Thu, 23 May 2013 14:58:06 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News 7a05e5a7-7a48-4644-86d4-d628ae86945a Fri, 26 Apr 2013 13:55:03 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Reinforces-Importance-of-Uniform-Application-of-Clear-ERISA-Plan-Language-in-US-Airways-v-McCutchen 27ce3d1f-ff20-44ea-a394-8fd504c9b5c2 Wed, 17 Apr 2013 14:52:58 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/California-District-Court-Finds-Lawful-Health-Plans-Categorical-Exclusion-of-Certain-Types-of-Prosthetic-Devices f0bd6119-17e5-4baa-b3ce-d79d38e32003 Thu, 18 Apr 2013 10:07:45 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Denies-Review-of-Third-Circuit-Decision-That-MA-Organizations-Have-a-Direct-Right-of-Recovery-Under-the-Medicare-Secondary-Payor-MSP-Act efafa362-07db-4657-ade5-feb1fd5c68a7 Thu, 11 Apr 2013 11:42:07 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-and-OIG-Propose-Amendments-to-the-Electronic-Health-Records-Exception-and-Safe-Harbor 30b15575-82fc-44a0-b940-dab0f3e994a4 Wed, 10 Apr 2013 13:42:54 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Federal-Court-Rules-Hospitals-Contracting-with-FEHBP-HMO-are-Subcontractors-Subject-to-Federal-Affirmative-Action-Requirements 16aac521-8bfe-457d-a0da-ebcf9ac51ddc Fri, 08 Mar 2013 11:41:41 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Publishes-Physician-Payment-Sunshine-Rule eaa532a9-fe62-4dab-8d4d-a7f822000ab8 Fri, 08 Mar 2013 12:36:08 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/OPM-Issues-Notice-of-Written-Suspension-and-Debarment-Policy a60b2b06-49b3-4138-bae6-b9e8a6bd90d9 Thu, 23 May 2013 14:58:06 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Treasury-IRS-Release-Proposed-Rule-Regarding-Annual-Health-Insurer-Fee c2adeb1c-7852-4ca9-8635-c50ab2099a2b Wed, 20 Mar 2013 11:57:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Proposed-2014-Payment-and-Policy-Updates-for-Medicare-Health-Drug-Plans-Draft-Call-Letter 38c99b56-7cc5-4930-b003-8b9f2922b389 Fri, 15 Mar 2013 15:38:35 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/HIPAA-Final-Rule-Expands-Liability-for-Violations-Clarifies-Penalty-Assessment-Methodology 61bda5f3-d682-4766-a5c9-444d6d599f56 Mon, 25 Feb 2013 10:02:05 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Announces-Medicare-Advantage-and-Prescription-Drug-Program-MLR-Proposed-Rule-Largely-Follows-Commercial-MLR-Rules f42b088a-68b1-4c9a-8913-67f95bcaaf15 Wed, 20 Feb 2013 18:31:58 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Nixes-State-Action-Immunity-for-Hospital-Acquisition-in-Georgia 71949812-84da-4935-95fc-681e3c9d6fc1 Tue, 26 Feb 2013 14:52:25 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Explains-the-PPACA-Exchange-Record-System 6cfb00cc-2636-4d2d-86c7-6666b3ee472c Tue, 12 Feb 2013 18:42:42 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Final-HIPAA-Rules-Clarifies-Direct-Liability-of-Business-Associates-and-Subcontractors 6d169891-00da-41c2-aa6b-82042d2fda7d Tue, 29 Jan 2013 17:29:53 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Conduit-Exception-Remains-Narrow-Under-New-HIPAA-Rule e7ca64c1-7e14-4729-8b50-a9fbb0703303 Tue, 05 Feb 2013 16:56:26 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Nixes-Equitable-Tolling-for-Hospitals-Seeking-to-File-Late-Appeals-of-Medicare-Underpayments 1995e67f-e0d6-4927-9c12-aca407bc873b Tue, 05 Feb 2013 17:17:06 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Mental-Health-Key-Component-of-President-Obamas-Gun-Control-Executive-Orders c9859abf-e14d-4c4b-9b0e-d15346436826 Tue, 12 Feb 2013 18:44:41 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/HHS-Issues-Final-HIPAA-Regulations-and-Eliminates-Risk-of-Harm-Standard 4aaeda4e-b08d-466d-9952-b68ed71b5f06 Thu, 24 Jan 2013 20:44:56 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/SMART-Act-Amends-Medicare-Secondary-Payer-Statute-Creates-Three-Year-Statute-of-Limitations-Opens-Possibility-of-Section-111-Safe-Harbors 8609215f-507d-45a8-b18a-b83f61e98963 Fri, 18 Jan 2013 11:46:37 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Releases-Proposed-Rule-to-Consolidate-Eligibility-Notices-Appeals-and-Cost-sharing-Maximums-for-Medicaid-CHIP-and-Exchanges e7b6ce45-7f07-4bfe-ba22-e775c99b6c2c Fri, 11 Jan 2013 12:57:57 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/OPM-Releases-Proposed-Rule-on-Establishment-of-Multi-State-Plan-Program-for-Affordable-Insurance-Exchanges 9143f703-3888-43a3-a69e-3f841dc3cf32 Thu, 13 Dec 2012 12:57:52 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Releases-Proposed-2014-Star-Ratings-Methodology da487a5d-c642-4a40-abe8-931ea0edc3d2 Wed, 12 Dec 2012 16:04:49 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Says-No-Extra-Funding-for-States-That-Do-Not-Make-Full-Medicaid-Expansion-and-Offers-Other-ACA-Guidance d20ffde0-61e4-49c7-8ad9-a6e4e3079432 Wed, 12 Sep 2012 13:34:25 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/OPM-Publishes-FAQ-on-FEHBP-Medical-Loss-Ratio 921a6fda-c798-499b-a6fa-d990c7766c45 Tue, 14 Aug 2012 18:40:49 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FEHBP-Community-Rated-HMO-Carrier-Contract-Changes b6e06017-d99e-45a7-9337-168c7be2b449 Mon, 27 Aug 2012 16:55:01 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Decision-on-Constitutionality-of-Health-Reform-Law-1374234 0ae80bd1-f1ce-4291-a51b-b10085db2b64 Thu, 28 Jun 2012 13:45:15 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Third-Circuit-Holds-that-MA-organizations-have-a-direct-right-of-recovery-under-the-Medicare-Secondary-Payer-MSP-Act-1374242 7835ba09-0744-44b6-84f8-aed02fffc033 Tue, 03 Apr 2012 11:55:28 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/New-MLR-Final-Rule-for-Community-Rated-Plans-Under-FEHBP 13aa7d28-3642-4648-a4bc-2f5d59b03162 Tue, 07 Feb 2012 11:50:50 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/DOL-Issues-Long-Awaited-Final-Rules-For-Service-Provider-Compensation-Disclosures-Under-ERISA