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Agencies issue amendments to the PPACA claims and appeals processes

Hodgson Russ LLP
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USA
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July 29 2011

The Treasury, DOL, and the Department of Health and Human Services jointly issued amendments to the interim final rules governing the internal claims and appeals and the external review processes required under the Patient Protection and Affordable Care Act (PPACA

Treasury, IRS seek public input and comment on health care reform shared responsibility provisions

Hodgson Russ LLP
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USA
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July 29 2011

Under health care reform, employers with 50 or more full-time employees that do not offer affordable health coverage to their full-time employees may be required to make a shared responsibility payment

Plan administrator not obligated to provide benefit accruals for unpaid hours

Hodgson Russ LLP
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USA
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July 29 2011

Nurse participants in a hospital retirement plan were upset that their unpaid meal breaks, during which they were required to work, and an unpaid 20-40 minute period of patient status review before the official start of their shifts were not counted for benefit purposes in the hospital's retirement plans

Legal challenges to health care reform continue to work through the courts

Hodgson Russ LLP
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USA
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April 15 2011

In late January, a district court in Florida ruled that the Patient Protection and Affordable Care Act (PPACA) is unconstitutional

MEWA held to be not fully insured under ERISA

Hodgson Russ LLP
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USA
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April 15 2011

When unrelated employers join together in an association or other group to purchase or arrange for health insurance, the association is defined as a "multiple employer welfare arrangement" or "MEWA" under the law

Same-sex domestic partner policy does not discriminate against opposite-sex couples

Hodgson Russ LLP
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USA
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April 15 2011

Reversing a decision by the Westchester County Human Rights Commission, a New York appeals court recently held that a policy adopted by a local Board of Cooperative Educational Services (BOCES) to offer health care to same-sex domestic partners did not unlawfully discriminate against opposite-sex domestic partners

New grandfathered plan regulations permit insurance contract changes

Hodgson Russ LLP
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USA
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February 11 2011

Under the Affordable Care Act, group health plans are required to comply with a number of new insurance market reform requirements

Insurer not a fiduciary when negotiating rates

Hodgson Russ LLP
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USA
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February 11 2011

The Court of Appeals for the Sixth Circuit ruled that an insurer was not acting as a fiduciary when it negotiated rates with hospitals that favored its health maintenance organization clients over its self-funded plan clients

Enforcement of insured plan nondiscrimination rules delayed

Hodgson Russ LLP
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USA
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January 4 2011

As many employers are by now well aware, the Affordable Care Act imposes nondiscrimination rules on insured non-grandfathered group health plans

More health care reform FAQs issued

Hodgson Russ LLP
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USA
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January 4 2011

Over the past several months DOL, HHS, and the IRS (collectively, the Agencies) have issued a series of frequently asked questions (FAQs) regarding the implementation of the Affordable Care Act