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State Net Capitol Journal Spotlight: Hot Issues Won’t Vary Much in 2014

By Rich Ehisen | For most states, 2013 was a welcome respite from the usual election year political gridlock. That all changes next year, with 38 governorships, 46 legislative chambers, 33 United States Senate seats and all 435 House of Representatives seats up for grabs. But amidst all that politicking...

Supreme Court Justice Halts Birth Control Mandate For Catholic Group

WASHINGTON, D.C. — (Mealey’s) U.S. Supreme Court Justice Sonia Sotomayor on Dec. 31 temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the...

Bradley J. Frigon on the Applicability of Medicare Secondary Payment Subrogation Rights to Medicare Part C and Part D Private Carriers

By Bradley J. Frigon Following several cases that challenged federal regulations, CMS published a memorandum to all Medicare Advantage Organizations and Prescription Drug Plan Sponsors regarding Medicare Secondary Payment Subrogation Rights for Part C and Part D private carriers seeking reimbursement...

Must My Company In New Jersey Offer or Provide Health Insurance to Its Employees?

Whether a business in New Jersey must offer or provide health insurance to its employees depends on the number of workers that the business employs. In general: Employers in New Jersey with 50 or more employees must provide “minimum essential” health care coverage for employees who...

Williams Mullen: Employer Healthcare Mandate Transition Relief Announced

By Brydon M. DeWitt This week, the Treasury Department announced transition rules that delay implementation of the Affordable Care Act (ACA) employer health insurance mandate for some employers and modify it for others. The ACA requires employers with at least 50 full-time employees to offer affordable...

High Court Hears Arguments In Birth Control Mandate Cases

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on March 25 heard arguments in two cases that will decide whether for-profit, secular businesses have to provide contraceptive services as part of their health insurance packages to employees even if they oppose such measures on religious...

Top Court Rejects Religious Groups’ Challenges In Birth Control Cases

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on March 31 denied petitions for certiorari from two nonprofit religious groups claiming that the contraceptive mandate contained in the Patient Protection and Affordable Care Act (ACA) violates the Religious Freedom Restoration Act (RFRA...

The Hobby Lobby Primer: How A Craft Store Changed The Legal Landscape

Now that the United States Supreme Court has issued its decision in Burwell v. Hobby Lobby Stores, Inc. , 2014 U.S. LEXIS 4505 (U.S. June 30, 2014) , many are left with questions on the breadth of the decision and what it means going forwards. Below is a brief primer . [lexis.com subscribers may access...

11th Circuit Cites Hobby Lobby, Enjoins Mandate During Appeal

MONTGOMERY, Ala. — (Mealey’s) A Catholic media outlet is entitled to an injunction while it appeals rejection of its Patient Protection and Affordable Care Act (ACA)’s contraceptive mandate challenge in light of Burwell v. Hobby Lobby (Nos. 13-354, 13-356, U.S. Sup. [lexis.com subscribers...

Foley & Lardner LLP: SEC's MCDC Initiative - The Clock is Ticking

By David Y. Bannard Not-for-profit health care providers that have borrowed on a tax-exempt basis within the last five years should be aware of the Securities and Exchange Commission’s (SEC) Municipalities Continuing Disclosure Cooperation (“MCDC”) Initiative. The MCDC Initiative...

4th Circuit Finds ACA Tax Credit Proper Under IRS Interpretation

RICHMOND, Va. — (Mealey’s) Patient Protection and Affordable Care Act (ACA) language governing whether individuals who enroll through the federal exchange are entitled to tax credits is ambiguous enough to defer to the Internal Revenue Service’s interpretation, a Fourth Circuit U.S...

Jail for False Health Insurance Claims – Health Insurance Fraud Conviction Stands

Because Medicare and Medicaid pay health care providers promptly and without any inquiry into the probity of the claim health insurance fraud is a fairly easy crime to commit with little chance of being arrested or convicted. Perhaps that is the reason why the extent of health insurance fraud is counted...

Ballard Spahr LLP: IRS Issues Draft ACA Reporting Forms

By Jonathan M. Calpas and Edward I. Leeds The Internal Revenue Service recently released draft versions of the forms that will be used to meet the shared responsibility reporting requirements under the Affordable Care Act (ACA). These draft forms have been released for comment and may not be used...