c770e2b6-5c4e-4afb-bdec-23ab17a61b1d Wed, 11 Jan 2012 18:11:44 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/IRS-Issues-Updated-Guidance-on-Mandatory-Form-W-2-Informational-Reporting-of-Employer-Sponsored-Health-Coverage bc8589ef-9ee5-414f-a6d8-24f547ccaba4 Thu, 01 Dec 2011 17:05:25 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Federal-Funding-Opportunity-Challenge-Grant-Announcement-Solicits-Proposals-Totaling-1-Billion-to-Promote-Health-Care-Innovation f43772a9-e07b-4d78-84cd-51fc3cde8f89 Fri, 18 Nov 2011 16:40:37 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Antitrust-Division-Challenges-Montana-Plans-Deal-with-Hospitals 0639e150-2167-472e-88ce-84410a810501 Tue, 01 Nov 2011 11:02:50 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Nevada-Supreme-Court-Rules-Common-Law-Doctrine-of-Unconscionability-Preempted-By-Medicare-Advantage-Law acceb843-f048-47db-bed7-7e142e9dbe71 Fri, 04 Nov 2011 11:03:14 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Centers-For-Medicare-Medicaid-Services-Releases-Final-ACO-Rule-and-Additional-Guidance a7559d54-dbab-4a61-9f57-3454cac64100 Fri, 21 Oct 2011 17:42:14 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/IOM-Issues-Report-Essential-Health-Benefits-Balancing-Coverage-and-Costs 482f4486-f974-491e-abec-0f42ea5b84fc Fri, 07 Oct 2011 14:11:39 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Issues-Proposed-Rule-to-Revise-Medicare-Parts-C-and-D-Regulations 1972b8d7-0455-49a3-9d1a-313e103f8f80 Tue, 04 Oct 2011 09:38:38 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Confirms-Hospitals-May-Not-Bill-Secondary-Payor-Insurers-For-Amounts-In-Excess-Of-Medicare-Coinsurance-And-Deductible-Amounts-1363848 a8a792e9-3207-4dbd-9082-9bbe56964813 Tue, 30 Aug 2011 10:03:30 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-issues-regulations-implementing-the-Medicare-Improvements-to-Patients-and-Providers-Act-MIPPA-of-2008 bfe244fc-27c3-486d-8ecf-3103795c4ce5 Fri, 12 Aug 2011 18:28:44 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/11th-Circuit-Ruling-On-PPACA-Constitutionality-1361893 12935c8b-46fe-4174-b665-94e1e0cb0402 Wed, 13 Jul 2011 12:59:00 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Department-of-Health-and-Human-Services-Releases-Affordable-Insurance-Exchange-Proposed-Regulations 94e212de-745a-49ed-adc8-d79ac281fab4 Mon, 12 Sep 2011 10:33:41 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Rules-on-Premium-Increases dc454e81-774e-4665-8daa-5fe20e4215bd Thu, 19 May 2011 18:28:34 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/New-Accountable-Care-Model-Information-From-CMS fcde6ff1-c9f5-43d7-9eff-0920d3b88201 Tue, 19 Apr 2011 12:51:51 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/IRS-Issues-Guidance-on-Mandatory-Form-W-2-Informational-Reporting-of-Employer-Sponsored-Health-Coverage On March 29, 2011, the IRS issued Notice 2011-28 ("Notice"), which provides interim guidance to employers regarding the new Form W-2 reporting requirement for employer-sponsored group health coverage. This requirement was added to the Internal Revenue Code ("Code") by last year's health reform legislation, the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-149 ("PPACA"). The IRS has requested comments, which are due by June 27, 2010, on this interim guidance. bfc1df5e-0159-4e77-8b2b-1a4f0bbd6636 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/OFCCP-Directive-Continues-Agencys-Efforts-To-Expand-Its-Jurisdiction-Over-Health-Care-Providers Despite pending litigation regarding the scope of the Agency's jurisdiction in this area, the Office of Federal Contract Compliance Programs ("OFCCP") has issued Directive Number 293 addressing when "health care providers and insurers are federal contractors or subcontractors based on their relationship with a Federal health care program and/or participants in a Federal health care program." The Directive attempts to reconcile recent case law on the issue and furthers the OFCCP's aggressive efforts to extend its jurisdiction over health care providers. c83ea1b8-02aa-428e-9d1a-e933136665d6 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Corrections-to-the-Medical-Loss-Ratio-Interim-Final-Rule 9f2d9b8e-34ba-414e-890a-cd1d915da8e1 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Issues-RADV-Methodology-for-Comment 8c582507-183c-4b6a-a8fc-5bec1bb25741 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/The-United-States-District-Court-for-the-Eastern-District-of-Virginia-Issued-a-Declaratory-Judgment-Today-Finding-PPACA-s-Minimum-Essential-Coverage-Provision-Exceeds-the-Constitutional-Boundaries-of-Congressional-Power The Attorney General of Virginia brought suit on behalf of the Commonwealth of Virginia challenging the constitutionality of Section 1501 of PPACA, commonly known as the Minimum Essential Coverage Provision or the Individual Mandate. This provision requires that every United States citizen, unless specifically excepted, maintain a minimum level of health insurance coverage for each month beginning in 2014, or the individual will have to pay a penalty. dd695011-7da1-4cae-bed8-410b1f392e4b Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Health-Insurance-Issuers-Implementing-Medical-Loss-Ratio-MLR-Requirements-Under-The-Patient-Protection-and-Affordable-Care-Act Office of Consumer Information and Insurance Oversight, HHS (Nov. 22, 2010): The Department of Health and Human Services ("HHS") has released an interim final rule on health insurer medical loss ratios under PPACA. The interim regulation certifies the draft rule proposed by the National Association of Insurance Commissioners this past October. 