June 27, 2011
On June 16, 2011, the Office of Personnel Management (“OPM”) released a Request for Information (“RFI”) regarding the requirements of Section 1334 of the Affordable Care Act (“ACA”) for OPM to contract with health insurers to offer multi-state qualified health plans (“MSQHPs”) to the individual and small-group markets. The purpose of the RFI is to provide OPM with information that will allow it to better understand the “interests and capabilities” of health insurance issuers that are potential MSQHP contractors. The contours of OPM’s implementation of the MSQHP contracts will have a significant impact on health insurance issuers that will participate in the state-based “American Health Benefit Exchanges” (“Exchanges”) for the individual and small-group markets.
This alert will describe the areas of feedback requested by OPM regarding implementation of MSQHPs. Although this document is not a Request for Proposal, the questions posed by the RFI are designed to aid OPM in the development of procurement documents. The RFI informs respondents that those who provide a “thoughtful, detailed response” may be invited to a one-on-one meeting with OPM for a more in-depth discussion. Accordingly, those health insurance issuers with a serious interest in participating as a MSQHP, either individually or as a member of a joint venture or teaming arrangement, would be well advised to submit a thoughtful response to secure the maximum opportunity to shape the procurement process. Respondents may protect the proprietary information in their response by marking it with a restrictive legend, and any disclosure by OPM to third parties for evaluation purposes will be subject to confidentiality obligations.
June 27, 2011
By: Kara M. Maciel and Casey Cosentino
The U.S. Equal Employment Opportunity Commission (EEOC) continues its aggressive quest to challenge “inflexible” medical leave policies, as Denny’s Inc. agreed earlier this month to pay $1.3 million to settle a nationwide class action lawsuit. Denny’s also entered into an injunction barring its restaurants from future violations of the Americans with Disabilities Act (ADA), including denying disabled employees reasonable medical leave and retaliating against employees for bringing disability discrimination claims.
The EEOC filed the class action in 2009 in federal court in Maryland alleging, among other things, that Denny’s violated the ADA by enforcing a leave policy that automatically denied additional medical leave beyond a predetermined limit, even when the employee requested additional leave as a reasonable accommodation. This “inflexible” leave policy, common to many employers, led to the termination of the employees.
June 27, 2011
For well over 40 years, the rule for labor consultants and management attorneys has been that if those individuals deal directly (i.e., face-to-face) with an employer’s employees in connection with labor relations matters, then the employer must fill out and file with the United States Department of Labor (DOL) an LM-10, and the attorney or consultant must fill out and file an LM-20. In contrast, consultation with the employers and their managers about the best way to communicate with rank-and-file employees was deemed “advice” and not subject to disclosure on the LM-10 and LM-20 forms.
In its June 21, 2011 proposed rule modifications, the DOL’s Office of Labor-Management Standards embarked on a mission to require employers and their advisors to disclose to the public the details of their consultations relating to labor relations, including those consultations with employers and their managers, as well as direct dealings with rank-and-file employees. In doing so, the DOL concluded that the regulation has not been properly applied. The DOL states that it does not intend to infringe upon the attorney-client privilege, and parties would be able to limit their descriptions to preserve the privilege.
June 26, 2011
What is a Radiologist’s Role in an ACO?
By: Rachel Yaffe
Accountable care organization (commonly referred to as an ACO) is the new buzz phrase swarming the medical community. Since ACOs are still a relatively new concept, radiologists are wondering how they can play a role in an ACO.
An ACO is an organization comprised of a variety of healthcare providers who work together to manage and coordinate patient care, and is held accountable for the quality and cost of such care. The financial attractiveness of the ACO model is that the organization will have the opportunity to share in the cost savings resulting from the provision of evidence-based, coordinated patient care, which shared savings will ultimately trickle down to the ACO’s members. A typical ACO will include, at a minimum, primary care physicians and specialists. While hospitals are likely to be involved in ACOs, and may, in many instances, even drive ACO formation, hospital participation is not required.
June 26, 2011
FDA Approves First Mobile Application for Diagnostic Radiology
By: Elizabeth Sullivan
Earlier this year, the FDA cleared the first mobile device application allowing physicians to view diagnostic radiology images on iPhones and iPads. The mobile application, Mobile MIM, allows a physician to view CT scans, MRI scans, and nuclear medicine technology, such as PET scans, through his or her mobile device. While the FDA has approved the mobile application, it is not intended to replace a full workstation and is indicated only for use where the physician does not have access to a workstation.
June 26, 2011
Medicare Reimbursement for Beneficiaries with Permanent Pacemakers
By: Elizabeth Sullivan
The Centers for Medicare & Medicaid Services (CMS) have proposed modifying the current National Coverage Determination Manual to cover reimbursement for MRIs performed on Medicare beneficiaries with permanent pacemakers.
In its Proposed Decision Memo for Magnetic Resonance Imaging (MRI) (CAG – 00399R3) (“Memorandum”), CMS issued the statement that “evidence is adequate to conclude that magnetic resonance imaging (MRI) improves health outcomes for Medicare beneficiaries with implanted permanent pacemakers when . . . used according to the FDA-approved labeling for use in an MRI environment.”
June 23, 2011
Over the past decade, employers have been subjected to an onslaught of class action claims on behalf of employees alleging wage-hour violations, unlawful discrimination and other wrongful conduct. Given the complexities of the legal principles governing class claims and the absence of hard-and-fast rules, many lower courts have approved class treatment of claims that are, at their heart, unique to each class member. These facts, coupled with an aggressive plaintiffs’ bar, has left employers with little recourse but to settle class claims that would likely be defensible if pursued on an individual basis or to incur mounting legal fees in their effort to push back against the tide.
Fortunately, on June 20, 2011, the United States Supreme Court signaled a changing tide. It put the brakes on a class action lawsuit against Wal-Mart that encompassed 1.5 million past and present female employees of the retail giant. In so doing, the Court clarified the requirements for pursuing class claims and provided employers with a measure of legal respite from the claims of overly broad, tenuously affiliated classes of employees.
June 22, 2011
Indian Economy: the Investor’s paradise
India is a booming economy which has seeing an exceptional growth in its aviation segment in last couple of decades. Counter to demands of aviation segment in the country the existing aviation infrastructure and the carrier’s technology needs serious up gradation. As there are ample of opportunities for growth of this sector therefore, venous domestic and international aviations giants are seeing India as paradise for investment in the Aerospace technology and development.
To see the full article, please click on the following link, Investment opp 220611 for the PDF.
June 22, 2011
So you’ve lost your job… What next?
Seek counseling. Talk it out! Don’tincubate. You have been cut loseand naturally, it hurts. You probablyhave a million things swirlingin your mind. Right now, all thatyou can think about are all thoseyears and tears that you sacrificedat the altar of employment only tobe cut loose at the whim of someoneelse’s discretion! This may be adifficult proposition, but do not takedramatic or hasty action. Talk tosomeone you trust; maybe a pastor, a parent, a close friend, arepresentative from Social Services or other Counselor. In fact,many companies have an Employee Assistance Program designedto assist recently terminated employees with coming togrips to life’s challenges. There is even DIAL A PRAYER!The important thing is just to find someone to talk to.
To see the full Bulletin, please click the following link, HC’s Bulletin- Employment 101 – June 2011 for the PDF.