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Health Insurance Contract Terms

Wiley Rein LLP

[Podcast] Contracting for Success: Key Legal Considerations When Segmenting Pharmacy Benefit Programs

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In this episode of The Wiley Contracting Chronicles, co-hosts Jordan Ross and Brooke DeLoatch take a deeper dive into program segmentation within pharmacy benefit programs. After outlining the concept in their previous...more

Whiteford

Understanding Price Transparency Laws and Gag Clauses: A Guide for Healthcare Providers

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Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more

ArentFox Schiff

Federal Court Holds That Pathology Group States Viable Claims Against Multiplan and Cigna for Failing to Ensure In-Network Payment

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A federal court recently rejected arguments by MultiPlan, Inc. and Cigna Health and Life Insurance Company that they had no obligation to ensure payments at the contractually negotiated, in-network rate to Anatomic and...more

Maynard Nexsen

Tri-Agency FAQ Provides Updated Guidance Regarding Compliance with the Gag Clause Prohibition

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On January 14, 2024, the Departments of Labor, Health and Human Services, and the Office of Personnel Management (the “Departments”) jointly released the FAQs About Consolidated Appropriations Act, 2021 Implementation Part 69...more

Stotler Hayes Group, LLC

CMS Cracks Down on Responsible Party Liability in LTC Admission Agreements

A nursing facility that participates in the Medicaid or Medicare programs may not require a third party to guarantee payment for a resident’s admission or continued stay. However, facilities are allowed to require a resident...more

Verrill

The Gag Clause Quandary for Self-Insured Group Health Plans—New FAQ Guidance

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The Departments of Labor, Health and Human Services, and the Treasury, with the Office of Personnel Management (the “Departments”) jointly released FAQs About Consolidated Appropriations Act, 2021 Implementation Part 69...more

Lippes Mathias LLP

Supreme Court Decides in Favor of Tribal Nations in Becerra v. San Carlos Apache Tribe

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The U.S. Supreme Court’s June 6 decision is a victory for Tribal Nations, affording them new opportunities to recover contract support costs pertaining to healthcare programs. In Becerra v. San Carlos Apache Tribe, the...more

Mintz - Antitrust Viewpoints

Reversible Error: District Court Stutters, Ninth Circuit Shudders, Litigation Continues for Sutter

Over ten years ago, individuals and businesses insured by health plans that contract with Sutter Health filed a class action lawsuit against Sutter Health alleging antitrust violations under federal and California laws....more

Bricker Graydon LLP

Gag Clause Attestations due December 31, 2023

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If you sponsor a group health plan, make sure you set a calendar alert before the winter holidays to submit the annual gag clause prohibition compliance attestation. Under the Consolidated Appropriations Act of 2021 (CAA),...more

Robinson+Cole Health Law Diagnosis

Connecticut Health Care Bill Revises Provider-Payor Contracting Requirements to Address Competitive Concerns

On June 7, 2023, the Connecticut Legislature passed HB6669, “An Act Protecting Patients and Prohibiting Unnecessary Health Care Costs” (“the Act”), which includes a prohibition on certain contractual clauses in agreements...more

Bond Schoeneck & King PLLC

How Long Does Your CBA Obligate You to Pay for Retiree Health Insurance Coverage?

If you are a municipal employer in New York State struggling to find the answer to that question, you are not alone. In the absence of express language in your collective bargaining agreement, a definitive response is...more

Jackson Walker

Preparing Employers and Employees for 2021 Benefit Plans Decisions

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Join Jackson Walker and Lockton Dunning Benefits as panelists discuss the upcoming 2021 open enrollment season and provide advice on how to communicate with employees about new programs and benefits, including new initiatives...more

McDermott Will & Emery

COVID-19 – Contingency Planning Checklist for Private Equity Portfolio Companies

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Following the wider outbreak of the coronavirus (COVID-19) around the world, radical—and sometimes controversial—actions have been and are further expected to be taken by national, federal and local governments and...more

Akerman LLP - Health Law Rx

Sutter Health Settles California Attorney General Antitrust Case With Cash and an Agreement to Make Significant Changes to its...

The terms of a settlement that resolved antitrust litigation between the State of California and Sutter Health, the largest health system in Northern California, have now become public, almost two months after the settlement...more

Littler

Circuit Courts Grapple With the Permanence of Retiree Health Benefits Under Collective Bargaining Agreements

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On August 7, 2019, in Kelly v. Honeywell International, the Second Circuit handed down the latest decision in a series of cases across the country on a company’s obligation to provide lifetime health care to retirees....more

Burr & Forman

DOL Provides Transitional Relief to Association Health Plans

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On April 29, 2019, the United States Department of Labor (the “DOL”) released a policy statement providing transitional relief from the potential adverse consequences arising from a District Court’s vacating portions of the...more

Polsinelli

Buyer Beware: Successor Employer Required by Court to Continue Retiree Health Benefits Under Language in Contract

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Mergers and acquisitions can be complicated transactions, particularly when the entity to be acquired has employees covered by a collective bargaining agreement with a union. ...more

Seyfarth Shaw LLP

Sixth Circuit Follows Ordinary Principles Of Contract Law To Find Whirlpool Is Not Obligated To Provide Lifetime Retiree...

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Seyfarth Synopsis: Over the last several years, the law governing disputes on lifetime retiree health benefits in the Sixth Circuit has had many twists and turns....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

New Year, New Laws: 2019 Brings Mini-COBRA, Nondisclosure Restrictions, and Minimum Wage Increase to Arizona

When Arizona’s fifty-third legislature ended last spring, we reported on four new laws that impact Arizona employers and employees. The legislature also passed two additional laws impacting Arizona employers....more

White and Williams LLP

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

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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

Mintz

DOJ Provides Additional Insight into Its Recent Anti-Steering Settlement

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Last month the Antitrust Division of the Department of Justice (the “DOJ”) announced a proposed settlement in its anti-steering case against Atrium Health (formerly known as Carolinas HealthCare System) (“Atrium”). US v. The...more

Akerman LLP - Health Law Rx

Drug Pricing Legislation Sent to the President for Enactment into Law

Two pieces of related legislation that would prohibit so called “gag clauses” in contracts between pharmacists and health plans and pharmacy benefit managers (PBM’s) have been passed by both the Senate and the House....more

Robinson+Cole Health Law Diagnosis

Connecticut Enacts Legislation to Address Hospital-Insurer Network Conflicts

On June 6, 2018, Connecticut Governor Dannel P. Malloy signed into law Public Act No. 18-115 “An Act Concerning Disputes Between Health Carriers and Participating Providers That Are Hospitals” (PA 18-115). This legislation...more

Seyfarth Shaw LLP

The Supreme Court Says Goodbye to the Yard-Man Inference Again and Reaffirms Ordinary Principles of Contract Law Apply When...

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Seyfarth Synopsis: Disputes over lifetime retiree health benefits for union retirees may become a memory of the past. For the second time in three years, the Supreme Court confirms that collective bargaining agreements must...more

Baker Donelson

Anthem Terminates Merger Deal with Cigna; Litigation Continues in Delaware Chancery Court

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On May 12, Anthem announced that it was terminating all efforts to complete its proposed merger with Cigna. The deal, announced back in 2015 and valued at $54 billion, would have combined the country's second and fifth...more

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