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Regulatory Standards Health Insurance

Holland & Knight LLP

Regulation of AI in Healthcare Utilization Management and Prior Authorization Increases

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Over the past two years, federal and state government agencies have moved to regulate the deployment of artificial intelligence (AI) in the healthcare setting, including in the utilization management (UM) and prior...more

McDermott+

Regs Coming Through the End of the Year: Expect the Expected and the Unexpected

McDermott+ on

There could be an all-you-can-eat buffet of regs (and eggs) from now until the end of the year! As you may recall, a July 2024 Regs & Eggs blog post highlighted the spring 2024 “unified agenda” that listed all the regs...more

Akin Gump Strauss Hauer & Feld LLP

The Regulatory Race Is On: The Biden Administration Sprints to Issue Key Health Policies

The upcoming election, and the approaching end of the President’s four-year term, introduce additional dynamics into the agencies’ rulemaking process and even the guidance process. From now through the November election, the...more

Nelson Mullins Riley & Scarborough LLP

High Screening May Lead to High Stakes for SNFs

In the CY 2023 Physician Fee Schedule Final Rule (CMS-1770-F) Centers for Medicare & Medicaid Service (CMS) cracks down on the provider enrollment process. Specifically, CMS added Skilled Nursing Facilities (SNFs) to the...more

Polsinelli

Louisiana Insurance Department Issues Cease and Desist Orders to a TPA and the Louisiana Office of Group Benefits for Failure to...

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The Louisiana Insurance Department (“Department”) recently issued separate Cease and Desist Orders to both a TPA operating as a Pharmacy Benefit Manager (“PBM”) and the Office of Group Benefits, a Louisiana state agency that...more

Baker Donelson

CMS Finalizes Repeal Of Regulatory Definition Of "Reasonable And Necessary"

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The Centers for Medicare & Medicaid Services (CMS) issued a Final Rule on November 15, 2021, (November 2021 Final Rule) repealing its regulatory definition of "reasonable and necessary," which had previously been finalized in...more

Manatt, Phelps & Phillips, LLP

Accessing Out-of-Network Subspecialty Cancer Care in Marketplace Plans

In a new report prepared in partnership with the Leukemia & Lymphoma Society (LLS), summarized below, Manatt Health reviews policy challenges that may hamper patients’ ability to navigate and obtain proper treatment for their...more

Manatt, Phelps & Phillips, LLP

Accessing Out-of-Network Subspecialty Cancer Care in Marketplace Plans - Key Findings From a Scan of Four States

Blood cancer takes a demanding physical, mental and emotional toll on the 1.3 million patients living with this disease in the U.S. Many blood cancer patients also face the daunting task of managing their own care—obtaining...more

Kramer Levin Naftalis & Frankel LLP

NAIC Considers PBM Regulation; Additional Requirements Possibly on Tap

Pharmacy benefit managers (PBMs) should consider the implications of a model law making its way through the National Association of Insurance Commissioners (NAIC) that would establish a licensure requirement and rules of...more

Hogan Lovells

CMS proposes “reasonable and necessary” definition, expedited breakthrough device coverage process

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On Tuesday, September 1, 2020, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule addressing the Medicare coverage standard and expedited coverage for certain medical devices. If finalized, the...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

Ballard Spahr LLP

NYDFS requires regulated institutions to submit plans describing preparations for LIBOR transition by Feb. 7

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The New York Department of Financial Services has sent a letter to the institutions that it regulates requiring each such institution, by February 7, 2020, to provide to DFS a description of its “plan to address its LIBOR...more

Polsinelli

Third Party Administrator Newsletter - December 2019

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Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of Their TPA and PBM Business Partners The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement...more

King & Spalding

Strategies for Addressing Reference-Based Plans

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The move by some employer plans to a “reference-based” pricing model has created a need for healthcare providers to develop a strategy to confront payment challenges that these plans create. A prevalent model of...more

Polsinelli

Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of their TPA and PBM Business Partners

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The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement action against an insurer after determining that the insurer had violated various provisions of Vermont’s insurance laws,...more

Akerman LLP - Health Law Rx

Long Delayed CVS/Aetna Merger Finally Gains Court Approval

Concluding one of the longest merger reviews in history, on September 4, Judge Richard Leon, District Judge for the District of Columbia, issued his final ruling in United States v. CVS Health, approving the proposed...more

Orrick - Antitrust Watch

Toward Uncharted Waters – The CVS-Aetna Merger

On June 4 – 5, 2019, Judge Richard J. Leon of the U.S. District Court for the District of Columbia held an extraordinary and unprecedented evidentiary hearing to decide whether to enter the proposed Final Judgment in U.S. v....more

Faegre Drinker Biddle & Reath LLP

“A Slice” of the 2019 ILTCI Conference

Drinker Biddle is pleased to present you with this recap—or “a slice” of the 2019 ILTCI Conference, Chicago, Illinois. Year after year, the ILTCI Conference is jam-packed with opportunities to reconnect with and learn from...more

Manatt, Phelps & Phillips, LLP

[Webinar] What Marketplace and Regulatory Drivers Are Transforming Healthcare M&A? - April 2nd, 1:00p.m. ET

What are the trends driving the growth in healthcare transactions? What are the new M&A strategies remapping the healthcare landscape? Find out the answers in a new Manatt webinar....more

Seyfarth Shaw LLP

Take Note: EEOC Vacates the Incentive Sections of its Final Wellness Regulations

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Seyfarth Synopsis: The EEOC has withdrawn the incentive provisions in its ADA and GINA wellness program regulations. The remaining provisions have less bite as a consequence, especially in the ADA context. But HIPAA wellness...more

Akerman LLP - Health Law Rx

CVS Completes Acquisition of Aetna

In a filing with the Securities and Exchange Commission on November 26, CVS Health Corporation announced that it has received all of the regulatory approvals necessary to complete its acquisition of Aetna and that the...more

Akerman LLP - Health Law Rx

DOJ Approves CVS/Aetna Merger, Contingent on the Sale of Aetna’s Medicare Part D Business

The United States Department of Justice Antitrust Division announced on October 10, 2018, that it was conditionally approving the CVS/Aetna merger, a $69 billion transaction that combines the nation’s largest retail pharmacy...more

Benesch

Benesch Market Intelligence: Health Care Quarterly Report - Q2 2018

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Private Equity & M&A - Real estate giant Hines partners with Sentio to invest in senior housing - Houston-based real estate company Hines has announced that it has partnered up with Orlando-based health care...more

Carlton Fields

Nebraska Adopts Reinsurance Credit Amendments To Insurance Law Based On NAIC Model

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On April 11, 2018 Nebraska Gov. Pete Ricketts (R) signed Legislative Bill 815 into law, joining the surge of states amending their insurance laws regarding when ceding insurers may claim credit for reinsurance....more

Hogan Lovells

IVASS and AGCM bring actions against unfair clauses contained in accident and health insurance contracts

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The Italian Insurance Regulator ("IVASS") and the Italian Competition Authority ("AGCM") have taken coordinated actions against certain clauses contained in health and accidents insurance policies that cover permanent...more

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