which entity has jurisdiction over health care coverage providers

Although the extent of the states future role in antitrust and healthcare affiliations, and, whether a change in the federal administration will affect that role, remains unclear, there is no doubt that a number of states have added or are considering adding to their available enforcement tools, giving them more opportunities to intervene. RCW 19.390.080. Each regional MAC. 0000008002 00000 n Whether to voluntarily notify state enforcers. 0000002523 00000 n 0000009634 00000 n means youve safely connected to the .gov website. For additional qualifications and requirements, please visit the U.S. Department of Labor Office of Federal Contract Compliance Programs website, at https://www.dol.gov/ofccp/ and ask your attorney to ensure your health care entity is in compliance. In Colorado, legislators recently expanded the states ability to challenge all mergers, not only healthcare transactions, by repealing a statutory provision that curbed its enforcement power.3 Although Colorado did not create a system for premerger notification, it did give the Colorado attorney general the ability to challenge transactions regardless of whether the federal antitrust authorities object to those deals. Holds a single federal contract, subcontract, or federally assisted construction contract in excess of $10,000.00; Has federal contract or subcontracts that combined total in excess of $10,000.00 in any 12month period; or. You can decide how often to receive updates. Pursuant to this authority, CMS may investigate and implement corrective action or impose civil monetary penalties for any non-Federal governmental plan that fails to comply with applicable PHS Act requirements. 1-888-4LA-CARE (1-888-452-2273)Provider Information. An official website of the United States government Which entity has jurisdiction over health care coverage providers? lock 0000016173 00000 n 41 CFR 60-741.2(i). Although not discussed in this Article, federal antitrust law also forbids agreements that restrain trade, including, for example, price-fixing conspiracies among competitors, under Sherman Act Section 1. Under Section 503 of the Rehabilitation Act of 1973, as amended (Section 503), a government contractor with 50 or more employees and a Government contract of $50,000 or more must develop a Section 503 AAP. For example, Washingtons reporting statute requires that the notice be submitted 60 days prior to close, which is 30 days longer than the federal HSR waiting period. California Senate Bill 977 (SB 977), proposed earlier this year, required written notification to and the consent of the states attorney general before consummation for most healthcare affiliations or change of control transactions.2 Under SB 977, the attorney general would be required to deny consent for transactions that would not lead to (a) clinical integration or (b) the increase or maintenance of access to healthcare in underserved populations. 0000002454 00000 n This enforcement framework, in place since 1996, ensures that consumers in all states have protections of the Affordable Care Act and other parts of the PHS Act. [Your company] shall abide by the equal employment opportunity and affirmative action requirements set forth in 41 C.F.R. Generally, whether a deal is reviewed by the FTC or DOJ depends on the industry and the agencys history of investigations in that industry. Self-Funded, Non-Federal Governmental Plans | CMS . How the proposed transaction affects competition. Is an insurance company that supplies workers compensation insurance to a federal contractor subject to the requirements of Executive Order 11246? Pre-ERISA Legislation Initially, the IRS was the primary regulator of private pension plans. 0000013829 00000 n Balance Billing by Health Care Providers: Assessing Consumer Currently, the Donnelly Act prohibits only anticompetitive activities from agreements or conspiracies, like federal laws Section 1 of the Sherman Act. RCW 19.390.040. An agency within the U.S. Department of Labor, 200 Constitution Ave NW To the extent that CMS and a state agree on a collaborative approach, the state will perform the same regulatory functions with respect to the Affordable Care Act market reform provisions as it does to ensure compliance with state law, and will seek to achieve voluntary compliance from issuers if the state finds a potential violation. Missouri 2. Yes. https:// Under this collaborative approach, if the state finds a potential violation and is unable to obtain voluntary compliance from an issuer, it will refer the matter to CMS for possible enforcement action. He also counsels clients on the HSR Act. Connecticuts legislation, enacted in 2014, requires that certain transactions between physician group practices and hospitals, captive professional entities, medical foundations, or other group practices be reported to the states attorney general.6 Under the law, a group practice can be as small as two physicians operating through the same entity, and transactions that cause a material change to the structure or business of a group practice need to be reported no less than 30 days prior to consummation.7 Transactions constituting a material change are broadly defined and include: (1) merger, consolidation, or other affiliation of a group practice with a hospital, hospital system, or another group practice that results in a practice with eight or more physicians; (2) acquisition of all or substantially all of the assets, stock, or equity interests of a group practice by a hospital, hospital system, or another group practice that results in a practice with eight or more physicians; and (3) employment of all or substantially all of the physicians in a group practice by a hospital, hospital system, or another group practice that results in a practice with eight or more physicians.8 Under the statute, the parties must provide to the attorney general a description of the nature of the proposed relationship and information regarding the physicians, entities, and service locations involved.9 In addition, the statute requires any hospital system or other healthcare provider conducting business in Connecticut that files a premerger notification under the HSR Act to provide written notice of that filing to the Connecticut