740fe731-b065-448a-a86c-d64357214328 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Announces-One-Year-Delay-Of-Requirement-To-Report-Liability-Payments-Under-The-Medicare-Secondary-Payer-Statute Late last week, the Centers for Medicare and Medicaid Services ("CMS"), the agency within the Department of Health and Human and Services that oversees the Medicare program, announced that it will delay, from January 1, 2011 to January 1, 2012, the start date for electronic filing of settlements, judgments, awards, or other payments made to Medicare beneficiaries, whether such payments are made by liability insurers, no-fault insurers, workers' compensation, or businesses that self insure their liability risks. In its announcement, CMS provided no explanation for the one-year extension. 6834c10c-0e42-40d8-b104-7fe00656a469 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Michigan-court-upholds-PPACA-Individual-Mandate A Michigan federal district court judge on October 7, 2010 denied an injunction and dismissed the plaintiffs' challenge to the "Individual Mandate" under the Patient Protection and Affordable Care Act ("PPACA"). The plaintiffs were a "public interest" law firm acting on behalf of its members and four individuals who asserted they do not have private health insurance and object to "being compelled to purchase heatlh care coverage". 6e2b054b-4605-4eab-91e2-8f9c8cbb3267 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Federal-Trade-Commission-and-Department-of-Health-and-Human-Services-Announce-Public-Workshops-Addressing-Legal-Implications-of-Accountable-Care-Organizations The Federal Trade Commission, the Centers for Medicare & Medicaid Services (CMS), and the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) have announced that they will be holding a public workshop regarding legal issues relating to Accountable Care Organizations (ACOs) on October 5, 2010. ACOs are integrated health care delivery systems designed to lower costs and improve quality by allowing physicians to work in groups and receive payments for shared savings. 8e02889f-70f2-43c6-a886-d391c4f61501 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Ninth-Circuit-Addresses-Medicare-Preemption-in-New-Uhm-v-Humana-Opinion On August 30, the U.S. Court of Appeals for the Ninth Circuit issued its long-awaited decision in Uhm v. Humana, Inc., No. 06-35672. This decision could have important ramifications for litigation involving Medicare Advantage and Part D plans, particularly because it is one of the few Circuit Court decisions addressing Medicare preemption since Congress revised the preemption statute in 2003. a076af9f-4df0-4b12-a4bc-07093ebf1780 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Administration-seeks-comments-to-get-ready-for-health-reform-expense-ratio-and-related-regulations The Departments of Labor, Treasury and Health and Human Services have issued a Federal Register notice requesting public comment on a series of questions concerning new Section 2718 of the Public Health Service Act, enacted as part of the Patient Protection and Affordable Care Act which became law on March 23rd. 1fe5bdf9-053d-41ec-bd45-c508d956364c Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Detailed-Summary-of-Health-Reform-Legislation Congress has enacted, and the President signed into law on March 23rd the Patient Protection and Affordable Coverage Act of 2010. On March 30th, Congress passed and the President signed amendments to the Act in the Health Care and Education Reconciliation Act of 2010 (the "Reconciliation Act"). Our comprehensive title by title summary of the reform legislation is now available. 8a0bcd74-8fa5-432e-b52a-a5b2f1ea00e5 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Issues-Final-Rule-on-Changes-to-the-Medicare-Advantage-and-Part-D-Programs On April 6, 2010, CMS issued a final rule that revises regulations governing the Medicare Advantage program and the Part D prescription drug benefit program. The proposed rule was issued on October 22, 2009. 538c2507-1908-440b-bebb-6bca66d8ade3 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Health-Reform-Legislation-Enacted ae45fd29-ff94-4673-9db5-ebea092aebc9 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Provides-Additional-Guidance-Regarding-The-Delay-Of-The-Reporting-Requirement-Under-The-Medicare-Secondary-Payer-Statute As reported in our February 16, 2010 Client Alert, the Centers for Medicare and Medicaid Services ("CMS") announced that it will delay, from April 1, 2010 to January 1, 2011, the start date for electronic filing of settlements, judgments, awards, or other payments made to Medicare beneficiaries, whether such payments are made by liability insurers, no-fault insurers, workers' compensation, or businesses that self insure their liability risks. At the time of the announcement, CMS indicated that further guidance would be issued the week of February 22, 2010. Late last week, CMS issued the additional guidance in the form of new CMS Alerts and an updated User Guide for reporting entities. bdd71d30-d60e-4169-8b78-c69078b3c53f Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Interim-Final-Mental-Health-Parity-and-Addiction-Equity-Act-Regulations-Issued On February 2, 2010, the Departments of Labor, Treasury and Health and Human Services jointly released interim final regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA"). (We previously discussed the MHPAEA in our December 10, 2008 Employee Benefits Alert.) Although the MHPAEA required that regulations be issued in October 2009, these interim final regulations are the first regulations to be issued implementing the MHPAEA. 