C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

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Supreme Court: FEHBA Preempts State Subrogation Prohibitions

Posted in Federal Employee Health Benefits Program (FEHB)
The U.S. Supreme Court unanimously decided, in Coventry Health Care of Missouri, Inc. v. Nevils, that the Federal Employees Health Benefits Act (FEHBA) preempts state laws that prohibit subrogation recovery by health insurance carriers. FEHBA expressly preempts state law. Specifically, “[t]he terms of any contract under this chapter [5 U.S.C. § 8901, et seq.] which… Continue Reading

CMS Delays Implementation of Episode Payment Models (EPMs)

Posted in Medicare
In an Interim Final Rule with Comment Period (IFC) published on March 21, 2017, CMS provided that implementation of the EPMs for cardiac and orthopedic care improvement, the cardiac rehabilitation incentive payment model, and the changes to the Comprehensive Care for Joint Replacement (CJR) model would be delayed from July 1, 2017 to October 1, 2017. The… Continue Reading

Court Delays Action on Appeal of ACA Subsidies Case

Posted in Exchanges, Health Care Reform & ACA
On December 5, 2016, the U.S. Court of Appeals for the D.C. Circuit issued an order to stay  the administration’s appeal of the district court decision in U.S. House of Representatives v. Burwell, a case challenging Cost-Sharing Reduction (“CSR”) payments to health insurance issuers under the Affordable Care Act (“ACA”) Section 1402. The district court… Continue Reading

GAO Finds HHS Exceeded Authority in Implementation of Transitional Reinsurance Program

Posted in Exchanges, Health Care Reform & ACA, Uncategorized
The Government Accountability Office (GAO), in a letter to members of Congress, found that the implementation of the Transitional Reinsurance Program by the U.S. Department of Health and Human Services (HHS) violates the Affordable Care Act. The Transitional Reinsurance Program is one of three premium stabilization programs authorized by the Affordable Care Act (ACA), commonly… Continue Reading

OPM Finalizes Regulations Implementing Self Plus One Enrollment Type for FEHBP and Addresses Carriers’ Cost Concerns

Posted in Federal Employee Health Benefits Program (FEHB)
Beginning January 1, 2016, the Federal Employees Health Benefits Program (FEHBP) will include a self plus one enrollment option for its members. For 2015 and previous years, federal employees and annuitants enrolling in FEHBP plans had only two options, self only or self and family. The change was initially mandated by the 2013 Bipartisan Budget… Continue Reading

CMS Letter to Insurance Commissioners Signals Market Stabilization

Posted in Health Care Reform & ACA
The Centers for Medicare & Medicaid Services (CMS) recently sent a letter to state insurance commissioners, available here, setting forth five findings for departments of insurance to consider as they render final decisions on health insurance rates. The letter’s findings discuss cost and utilization trends as well as policy matters. First, CMS notes that Marketplace… Continue Reading

Departments Reverse Course on Implementation of Affordable Care Act Provider Contracting Provision

Posted in Health Care Reform & ACA
On May 26, 2015, the Departments of Health and Human Services, Labor, and the Treasury (Departments) released subregulatory guidance that, among other things, reversed previous guidance addressing provider nondiscrimination in health coverage. The Affordable Care Act added Section 2706 to the Public Health Service Act, 42 U.S.C. § 300gg-5, which states that plans and issuers… Continue Reading

CMS Proposed Rule Implements Mental-Health Parity Requirements for Medicaid Managed Care and CHIP Plans

Posted in Medicaid, Mental Health Parity
On April 6, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule to implement the 2008 Mental Health Parity and Addiction Equity Act (“MHPAEA”) for coverage offered by Medicaid Managed Care Organizations (“MCOs”), Medicaid Alternative Benefit Plans (“ABPs”) and the Children’s Health Insurance Program (“CHIP”).  MHPAEA requires group health plans and health… Continue Reading

FY 2016 Proposed Federal Budget’s Potential Impact on Healthcare Industry

Posted in Health Care Reform & ACA, Medicaid, Medicare
The President’s proposed budget, released February 2, includes a number of provisions that will impact the health care industry. Most prominently, the budget would seek savings through modifications to Medicare prescription drug coverage, extend the Children’s Health Insurance Program (CHIP), and continue to push Medicare delivery system reforms.… Continue Reading

Federal Funds, States, and Health Care Reform: Innovation and Opportunity in 2015

Posted in Health Care Reform & ACA
States are on the front lines of health reform. The Affordable Care Act (ACA) acknowledged this by authorizing several grant programs for states to promote its implementation in addition to the many programs that already existed. Recently, the Department of Health and Human Services has awarded hundreds of millions of dollars in grants to states,… Continue Reading

OPM Proposes Changes to Evaluation of FEHB Plan Performance

Posted in Federal Employee Health Benefits Program (FEHB)
On Monday, December 15, the Office of Personnel Management (OPM) published a notice of proposed rulemaking that would modify the framework within which OPM evaluates Federal Employees Health Benefits (FEHB) plan performance. For both experience-rated and community-rated plans, plan performance significantly impacts FEHB carriers’ profits. OPM describes the proposed framework as more consistent, objective, and… Continue Reading