related flexibilities that are critical for Medicare beneficiaries and providers until September 30, 2025. As we previously reported, the...more

DLA Piper

Medicare Drug Price Negotiation: Saving Money for Medicare, but What About Patients?

DLA Piper on

Evaluating current formulary access for the 25 drugs selected for Drug Price Negotiation in Medicare Part D shows several selected drugs have higher co-pays in 2025 relative to 2024 - Introduction - The Inflation Reduction...more

Kohrman Jackson & Krantz LLP

Child Support in Ohio: Key Factors in Child Support Calculations – Part 2

One of the most common questions posed by parents of minor children who are separated – or who are about to separate – is the following: what is child support and how much can I expect to pay or receive in child support from...more

ArentFox Schiff

Investigations Newsletter: FCA Enforcement & Compliance Digest — Summer 2024 False Claims Act Newsletter

ArentFox Schiff on

Welcome to the Summer 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and...more

Mintz - Health Care Viewpoints

Mintz IRA Update — The Consequences and Costs of Redesigning the Part D Program

The passage of the Inflation Reduction Act of 2022 (IRA) marked a significant milestone in Congress’s ongoing efforts to address escalating health care costs. While the IRA aims to rein in government spending on Medicare and...more

ArentFox Schiff

Health Insurers Sued Over Use of Artificial Intelligence to Deny Medical Claims

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With the surge of interest in artificial intelligence (AI), it should be no surprise that health insurers have come under scrutiny concerning their use of AI predictive tools to deny medical insurance claims. The question...more

Foley Hoag LLP - Medicaid and the Law

CMS Issues Rule Implementing Medicaid Redetermination Policies

We’ve written recently about the process that states are undertaking to begin to wind down the Medicaid enrollment expansion that was necessitated by the enactment of the Families First Coronavirus Response Act in March of...more

McAfee & Taft

More details on transparency rules that apply in 2022 and beyond

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On December 6, 2020, we posted an article titled “RADICAL new transparency rules likely apply to your health plan in one year.” The regulations are a little more than 150 PDF pages long. The following is intended to provide a...more

Fox Rothschild LLP

New Relief For Employee Benefit Plans And Participants

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Providing sweeping relief to employee benefit plan sponsors, participants and beneficiaries impacted by the COVID-19 emergency, the Employee Benefits Security Administration joined with the IRS to extend deadlines in order to...more

Seyfarth Shaw LLP

ERISA Preemption — The Courts of Appeal Continue to Rule As They Await Further Supreme Court Attempts To Define, Once and for All,...

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Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more

Chambliss, Bahner & Stophel, P.C.

IRS Issues Long-Term Care Premium Deductibility Limits for 2019

The Internal Revenue Service (IRS) is increasing the amount taxpayers can deduct from their 2019 income as a result of buying long-term care insurance. Premiums for "qualified" long-term care insurance policies (see...more

White and Williams LLP

Purported Assignment and Power of Attorney Held Invalid in Provider’s Suit to Recover Health Benefits

White and Williams LLP on

On December 4, 2018 United States District Judge Noel L. Hillman dismissed a suit for unpaid medical bills by a healthcare provider against its patient’s ERISA-governed health benefits plan, finding the assignment/power of...more

Chambliss, Bahner & Stophel, P.C.

More States Asking to Eliminate Retroactive Medicaid Benefits

Arizona and Florida are the latest states to request a waiver from the requirement that states provide three months of retroactive Medicaid coverage to eligible Medicaid recipients. Medicaid law allows a Medicaid applicant...more

White and Williams LLP

Third Circuit Issues Precedential Ruling: “Anti-Assignment” Clauses in ERISA-Governed Health Insurance Plans Are Enforceable

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On May 16, 2018, the US Court of Appeals for the Third Circuit held in a precedential opinion that “anti-assignment clauses in ERISA-governed health insurance plans as a general matter are enforceable.” In so holding, the...more

Nelson Mullins Riley & Scarborough LLP

Gold Dome Report - February 2018

Although all signs this morning pointed to a quiet day under the Gold Dome, the halls quickly became abuzz with news of a compromise on HB 159, the adoption bill authored by Rep. Bert Reeves (R-Marietta). The masses got their...more

Bass, Berry & Sims PLC

CMS Guidance Paves Way for Medicaid Work Requirements

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The Centers for Medicare & Medicaid Services (CMS) started the year with a bang, issuing guidance on January 11, 2018, in support of Medicaid demonstration projects that condition coverage on beneficiary participation in work...more

Chambliss, Bahner & Stophel, P.C.

Medicare's Part B Premium Will Be Unchanged in 2018, But Many Will Pay More. Got That?

The announcement of the 2018 Medicare premium is good news for some beneficiaries and bad news for many others. The good news is that the standard monthly Part B premium, which about 30 percent of Medicare beneficiaries pay,...more

Foley & Lardner LLP

Medicare Advantage Value-Based Insurance Design Model

Foley & Lardner LLP on

CMS, through the Center for Medicare and Medicaid Innovation, announced on September 1, 2015, the introduction of the Medicare Advantage Value-Based Insurance Design (VBID) Model as part of the Health Plan Innovations...more

King & Spalding

OIG Issues Advisory Opinion Regarding Pharmaceutical Manufacturers’ Program to Provide Free Limited Drugs to Beneficiaries When...

King & Spalding on

On August 12, 2015, the Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion No. 15-11, finding that a program to supply a limited amount of free cancer drugs to federal health...more

Mintz - Health Care Viewpoints

Delivery System Reform 2.0: Scaling Alternative Payment Models is the New Normal

For some health care providers, a pair of recent announcements made by the Obama Administration to implement mandatory alternative payment models (APMs) for home health value-based purchasing and bundled payments for hip and...more

Arnall Golden Gregory LLP

GAO Recommends Congress Reduce Incentives for Prescribing 340B Drugs

The United States Government Accountability Office (GAO) recently released a report entitled “Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals” (“the...more

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