Regions

Massachusetts Division of Insurance Rate Disapprovals Show Mixed Results; Implications for National Health Reform

As we await federal medical loss ratio (“MLR”) standards and federal rulemaking by the Secretary of the US Department of Health and Human Services (“HHS”) related to new federal reporting obligations by health insurance issuers of “unreasonable premium increases,” it is helpful to consider recent health insurance premium rating activities and challenges in Massachusetts. In summary, on April 1, 2010, the Massachusetts Division of Insurance (“Division”) disapproved all premium rate increases filed by health insurance carriers for small business and individual customers that exceeded 7.7 percent – which was 150 percent of the New England Medical CPI for 2009. The affected health insurance carriers filed administrative appeals of the Division’s disapprovals of their premium rates. All of these administrative appeals have now been resolved, with mixed results. This client alert summarizes the Massachusetts rate disapproval proceedings and resolutions, the new Massachusetts rate filing legislation, and the implications of the Massachusetts experience for national health reform.[1]

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DAVIS MALM ATTORNEYS PAUL L. FELDMAN, DAVID RAPAPORT, AND MICHAEL D. WEISMAN SELECTED 2011 "BEST LAWYERS IN AMERICA"

Davis Malm is pleased to announce that Paul L. FeldmanDavid Rapaport, and Michael D. Weisman have been selected 2011 “Best Lawyers in America” for their exceptional work in their respective areas of Real Estate Law, Labor and Employment Law, and Personal Injury Litigation. Selections are featured in the just-released 2011 edition of The Best Lawyers in America and will be excerpted in theBoston Globe in 2011. Please click here to see Davis Malm’s listing in the 2011 edition.

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Special Immigration Alert: 2012 Diversity Visa Lottery Begins on October 5, 2010, and Ends on November 3, 2010!

The Department of State (DOS) announced on September 23, 2010, the opening of the registration period for the DV-2012 Diversity Visa lottery. Entries for the DV-2012 lottery must be submitted electronically between 12:00 p.m. EDT (GMT-4) on Tuesday, October 5, 2010, and 12:00 p.m. EST (GMT-5) on Wednesday, November 3, 2010. It is strongly recommended that applicants not wait until the last week of this registration period to enter because heavy demands could result in website delays. No entries will be accepted after 12:00 p.m. EST on November 3, 2010. During the registration period, information, instructions and the Electronic Diversity Visa Entry Form for the DV-2012 lottery will appear at www.dvlottery.state.gov.

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FDA Accepting Comments on Proposed Program to Integrate FDA Premarket Approval and CMS Coverage Decision-Making Process

On September 17, 2010, the Centers for Medicare & Medicaid Services (“CMS”) and the U.S. Food and Drug Administration (“FDA”) issued a notice in the Federal Register requesting public comment on a proposed new program referred to as “parallel review” (“Comment Request”).[1] This program would give drug and device sponsors the option of receiving an FDA premarket evaluation and a Medicare National Coverage Determination at the same time. By reducing the waiting times associated with CMS and FDA product evaluations and decreasing the likelihood that product sponsors will have to conduct separate clinical studies for each agency, CMS and FDA believe that parallel review will hasten consumer access to new innovative products and minimize the burden that FDA reviews and Medicare National Coverage Determinations impose on drug and device sponsors. These changes will not only affect parties who are interested in drug and device innovation, but providers, payers, and health care consumers as well.

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Immigration Alert: September 2010

Chichoni Convinces Federal Court to Dismiss Florida University Professor’s Immigration Claims of Forced Labor

ICE Reports Record Worksite Enforcement Activity

Kentucky Consular Center Conducts Unannounced Telephonic Contacts of Employers that Have Secured Approved Nonimmigrant Visa Petitions

Old Version of Puerto Rican Birth Certificate Not Valid for Form I-9 Verification

Third Circuit Rejects Hazelton, Pennsylvania’s Local Immigration Ordinance

Senator Menendez Announces Plan to Introduce Immigration Overhaul Legislation in Senate

DOS Expands Visa Reciprocity Schedule for China

New York’s Domestic Bill of Rights

DOS Issues October 2010 Visa Bulletin

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CMS Proposes to Withdraw Regulations on Average Manufacturer Price Determination, Multiple Source Drug Definition, and Medicaid Federal Upper Limits

by Wendy C. Goldstein, Kathleen A. Peterson, Benjamin S. Martin, and Constance A. Wilkinson

On September 3, 2010, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule withdrawing regulations governing the determination of “Average Manufacturer Price” (“AMP”), the definition of “Multiple Source Drug,” and the application of federal upper reimbursement limits (“FULs”) for Multiple Source Drugs (the “Proposed Rule”). This withdrawal would impact the applicable regulations finalized by CMS in 2007 and 2008 but would leave intact other sections of the 2007 regulations, including, for example, the “Best Price” provisions and certain “definitions” (including the definition of “bona fide service fee”). Comments may be submitted to CMS until 5:00 p.m. EDT on October 4, 2010. We recommend that organizations consider commenting on the impact of the withdrawn regulations, as well as on the open items that have not been addressed under the recent “health reform” legislation. 

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The ‘Retirement’ of the Default Retirement Age?

The Employment Equality (Age) Regulations were introduced in 2006. One of the most significant changes introduced by the regulations was that of a Default Retirement Age (“DRA”) which made it possible for an employer to fairly dismiss an employee on the ground of retirement once they reached the age of 65. So long as the employer complied with the statutory procedure, any dismissal on the ground of retirement would be fair.

This law has been under constant scrutiny since its introduction, even leading to Age Concern raising a legal action against the UK Government which was pursued all the way to the European Court of Justice. Whilst the (then Labour) Government successfully resisted this action, they did give an indication that the DRA would be reviewed in 2011. This is a nettle which has been firmly grasped by the new coalition Government who have now announced plans to phase out the DRA by 1 October 2011.

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HEALTH REFORM: CMS Proposes to Withdraw Regulations on Average Manufacturer Price Determination, Multiple Source Drug Definition, and Medicaid Federal Upper Limits

On September 3, 2010, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule withdrawing regulations governing the determination of “Average Manufacturer Price” (“AMP”), the definition of “Multiple Source Drug,” and the application of federal upper reimbursement limits (“FULs”) for Multiple Source Drugs (the “Proposed Rule”).[1] This withdrawal would impact the applicable regulations finalized by CMS in 2007 and 2008[2] but would leave intact other sections of the 2007 regulations, including, for example, the “Best Price” provisions and certain “definitions” (including the definition of “bona fide service fee”). Comments may be submitted to CMS until 5:00 p.m. EDT on October 4, 2010. We recommend that organizations consider commenting on the impact of the withdrawn regulations, as well as on the open items that have not been addressed under the recent “health reform” legislation.

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Miller Samuel Shortlisted at Law Awards of Scotland 2010

We are delighted to announce that we have been shortlisted for three categories at the prestigious Law Awards of Scotland 2010. The awards are a recognised highlight in the Scottish legal community and celebrate, in their own words, “fantastic thinking and brilliant execution”.

We are shortlisted in the following categories:

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Take Action to Appoint a ‘Human’ Director before 1 October 2010

Is your board made up exclusively of corporate directors?

If so, then you have been making use of the transitional provisions under the Companies Act 2006. Under the Act all companies must have at least one natural person (otherwise, a ‘human’) as a director, although if your company was already incorporated before the new law came into effect then a grace period applies until 1 October 2010.

Failure to appoint a natural person by the end of this month could result in hefty fines being levied against both the company and the defaulting directors of up to £5,000 with the possibility of additional daily fines accruing for continuing default.

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