33f7d101-5e2f-43a6-95bd-274ad6c44409 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Unexpectedly-Announces-9-Month-Delay-Of-Requirement-To-Report-Liability-Payments-Under-The-Medicare-Secondary-Payer-Statute On February 16, 2010, the Centers for Medicare and Medicaid Services ("CMS"), the agency within the Department of Health and Human Services that oversees the Medicare program, unexpectedly announced that it will delay, from April 1, 2010 to January 1, 2011, the start date for electronic filing of settlements, judgments, awards, or other payments made to Medicare beneficiaries, whether such payments are made by liability insurers, no-fault insurers, workers' compensation, or businesses that self insure their liability risks. Click here for the announcement. CMS indicated that further guidance will be issued the week of February 22, 2010. dba8dc4c-afe2-4064-8b75-83b6557495ae Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Proposes-Definition-Of-Meaningful-Use-Of-EHR-ONC-Publishes-Interim-Final-Rule-Regarding-EHR-Certification-And-Standards On December 31, 2009, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced proposed rules to implement provisions of the American Recovery and Reinvestment Act of 2009 (Recovery Act) relating to the adoption of Electronic Health Records (EHR) and other Health Information Technology (HIT). The new regulations would provide standards and guidance for programs designed to encourage "eligible professionals" (EP), eligible hospitals, and critical access hospitals (CAH) to make "meaningful use" of EHRs and HIT. Providers making "meaningful use" of EHRs and HIT qualify for higher Medicare payments. e7b53866-0289-4145-8a37-7cd6d6fb792d Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Proposed-Rulemaking-For-The-Medicare-Advantage-And-Medicare-Prescription-Drug-Programs On October 22, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking that would make numerous regulatory changes relating to the Medicare Advantage and Medicare Prescription Drug Programs. (74 Fed. Reg. 54634) The proposed changes vary from clarifications of current CMS policy, updating regulations to reflect current CMS subregulatory guidance, and implementing altogether new regulations for these programs. Set forth below is summary of many of the proposed changes. 5eb0fab0-f535-4e8f-a11a-c3f5a2cc0073 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Ninth-Circuit-Leaves-Open-Possibility-for-Claims-by-FCA-Defendant-Against-Allegedly-Liable-Third-Party The U.S. Court of Appeals for the Ninth Circuit recently ruled that a company, which entered into a settlement with the Government and a qui tam relator to resolve False Claims Act ("FCA") allegations, may pursue claims of breach of contract and negligence against the third party, which allegedly improperly advised it on Medicare reimbursement protocol. Cell Therapeutics Inc. v. Lash Group Inc., 9th Cir., No. 08-35619, 11/18/09. Cell Therapeutics, Inc. ("CTI") entered into a settlement agreement with the Government and with the relator who initiated the FCA case, which was based on the alleged off-label promotion of the leukemia-fighting drug Trisenox (arsenic trioxide). The lawsuit alleged that CTI caused the submission of false claims to Medicare by promoting an off-label use of Trisenox to insurers and health care providers. Following the FCA settlement, CTI brought suit against a predecessor of Lash Group, Inc. ("Lash"), which CTI alleged improperly and ... 32bc742d-1698-4b50-a0eb-f6e3d887242a Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Announces-Fourth-Extension-of-Red-Flags-Rule-Enforcement The Federal Trade Commission (the "FTC") has announced that it will postpone enforcement of the Red Flags Rule1 until June 1, 2010 for financial institutions and creditors that are subject to FTC oversight. This is the fourth time that the FTC has extended the enforcement timeline. While the Red Flags Rule became effective on January 1, 2008, and the mandatory enforcement date was originally November 1, 2008, the FTC subsequently suspended enforcement of the Rule until May 1, 2009 and then again until August 1, 2009.2 3273fe19-be51-4fa1-bff9-da9add0b9692 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/HIPAA-Interim-Final-Rule-October-30-2009 689422a2-fdfb-412b-a537-d449d7991e23 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Retroactive-Amendments-to-False-Claims-Act-Found-Unconstitutional On October 27, 2009, the United States District Court for the Southern District of Ohio held that one of the recent amendments to the False Claims Act (FCA), 31 U.S.C. § 3729 et seq., violates the Ex Post Facto Clause of the United States Constitution. See U.S. ex rel. Sanders, et al. v. Allison Engine Co., Inc., et al., C. No. 1:95-cv-970 (S.D. Ohio). bfc5c280-7d8f-48bc-950e-0752cd21681d Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Provides-Guidance-on-Use-of-Medicare-Advantage-Enrollee-Information-for-Communications On October 16, 2009, the Centers for Medicare & Medicaid Services ("CMS") issued a memorandum regarding allowable use of Medicare beneficiary information obtained from CMS to all Medicare Advantage ("MA") Organizations and Part D sponsors, among others. By signing the CMS restrictions contained in the Data Use Attestation, organization or sponsors agree to restrict the use of Medicare data to those purposes "directly related to the administration of the Medicare managed care and/or outpatient prescription drug benefits for which they have contracted with CMS to administer." 7d1d599d-aa1c-4bed-803b-4c9a572b0c02 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Updates-on-the-HIPAA-Breach-Notification-Requirements On October 1, 2009, the US House Ways and Means Committee and the House Energy and Commerce Committee sent a joint letter to the Secretary of Health and Human Service urging her to "revise or repeal" the recent guidance offered by HHS in its interim final rule which included a harm standard for breach notification. If the guidance stands, Covered Entities and their Business Associates will not be required to notify affected individuals of a breach involving their PHI unless there is a "significant risk of financial, reputational or other harm to the individual." According to HHS, the risk of harm standard would allow CE's and BA's to forego notification in circumstances such as an inadvertent disclosure to another CE, or a disclosure that was immediately remedied. In the October letter, the Committee members explain that they specifically considered including a harm standard in the breach notification statute and rejected ... 