Tag Archives: Insurance

Payor/Provider Convergence: Joint Venture Health Plans

Background Health Plans and health care providers are getting into each other’s business.  This payor/provider convergence has taken different forms.  Health systems have ventured into the health insurance business by acquiring or starting their own health plans and by establishing joint ventures with payors, to jointly own and operate a health plan.  Health plans have … Continue reading this entry

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills.  AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers during or because of a stay at an in-network facility.  The law limits cost sharing for covered services to in-network amounts unless the … Continue reading this entry

Injunction Enjoining Enforcement of HHS Attestation Rule Affirmed

The Court of Appeals for the District of Columbia affirmed the District Court’s decision in Central United Life v. Burwell on July 1, 2016. This decision is very significant for those assessing the future strength of, and compliance framework for, the fixed indemnity market. Central United Life v. Burwell enjoined the U.S. Department of Health … Continue reading this entry

Why Arizona’s New Telemedicine Law Sends an Important Message

Arizona Governor Doug Ducey signed a bill (S.B. 1363) into law, on May 17, 2016, requiring private health plans to pay for telemedicine services across the whole state rather than only services received in rural areas of the state. The State’s current telehealth coverage law, which went into effect January 2015, only requires commercial health insurers … Continue reading this entry

Employee Assistance Programs and State Insurance Regulation Structuring EAPs to Ensure Compliance

Employee Assistance Programs (or EAPs) have served employers and their employees for decades, providing a variety of benefits to address issues that might otherwise adversely affect the overall health and work of employees. A National Study of Employers conducted in 2008 found that 65 percent of employers in the United States provided EAP benefits, an … Continue reading this entry

Virginia Telehealth Law: What You Need to Know

Virginia has made strides to expand the telehealth offerings available to its residents and the Old Dominion took another step forward advancing telemedicine when it enacted a bill amending Virginia Code § 38.2-3418.16 to expand commercial insurance coverage of telemedicine-based services. Additionally, the Virginia Board of Medicine last year published Telemedicine Guidelines to instruct practitioners … Continue reading this entry

Key Takeaways From Indiana's New Telemedicine Law

Indiana Gov. Mike Pence (R) signed into law, on March 21, 2016, a new bill (House Act No. 1263) implementing a variety of telemedicine practice standards and remote prescribing rules in the Hoosier State. Effective July 1, 2016, the new law replaces the old Indiana Telehealth Pilot Program, which is set to self-expire on that … Continue reading this entry

Florida Passes New Telehealth Bill: Focus is Reimbursement

After several hard-fought years of unsuccessful attempts, the Florida Legislature on Friday passed a new bill designed to set the stage for telehealth commercial insurance coverage in the Sunshine State. This is a great step forward for providers of telehealth services, as the bill will result in a formal report to the Governor and Legislature … Continue reading this entry

New Guidance Outlines Requirements for State Innovation Waivers

New guidance from Centers for Medicare & Medicaid Services (CMS) places the spotlight on the ability of states to seek approval of “State Innovation Waivers” to test new approaches for delivering health insurance reform. Authorized under Section 1332 of the Affordable Care Act (ACA), State Innovation Waivers can grant statewide modifications to many of the … Continue reading this entry