attorney general.10 Notice of appointment must be submitted to the Commissioner. Oklahoma Insurer What type of license is required for an individual who charges a fee to review an insured's existing life insurance policy? A TRICARE provider that holds another covered contract, such as a prime contract or a subcontract apart from the TRICARE provider contract, would still need to comply with OFCCPs requirements. Federal Reserve Bank of Boston v. Commissioner of Corporations and Taxation of the Commonwealth of Massachusetts, 499 F.2d 60 (1st Cir. What is Pete guilty of? 1980). Megan Morleyis a Senior Attorney in the Business Litigation practice group at Troutman Pepper. She advises healthcare clients on the antitrust implications of transactions, defends hospital systems against allegations of antitrust wrongdoing, and prepares pre-merger notification filings for healthcare deals. She can be reached atmegan.morley@troutman.com. COVERED CALIFORNIANS Watch out for this language! This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies. Which of the following actions is NOT allowed by Health Insurance Counseling and Advocacy Program (HiCAP) counselors? CMS has responsibility for enforcing these requirements in a state that is not enforcing the health insurance market reforms either through a collaborative arrangement with the state or by direct enforcement to ensure all residents of the state receive the protections of the Affordable Care Act. The new Department of Managed Health Care (DMHC) primarily regulates health maintenance organizations (HMOs), while the California Department of Insurance (CDI) has jurisdiction over traditional health insurance. It's time to renew your membership and keep access to free CLE, valuable publications and more. The Health Insurance Enforcement and Consumer Protections Grant program will provide $25.5 million in grant funds to assist States in implementing and/or planning the following provisions of Part A of Title XXVII of the Public Health Service (PHS) Act: The State Flexibility to Stabilize the Market Grant Program, comprised of - (State Flexibility Cycle I and II Grants,) will provide a funding source to enhance the role of States in planning and implementing several of the Federal market reforms and consumer protections. Accordingly, non-Federal governmental plans are subject to the provisions of Part A of title XXVII of the PHS Act, including any changes made by the ACA. 0000017052 00000 n trailer << /Size 110 /Info 60 0 R /Root 63 0 R /Prev 113598 /ID[<316761acfb838f940b729f6e746b7375><0433f655088ef2546be3616a7ff69e33>] >> startxref 0 %%EOF 63 0 obj << /Type /Catalog /Pages 59 0 R /Metadata 61 0 R /PageLabels 58 0 R >> endobj 108 0 obj << /S 360 /L 533 /Filter /FlateDecode /Length 109 0 R >> stream 0000006364 00000 n The implementing regulations for VEVRAA and Section 503, found at 41 CFR 60-300.2 and 41 CFR 60-741.2, respectively, also define a government contract as any agreement or agreement modification between any contracting agency and any person for the purchase, sale or use of personal property or nonpersonal services. If a conflict develops for a contractor who is subject to both Executive Order 11246 and Proposition 209, the requirements of Executive Order 11246 should prevail under the U.S. Constitutions Supremacy Clause the Executive Order is federal law and Proposition 209 is state law. A person compensated for transacting insurance on behalf of another person with an insurer. No, Federal Reserve Banks are not subject to OFCCPs equal employment opportunity and affirmative action laws because they are federal entities and not federal contractors. Therefore, even small transactions, which might have gone unnoticed by federal enforcers, could be subject to antitrust scrutiny by state enforcement agencies. Are Federal Reserve Banks subject to the affirmative action and equal employment opportunity laws OFCCP enforces? All contractors and subcontractors who hold a federal contract in excess of $10,000 are subject to regulatory requirements under one or more of the laws enforced by OFCCP depending upon the amount of the contract. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Coventry Life and Health Insurance Company, East Missouri (PDF), Coventry Life and Health Insurance Company, West Missouri (PDF), UnitedHealthCare Insurance Company, Texas (PDF), In-Person Assistance in the Health Insurance Marketplaces, The Mental Health Parity and Addiction Equity Act (MHPAEA), Self-Funded, Non-Federal Governmental Plans, Federal Market Conduct Examination (Oversight Group) Checklist (PDF), Blue Cross and Blue Shield of Alabama (PDF), Allegiance Life and Health Insurance Company, Inc., Montana (PDF), Health Insurance and Consumer Protections Grant Fact Sheet (PDF), Health Insurance and Consumer Protections Grant Map: State-by-State Summary of Health Insurance and Consumer Protections Grants, State Flexibility to Stabilize the Market Cycle I Grant Map: State-by-State Summary of State Flexibility to Stabilize the Market Grantsfor Cycles I and II, Fact Sheet: The State Flexibility to Stabilize the Market Cycle I Grant Program (PDF), Fact Sheet: The State Flexibility to Stabilize the Market Cycle II Grant Program (PDF), Information Related to COVID19 Individual and Small Group Market Insurance Coverage, FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19), FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19), FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19), Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency, FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets, FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation, Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV), Section 2707 - Non-discrimination under Comprehensive Health Insurance Coverage (Essential Health Benefits Package), Section 2713 - Coverage of Preventive Health Services, Section 2718 - Bringing down the Cost of Health Care Coverage (MLR), Section 2726 - Parity in Mental Health and Substance Use Disorder Benefits, Section 2702 Guaranteed Availability of Coverage, Section 2703 Guaranteed Renewability of Coverage, Section 2707 Non-discrimination under Comprehensive Health Insurance Coverage (Essential Health Benefits Package).
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