2aa9939a-35fd-4bc0-bba7-3a6abf00cc06 Wed, 06 Jun 2012 09:47:51 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Attorney-General-Commits-to-Smart-on-Crime-Approach-to-Economic-Crimes In an address on August 3, 2009, at the American Bar Association's annual convention, Attorney General Eric H. Holder Jr. touted the administration's efforts to date in prosecuting health care fraud, and committed to a "smart on crime" approach to economic and other crimes. Highlighting last week's indictments by a Houston grand jury of thirty-two health care executives, providers, and operators who allegedly made $16 million in fraudulent Medicare claims, Holder noted that the indictments were examples of the success of this "smart on crime" policy. The operation relied on the innovative tactic of real time data analysis of Medicare billing records. Real time data analysis allowed fraud investigators to contemporaneously review billing claims as they were filed by Medicare providers and thereby immediately identify irregularities - a strategy that varies greatly from the previous complaint-driven approach taken by fraud investigators. e96ff59d-288e-4f0f-b171-eb3016352a74 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Extends-Enforcement-Date-of-Red-Flags-Rule-1352292 8881c0e8-4e2d-42e2-bf26-f44247b347f7 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Again-Delays-Enforcement-of-Red-Flags-Rule The Federal Trade Commission has announced it will again extend the date for commencement of enforcement of the Red Flags Rule to prevent identity theft, moving the date back three months until November 1, 2009. d694cebb-a2e0-4fdf-98f8-374ee899c1c9 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Sues-Virginia-Health-System-for-Alleged-Anticompetitive-Acquisition-of-Imaging-Center-and-Outpatient-Surgery-Center The Federal Trade Commission ("FTC" or the "Commission") sued a Roanoke, Virginia-based health system on July 23, 2009, claiming that its acquisition of an imaging center and an outpatient surgery center will lessen competition. The complaint alleges that Carilion Clinic's acquisition of the two outpatient provider entities -- the Center for Advanced Imaging ("CAI") and the Center for Surgical Excellence ("CSE") will eliminate the only non-hospital based competitor from each market, leaving only HCA as a competitor to Carilion. Specifically, the administrative complaint alleges that CAI and CSE "offered high-quality services at prices substantially lower than Carilion's" prior to the acquisitions. The FTC alleges that these acquisitions will decrease competition in the area while driving up prices for health plans and consumers. 9430a703-64d9-470d-8b90-365255a86c8e Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Hospitals-Contracting-With-HMO-to-Provide-Medical-Services-to-Federal-Employees-Held-to-be-Subcontractors-Even-Where-Subcontract-Fails-To-Include-EEO-And-Affirmative-Action-Provisions In a potentially far-reaching decision issued by the Administrative Review Board ("ARB") of the U.S. Department of Labor ("DoL"), several Pittsburgh-area hospitals were recently found to be "subcontractors" for purposes of Executive Order 11246 and, therefore, subject to audit by the Office of Federal Contract Compliance Programs ("OFCCP"). The hospitals were contracted providers for a health maintenance organization ("HMO") participating in the Federal Employees Health Benefits Program ("FEHBP"). ddad7a83-c0bd-4d00-8d2d-1ec376767952 Thu, 21 Apr 2011 09:31:30 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/New-False-Claims-Act-Amendments-Significantly-Impact-Health-Care-Entities-And-Their-Obligations-Regarding-Overpayments Late last week, President Obama signed into law the Fraud Enforcement and Recovery Act of 2009 ("FERA"), which includes significant amendments to the civil False Claims Act ("FCA") 31 U.S.C. § 3729 et seq. -- the government's chief weapon and enforcement tool against fraud in the health industry. The passage of FERA constitutes an exponential expansion of the liability provisions under the FCA. It also constitutes the first major amendment of the FCA in over 20 years. These amendments will have a substantial -- and adverse -- impact on virtually every person, company, and/or entity that either pays money to the government or receives Federal funds. Health care entities are likely to be the hardest hit by these changes. We at Crowell & Moring are especially concerned about the amendments to the "reverse false claims" component of the FCA, and its impact on our health care clients' "overpayment repayment obligations." ... 8b8fc459-aca0-4c5d-b71c-877d6aa5f250 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Genetic-Discrimination-Act-Restriction-Becomes-Effective The Genetic Information Nondiscrimination Act of 2008 ("GINA") is a new federal law that protects Americans from discrimination and from being treated unfairly on the basis of differences in their DNA that may affect their health. President George W. Bush signed the Act into law on May 21, 2008, and a key portion pertaining to health insurers goes into effect May 21, 2009. The provision dealing with health insurers prevents those entities from denying coverage, adjusting premiums or otherwise discriminating based on genetic information. Prior to the enactment of this law, many states had adopted similar regulations, and GINA is designed to set the requisite minimum standards against genetic discrimination in the health insurance industry. This new law does not pertain to life insurance, disability insurance, and long-term care insurance. da35fd3d-c232-4cce-92ad-05914b585444 Thu, 21 Apr 2011 09:32:00 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/OIG-Issues-New-Advisory-Opinion-Identifying-Acceptable-and-Risky-On-Call-Physician-Payment-Arrangements