Tag Archives: health care law

Patient Protection and Affordable Care Act Alert-Issue 1: Health Care Reform: It’s the law!

The re-election of President Obama and the lack of change in the control of the houses of Congress effectively ensure that the provisions of Health Care Reform will remain in place and will continue along the path of implementation.

In order to help employers address the effects of Health Care Reform and decide whether to design their plans to comply or to forego offering health plans, McDonald Hopkins will issue a series of Alerts over the coming months focusing on various issues. At this point, most of the regulatory guidance needed has not yet been issued. Therefore, we will provide the best possible guidance based on existing knowledge.

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New Jersey Appellate Division Upholds Immunity for Health Care Entity That Provided Negative Information About Former Employee in Response to Request for a Reference

On December 1, 2011, the Superior Court of New Jersey, Appellate Division, upheld immunity from civil liability for certain health care entities that provide information in good faith about a current or former employee’s job performance to another health care entity.Senisch v. Carlino, A-6218-09T3 (N.J. App. Div. Dec. 1, 2011). Specifically, the court granted civil immunity to a health care entity under the New Jersey Health Care Professional Responsibility and Reporting Enhancement Act (the “Act”),[1] in connection with its reporting of negative, but truthful, information to another health care entity about a former health care professional’s termination of employment.

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HHS Announces First Insurance Premium Rate Review Determinations: Implications for Insurance Carriers and Future Rate Reviews

by Jesse M. Caplan and Serra J. Schlanger

On November 21, 2011, the Center for Consumer Information & Insurance Oversight, in the Centers for Medicare & Medicaid Services (“CMS”), announced its determination that a health insurance premium rate increase of 11.58 percent in the small group market in Pennsylvania represented an “unreasonable” rate increase, while an 11.10 percent increase in the individual market in Montana did not. These long-awaited determinations represent the first application of CMS’s rate review regulations under federal health reform.

This Implementing Health and Insurance Reform alert discusses these first federal rate review determinations, and their implications for insurance carriers and future insurance premium rate reviews. It also provides a link to Epstein Becker Green’s interactive National Health Insurance Rate Review Scorecard, which offers insurance carriers, lawyers, and other stakeholders an up-to-date resource on federal and state health insurance rate review programs, standards, and initiatives.

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Medicare Providers and Suppliers Continue in the Spotlight: Medicare Providers and Suppliers Continue in the Spotlight

Expansion of the DMEPOS Competitive Bidding Program; Legislative Inquiry Related to Fraud and Abuse Enforcement Actions; and Automated Pre-Enrollment Provider Screening

by George B. Breen, Amy F. Lerman, Emily E. Bajcsi, Deepa B. Selvam

In order to be prepared for upcoming changes and to respond to new initiatives, providers and suppliers participating in Medicare must be aware of recent Congressional activity that would hold the federal government accountable for its intended enforcement efforts designed to curb health care fraud, waste, and abuse, as well as an effort by the Centers for Medicare & Medicaid Services (“CMS”) to implement automated pre-enrollment provider and supplier screening in January 2012. One example of the pressures that providers and suppliers face in this enhanced regulatory and enforcement climate is the upcoming expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Competitive Bidding Program, which is targeted to launch in July 2013 and for which the Round 2 bidding timeline was announced on November 30, 2011.

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Maine Repeals Pharmaceutical Disclosure Requirements Related to Marketing Costs, Drug Pricing, and Clinical Trials

On July 8, 2011, Governor Paul LePage of Maine signed into law LD 719, “An Act to Make Certain Prescription Drug Disclosure Laws Consistent with Federal Law” (“LD 719”).[1]LD 719 repeals three statutes that require prescription drug manufacturers and labelers to disclose information related to clinical trials, Me. Rev. Stat. Ann. tit. 22, § 2700-A (“§ 2700-A”); marketing costs, Me. Rev. Stat. Ann. tit. 22, § 2698-A (“§ 2698-A”); and drug pricing, Me. Rev. Stat. Ann. tit. 22, § 2698-B (“§ 2698-B”). The repeal becomes effective on September 28, 2011. This Client Alert discusses LD 719.

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Medical Marijuana/Cannabis and Employment Considerations

Read about ESSB 5073, the bill in the legislature regarding medical marijuana, and medical marijuana considerations in the employment context.

For more information please visit www.omwmunilaw.com.

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CMS Releases Proposed Rules for Accountable Care Organizations

On March 31, 2011, CMS released its proposed rules for public review and comment relating to Medicare payments for health care providers participating in Accountable Care Organizations (ACOs).

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