Private Insurers

New Jersey to Set Up State Health Insurance Exchange
March 26, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers

New Jersey Governor Phil Murphy announced on March 22 that the state will create its own health insurance exchange for plan year 2021, replacing the federally run marketplace. Gov. Murphy also gave notice of the change by sending a Declaration of Intent Letter to the federal government’s Center for Consumer Information and Insurance Oversight.

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“Surprise Bill” Solution is on Senate’s To-Do List
March 20, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers

A bipartisan group of U.S. senators is at work on federal “surprise bill” legislation that may be officially proposed within weeks. The proposal will target the common scenario in which an insured individual receives covered healthcare services from an in-network hospital, surgery center, imaging center or laboratory, while an out-of-network healthcare provider also provides non-emergency

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Fitbit, Solera Health Expand Diabetes Efforts
March 12, 2019 | Eric D. Fader | Electronic Health Records | Medical Devices and Wearables | Private Insurers

Fitbit and Solera Health announced on March 6 that they have expanded their partnership that seeks to reduce the prevalence of type 2 diabetes. Solera, an integrated benefit network, will make Fitbit devices available to all Solera patients who participate in the National Diabetes Prevention Program (DPP).

In a study, Solera found that its patients

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Healthcare: The Next Frontier
March 5, 2019 | Rivkin Rounds Staff | Affordable Care Act | Employer/Employee | Hospitals | Legislation and Public Policy | Private Insurers

A March 1 article in Long Island Business News entitled “Healthcare: The next frontier” discussed the issues raised at a recent roundtable discussion on the current state of the healthcare industry. The panel included Rivkin Radler partners Robert Iseman and Benjamin Malerba; Dr. Zeyad Baker, ProHEALTH Care Associates’ president and CEO; Jeffrey Kraut, executive vice

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Anti-Assignment Clause Bars Doctor’s Reimbursement Claim
February 20, 2019 | Rivkin Rounds Staff | Litigation | Private Insurers

Rivkin Radler’s Employee Benefit Plan Review included a summary of a case in which the U.S. Court of Appeals for the Eleventh Circuit held that an anti-assignment provision in a group health benefit plan barred direct reimbursement to an Atlanta dermatologist. The patient had executed an Assignment of Benefits in favor of the physician, a

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New Medicare App to Explain Coverage
February 6, 2019 | Hospitals | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Private Insurers

On January 28, the Centers for Medicare & Medicaid Services (CMS) announced the launch of a new mobile app called “What’s Covered” to help consumers understand which items and services are covered by Medicare. The app is part of the eMedicare Initiative, launched in October 2018 to modernize the delivery of information about the program.

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FTC Investigations Could Bring Unwanted Scrutiny to Hospitals
January 18, 2019 | Rivkin Rounds Staff | Affordable Care Act | Antitrust | Hospitals | Legislation and Public Policy | Litigation | Private Insurers

An article in Relias Media’s Healthcare Risk Management newsletter, “FTC Investigations Could Bring Unwanted Scrutiny to Hospitals,” discussed potential investigations of hospitals’ anti-competitive behavior by the Federal Trade Commission.  Rivkin Radler’s Robert H. Iseman was featured prominently in the article.

Bob noted that hospitals and health systems that are considered “must-have” participants in health insurance plans face

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NJ Insurance Commissioner Confirms State Law Trumps Changes to ACA
November 14, 2018 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers

On October 29, 2018, the Commissioner of the New Jersey Department of Banking and Insurance issued two bulletins confirming that recent federal changes affecting the Affordable Care Act (ACA) don’t supersede New Jersey state law.

Bulletin No. 18-12, captioned “Short-Term, Limited Duration Insurance,” confirms that short-term, limited-duration health insurance plans, which never comply with New

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Proposal Would Expand Use of HRAs
October 29, 2018 | Margarita Christoforou | Employer/Employee | Legislation and Public Policy | Private Insurers | Tax/IRS

On October 23, 2018, the U.S. Department of Labor, Department of Health and Human Services, and Treasury Department issued a proposed regulation that would expand the usability of health reimbursement arrangements (HRAs). The regulation would allow company employees to use HRAs to cover the cost of individual health insurance coverage, subject to certain conditions. The

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Execs Discuss the Future of Healthcare
October 23, 2018 | Rivkin Rounds Staff | Affordable Care Act | Employer/Employee | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers

The Albany Business Review recently held a roundtable event to explore the future of a single-payer system, the rising cost of healthcare and the rapid pace of change in the industry. Rivkin Radler Partner Robert H. Iseman was joined by Barry McNamara, President of employee benefits firm Benetech Inc.; and Kelly K. Smith, Vice President

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