On May 21, 2009 the Department of Health and Human Services' Office of Inspector General ("HHS-OIG") issued Advisory Opinion ("AO") No. 09-05, which addressed an inquiry relating to a Hospital's proposal to compensate its medical staff physicians for Emergency Room on-call services to indigent patients. In this AO, the OIG concluded that a proposed compensation plan, which would compensate on-call physicians at fair market value on the basis of services actually provided to indigent patients, while potentially violative of the civil monetary penalty anti-kickback prohibitions (42 USC § 1320a-7a(7)), would not be pursued by the OIG based on the facts as set forth in the AO. 3a856f27-1e3c-43bb-bc52-add5bd0c048e Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Re-Issues-Draft-2010-Medicare-Advantage-Prescription-Drug-Plan-and-Health-Plan-Call-Letter On February 23, 2009, the Centers for Medicare & Medicaid Services (CMS) re-issued the Draft 2010 Call Letter for Medicare Advantage organizations (MAOs) and Part D sponsors (Revised Draft Call Letter).1 MAOs and Part D sponsors have been awaiting this guidance since CMS withdrew the original Draft 2010 Call Letter on January 22, 2009 (Original Draft Call Letter). 9d0a7003-4540-4d17-a9a6-0f6b92b227ac Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Changes-in-American-Recovery-and-Reinvestment-Act-of-2009 The American Recovery and Reinvestment Act of 2009 ("Stimulus Act" or "ARRA"), signed into law by President Obama on February 17th, contains a number of key health care-related provisions. 01559e28-4bc0-4313-842b-5b11899585f3 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Files-Antitrust-Suit-Against-Ovation-The-Government-Seeks-Divestiture-and-Disgorgement-of-Profits On December 16, 2008, the FTC and the Minnesota Attorney General each filed complaints in Minnesota federal district court against Ovation Pharmaceuticals, Inc., in connection with the company's January 2006 acquisition of Neoprofen - a drug used to treat heart defects in premature infants. Each complaint alleges that the acquisition gave a monopoly to Ovation which it used to raise prices almost 1,300 percent. cad4f978-d1f7-4f55-939e-b41066af2247 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Secretary-Leavitt-Announces-New-Principles-Tools-to-Protect-Privacy-Encourage-More-Effective-Use-of-Patient-Information-to-Improve-Care On December 15, 2008, Health and Human Services Secretary Michael Leavitt announced new principles and tools to be used in order to protect patient information and confidentiality. The new principles were developed based on the recognition that the growing use of computers and electronic transmissions of patient information, while offering the potential to improve the quality of care, also pose significant privacy issues. dc41d212-6388-4bdd-8ce5-f256110bf892 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/NIST-HIPAA-Security-Rule-Guidance ac8cdbbd-8ee7-48da-a677-314042879234 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/EPA-to-Allow-Certain-Hazardous-Pharmaceuticals-to-be-Disposed-of-as-Universal-Waste Late November, the United States Environmental Protection Agency ("EPA") announced plans to regulate certain spent hazardous pharmaceuticals and their containers as "universal wastes" under the agency's Resource Conservation and Recovery Act ("RCRA") Universal Waste Rule, 40 C.F.R. Part 273. The proposal, expected to be published in the Federal Register imminently and effective by 2010, will allow hazardous pharmaceuticals and containers to be disposed of in accordance with standards less stringent than those applicable to hazardous waste. 173babe0-455c-4477-8edc-0ead642dd272 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Grants-Reprieve-Health-Care-Companies-Prepare-1352109 The Federal Trade Commission announced October 22, 2008 that it would delay enforcement of the new Red Flag Identity Theft Rules (rules that require organizations to spot and protect against the red flags that can be signs of potential identity theft), pushing the compliance deadline from November 1, 2008 to May 1, 2009. 50dca170-3cf5-4e43-ab8f-cf3eedb1dd06 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Court-Issues-Final-Consent-Judgment-On-United-Sierra-Acquisition On September 24, 2008, the federal district in Washington, D.C. entered a final consent judgment resolving antitrust allegations concerning UnitedHealth Group's acquisition of Sierra Health Services. Consistent with the judgment's terms, United had already divested its individual Medicare Advantage product line in the Las Vegas, Nevada area shortly after the acquisition closed earlier this year. 31a98fa8-12bb-434e-a0cd-3abde8a60ebe Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Non-Contracted-Ambulance-Services-Can-Be-Emergency-Services-Subject-to-State-Medicaid-Rate-Cap-Payment-by-Medicaid-MCOs The Centers for Medicare and Medicaid Services ("CMS") has issued an opinion letter clarifying the definition of "provider of emergency services" as it relates to non-contracted ambulance service providers. Section 1932(b)(2)(D) of the Social Security Act, which imposes limits on Medicaid managed care organization ("MCO") payments for emergency services provided by non-contracted providers, requires that non-contracted providers of emergency services "accept as payment in full no more than the amounts . . . that it could collect if the beneficiary received medical assistance under this title." 