Judge Finds Indiana, School District Employers Allege Injury Under ACA

INDIANAPOLIS — (Mealey’s) A state and 39 school districts challenging the legality of payments imposed on large employers under the Internal Revenue Services’ implementation and interpretation of Patient Protection and Affordable Care Act (ACA) regulations allege an addressable injury...

DLA Piper: Don’t Forget the Sept. 23 Deadline to Ensure Your Business Associate Agreements Comply with the HIPAA Omnibus Final Rule

By Marcia L. Augsburger Under the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule published January 25, 2013, 78 Fed.Reg. 5566, Covered Entities (CEs) with Business Associate Agreements (BAAs) that were entered on or before January 25, 2013 and that were not modified...

Norton Rose Fulbright: Physicians Payments Sunshine Act Data 33 Percent Unpublishable, Penalties Next?

By Benjamin Koplin , Selina Coleman and R. Jeffrey Layne Despite extending the dispute-and-resolution deadline to account for the days that the Centers for Medicare & Medicaid Services (CMS) pulled down the reporting system, the public Physician Payments Sunshine Act website is still expected...

ACA Compliance: Getting Ahead of the Curve. A LexisNexis® White Paper with Cynthia Stamer

The looming implementation of another round of employer mandates under the Affordable Care Act (ACA) has business leaders scrambling for help from legal counsel and other advisors. This flurry of activity is prudent; compliance with ACA is a matter of federal law and many penalties for failure to comply...

Ballard Spahr LLP: Government Agencies Release Further Accommodations to Organizations Opposing Mandated Contraceptive Coverage

By Jean Hemphill and Brian Pinheiro In response to the recent U.S. Supreme Court decision in Burwell v. Hobby Lobby, Inc., [ enhanced opinion available to lexis.com subscribers ], the U.S. Departments of Health and Human Services (HHS) and Labor (DOL) published proposed rules on August 22, 2014, expanding...

Study Finds States With Expanded Medicaid Experiencing Bump In ER Volume

GREENWOOD VILLAGE, Colo. — (Mealey’s) States with expanded Medicaid under the Patient Protection and Affordable Care Act (ACA) saw a threefold increase in emergency-department visits over nonexpansion states in the second quarter of 2014, according to a Sept. 8 study. (This story is an...

State Net Capitol Journal: California Ponders Health Insurance Rate Regulation

By Rich Ehisen | Note: On Nov. 4, 46 states will hold legislative elections, while 36 will elect or retain a governor. Meanwhile, 41 states will also weigh in on a wide range of ballot measures addressing some of the most controversial issues of the year, including abortion, marijuana use and the...

U.S. Supreme Court Hears Arguments Over ACA Federal Exchange Subsidy Availability

WASHINGTON, D.C. — (Mealey’s) Both sides faced critical questioning from Justice Anthony Kennedy during oral arguments March 4 in the case challenging the availability of subsidies in the Patient Protection and Affordable Care Act (ACA) federal exchange ( David King, et al. v. Sylvia Mathew...

Top Court Cites Hobby Lobby In Vacating, Remanding ACA Accommodation Ruling

WASHINGTON, D.C. — (Mealey’s) The U.S. Supreme Court on March 9 vacated a Seventh Circuit U.S. Court of Appeals opinion that denied the University of Notre Dame an injunction in its challenge to the Patient Protection and Affordable Care Act (ACA) accommodation process and remanded the case...

High Court Affirms Availability Of Tax Credits In ACA Federal Exchange

WASHINGTON, D.C. — (Mealey’s) The Patient Protection and Affordable Care Act (ACA)’s structure suggests the availability of tax subsidies in the federal exchange, and Congress could not have intended the state insurance market “death spirals” likely to result from barring...

Williams Mullen: Supreme Court Upholds ACA Premium Assistance Nationwide

By: Brydon M. DeWitt This morning [June 25], the Supreme Court ruled that Affordable Care Act (ACA) premium tax credits will remain available to individuals residing in states that did not establish their own health insurance marketplaces. In King v. Burwell , the Supreme Court analyzed ACA statutory...