8602b5fc-1254-46d8-a92e-a073b78d1411 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Massachusetts-Law-Imposes-Limitations-and-Monitoring-Requirements-on-Medical-Device-and-Pharmaceutical-Company-Interactions-with-Health-Care-Practitioners-and-Facilities On August 10, 2008, Massachusetts Governor Deval Patrick signed into law the Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care. Aimed at improving the quality and cost of health care in the Commonwealth, this legislation includes new measures regulating pharmaceutical and medical device manufacturer conduct. a549236d-b87e-469d-a8fe-51b3d57e7c14 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/New-FDA-Label-Change-Rule The FDA has posted on its website a final rule regarding label changes for drugs, biologics and medical devices. The new rule allows manufacturers to change a product's label to reflect newly acquired information or to add or strengthen language regarding contraindications, precautions, warnings or adverse reactions, provided that there is a sufficient causal association with the product. The new rule allows manufacturers to submit these label changes through "changes being effected," or CBE, supplements, rather than through prior approval supplements. FDA's rationale for this change was to ensure that scientifically accurate information appears on FDA approved labeling. 8dab30e2-046a-47e8-9f8a-50061a4a328e Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/PhRMA-Updates-Marketing-Code-for-Interacting-with-Healthcare-Professionals-California-Law-Mandates-Updates-to-Comprehensive-Compliance-Programs-of-Covered-Pharmaceutical-and-Medical-Device-Companies On July 10, 2008, the Pharmaceutical Research and Manufacturers of America ("PhRMA") updated its voluntary code of conduct applicable to the marketing of pharmaceutical products to healthcare professionals. PhRMA's original Code on Interactions with Healthcare Professionals ("the Code") became effective on July 1, 2002. The new Code takes effect in January 2009. Like the 2002 version, the 2009 version of the Code addresses interactions relating to marketed products and product pre-launch activities, including activities involving relationships between pharmaceutical companies and clinical investigators, consultants and educators. 2cbe1d50-9e2b-41a1-b9d7-bfca67922089 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Supreme-Court-Limits-Deference-for-ERISA-Claims-Denials-by-Fiduciaries-with-Conflicts-of-Interest Since the landmark decision in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), courts have struggled with the issue of the level of deference to accord to a fiduciary's claims denial decision when that fiduciary is operating under a conflict of interest. The Circuit Courts have differed not only on the methodology to be employed in weighing the effect of such conflicts, but also on the extent to which conflicts exist at all. The Supreme Court has once again entered this field in its decision in Metropolitan Life Ins. Co. v. Glenn, (No. 06-923, June 19, 2008), adopting a broad view of those situations involving a conflict of interest, and requiring courts to take such conflicts into account on a case-by-case, situation specific basis. While technically preserving the deferential standard originally set forth in Firestone, the Court's decision in Glenn will likely subject fiduciary claims decisions to ... 1dd84e8f-802a-46b8-bde1-96b6481fc42e Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/The-Fifth-Circuit-Affirms-the-FTC-s-Ruling-and-Order-Against-North-Texas-Specialty-Physicians On May 14, 2008, the U.S. Court of Appeals for the Fifth Circuit ("Fifth Circuit") affirmed the Federal Trade Commission's ("FTC") holding that the so-called "messenger model" activities of North Texas Specialty Physicians ("NTSP") constituted naked price-fixing in violation of Section 5 of the Federal Trade Commission Act, and ordering NTSP to "cease and desist" from these activities. Although the FTC has charged many provider networks with price-fixing, group boycotts or other restraints of trade in violation of Section 5, this is the first time a provider network has fought those charges in federal court rather then resolving them through a negotiated consent order. Antitrust enforcement authorities and private plaintiffs will find support in the Fifth Circuit ruling. 655203dd-7b51-44d1-a59e-496f782790e0 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Two-New-FTC-Hospital-Merger-Enforcement-Actions-The-FTC-Seeks-to-Block-Hospital-Merger-in-Northern-Virginia-and-Issues-Order-Requiring-Merged-Hospital-in-Illinois-to-Create-Independent-Negotiating-Teams-1351928 During the last several weeks, the Federal Trade Commission ("Commission" or "FTC") has taken two significant antitrust enforcement actions affecting hospitals: (1) The initiation of a merger challenge seeking to block Inova Health System Foundation's ("Inova") acquisition of Prince William Health System, Inc., ("Prince William") and (2) The issuance of a final decision and order relating to Evanston Northwestern Healthcare Corporation's ("ENH") acquisition of Highland Park Hospital ("Highland Park"). These actions indicate that the FTC's hospital merger enforcement program is alive and well. eb4b7aa9-4ba3-427d-828f-c3f944918a76 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/CMS-Proposes-New-Medicare-Advantage-and-Prescription-Drug-Plan-Rule CMS issued today a proposed rule that would affect Medicare Advantage Organizations and Prescription Drug Plan Sponsors. The proposed rule would incorporate into regulation a number of requirements that CMS previously imposed through operational guidance and is based on "lessons learned since 2006." Among other changes, the proposed rule would impose new restrictions on MA marketing and sales activities including commission structures. The proposed rule would also codify CMS' guidance on best available evidence to determine low income subsidy eligibility, impose additional requirements on Special Needs Plans to ensure the plans focus on the needs of their target population, and expand CMS’ flexibility in determining penalties against Medicare Advantage Organizations and Prescription Drug Plan Sponsors. 3be2a4b2-8575-41bf-9b6e-7efcf83e1dd6 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/United-s-Acquisition-of-Sierra-Proceeds-with-Settlement-of-Medicare-Advantage-Antitrust-Allegations-1351884 The United States Department of Justice (the “Department”) and the Nevada Attorney General settled allegations on February 25, 2008 that UnitedHealth Group’s ("United") acquisition of Sierra Health Services ("Sierra") would harm competition in the sale of Medicare Advantage (“MA”) plans in the Las Vegas area. The acquisition closed later that same day. Crowell & Moring represented Sierra in the transaction. 88d80237-9901-4391-8536-e61831ebe608 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Crowell-Moring-Obtains-Victory-In-First-Tried-Indirect-Purchaser-Pharmaceutical-Antitrust-Case-1351858 Crowell & Moring lawyers, led by Robert T. Rhoad, obtained a significant victory on behalf of Health Care Service Corporation ("HCSC") in the first and only indirect purchaser antitrust case to date tried to verdict involving the pharmaceutical industry. On Thursday, January 24, 2008, Chief Judge Thomas F. Hogan of the U.S. District Court of the District of Columbia granted HCSC's motion to treble the damages awarded by the jury to HCSC in the In re Lorazepam & Clorazepate Antitrust Litigation (D.D.C.). Initially, HCSC was included within a class of indirect purchasers/third-party payors in the underlying class actions. Although the class litigation was settled, HCSC, along with three other third-party payors (Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Minnesota and Federated Mutual Insurance Co.), elected to opt-out of the class settlement and litigate their antitrust claims on their own. e54910fd-29b0-4e54-b2fc-9d7916f10ea7 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/IRS-Releases-Final-Version-of-Form-990-Return-of-Organization-Exempt-from-Income-Tax On December 20, 2007, the IRS released the long-awaited final version of the Form 990 (Return of Organization Exempt from Income Tax) for 2008. These revisions mark the first significant changes to take place with respect to the Form 990 in nearly three decades. The revisions are the product of many months of commentary on earlier draft versions from exempt organizations, accounting professionals, private individuals and others. It reflects, among other things, the changing and increasingly complex nature of exempt organizations, as well as a new focus by the IRS on areas like corporate governance and employee compensation. 725bfeb9-397f-473c-91fa-519502454960 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/EEOC-Final-Rule-Allows-Employers-to-Reduce-or-Eliminate-Retiree-Benefits-for-Medicare-Eligible-Retirees On December 26, 2008, the EEOC promulgated a final regulation allowing employers to coordinate retiree health benefits with Medicare, without running afoul of the Age Discrimination in Employment Act. 9768aa34-b046-418e-bc05-46fd265787d2 Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/HHS-OIG-OKs-Incentive-Arrangements-for-Hospital-Services-in-MediGap-Product On December 3, 2007, the Office of Inspector General of the Department of Health and Human Services (“OIG”) gave favorable advisory opinion guidance to a mutual life insurance company (“Company”) offering Medicare Supplement Health Insurance (“Medigap”) policies in nearly 50 states who is arranging for preferred provider hospitals to give a 100% discount on Medicare Part A deductibles and to pass along some of the resulting savings to policyholders through a premium credit. d8d0bbae-4f62-498d-b7da-513405ab6e1c Fri, 08 Apr 2011 17:37:55 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Dept-of-Labor-Clarifies-HIPAA-with-Compliance-Safe-Harbor Enactment of Titles I and IV of HIPAA and subsequent amendments improved access to and coverage by health insurance plans, addressing contentious issues such as hospital stays after childbirth and exceptions to coverage based on preexisting conditions. Intended to affect general health insurance coverage, including employer-based and open-market group or individual plans, the law did not cover certain excepted benefits. Thus, plans technically comprised entirely of “excepted benefits” could find themselves exempt from the requirements of these reforms. 3980a71b-0325-44f3-8e43-80026f518fa4 Fri, 08 Apr 2011 17:37:54 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/FTC-Finds-Evanston-Hospital-Merger-Unlawful-But-Refuses-to-Order-Spin-Off The Federal Trade Commission (the “Commission”) has declared that Evanston Northwestern Healthcare Corp. (“ENH”) substantially lessened competition in violation of Section 7 of the Clayton Act when it acquired Highland Park Hospital (“HPH”) and subsequently, immediately, and substantially raised its prices for inpatient hospital services, but declined to order divestiture of the acquired hospital. See Evanston Northwestern Healthcare Corporation, FTC, No. 9315 (Aug. 2, 2007), 9d98c698-77af-44a4-a21e-09be39e2c521 Fri, 08 Apr 2011 17:37:54 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Third-Circuit-Upholds-EEOC-Rule-Permitting-Retiree-Health-Plan-Coordination-of-Benefits-with-Medicare The United States Court of Appeals for the Third Circuit has upheld a controversial EEOC regulation that would allow employer-sponsored retiree health plans to alter, reduce or eliminate benefits for participants who become eligible for health benefits under Medicare or similar state-sponsored programs. AARP v. EEOC (No. 05-4594, June 4, 2007). a9f1337d-c534-4da4-9db3-92281463d133 Fri, 08 Apr 2011 17:37:54 GMT http://www.crowell.com/NewsEvents/AlertsNewsletters/Health-Law-In-The-News/Health-Plans-Need-Contingency-Plans-for-National-Provider-Identification-Compliance-after-May-23-2007 Health plans who are not ready to comply with the National Provider Identifier Rule by the May 23, 2007 deadline should already have contingency plans in place or should be developing contingency plans now, according to representatives from the Centers for Medicare and Medicaid Services (“CMS”).