Tag:Health Insurance
Will the Silver Lining Fade? The Pros and Cons of Teletherapy & Behavioral Telehealth
Joanna Shea Associate Editor Loyola University Chicago School of Law, JD 2022 A common topic of COVID-adjacent conversation these days is the ‘silver lining’ – unexpected positives resulting from the dark grey cloud that has claimed over half a million lives in the United States. Emergency adaptation measures taken by industries otherwise slow to modernize …
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Exploring the Ramifications of the Department of Justice’s Withdrawal from Health Care Antitrust Guidelines
On February 3, 2023, the Department of Justice (DOJ) formally withdrew its support for three policies that created longstanding safe harbors from antitrust enforcement, relied upon by the healthcare industry for nearly thirty years. Assistant Attorney General, Jonathan Kanter, of the DOJ’s Antitrust Division stated that these changes were “long overdue”, and that the, “[DOJ] will continue to work to ensure that its enforcement efforts reflect modern market realities.” In striking these guidelines, the DOJ notably left no new guidelines in its place, leaving many healthcare providers and purchasers uncertain of whether they will face litigation or even criminal prosecution under the Sherman Act.
New Mental Health Parity Rules on the Horizon
On July 25, 2023, the Departments of Labor, Health and Human Services, and the Treasury (the agencies) proposed new rules placing heightened compliance standards on health insurers and plans regarding the use of Non-Quantitative Treatment Limitations (NQTLs) for mental health and substance abuse disorder (MHSUD) services. These new rules amend the current reporting requirements with the intent to establish ongoing reporting that more clearly demonstrates whether MHSUD services are provided in compliance with the law.
Considerations for Employer-Provided Abortion Benefits
Following the ruling of Dobbs v. Jackson Women’s Health Organization and subsequent reversal of Roe v. Wade, employers have begun to re-strategize how to help their employees legally access abortions. Several U.S. companies, including Amazon, Meta, Apple, and Microsoft, have released statements that they will cover transportation costs to other states for employees seeking an abortion.
How the Inflation Act of 2022 has Impacted the Pharmaceutical Industry
Prescription drug price increases have long been a detriment to Americans. The Inflation Reduction Act (the Act) is in part designed to assist in this corporate pharmaceutical problem. This Act plans to do this through the implementation of seven major prescription drug provisions. Two of the major ones are requiring negotiations for certain drug prices by the federal government and limiting the monthly cost-sharing for insulin to $35. Through these changes along with various others, advocates hope that the burden will be lifted off Medicare beneficiaries. It has also been estimated that the Act will work to reduce the federal deficit by $237 billion over 10 years (2022-2031).
The Sicker, The Better: Cigna Orchestrates Fraudulent Scheme to Defraud Government
Cigna Corporation (Cigna)–a global juggernaut in the insurance arena–faces a health care fraud lawsuit brought by the government under the federal False Claims Act (the FCA). By allegedly exaggerating patients’ illnesses to boost its own risk scores, Cigna secured inflated payments from the Medicare Advantage reimbursement system.
An Overview of Illinois Public Act 100-0538 Compliance with the Hyde Amendment
Illinois Public Act 100-0538, commonly referred to as House Bill 40, was signed into law on September 28, 2017. The Act repeals provisions in existing Illinois laws that aim to make abortion illegal should there be any change to the federal standard. Additionally, the Act lifts a ban on insurance coverage for abortions for low-income individuals enrolled in Medicaid. While enacting House Bill 40 was a win for advocates of reproductive rights in Illinois, the state will still need to comply with federal anti-abortion laws, such as the Hyde Amendment.
Current Trends in Medicaid 1115 Waiver Requests: Are They Schemes to Avoid Compliance with Disfavored Requirements?
States looking for flexibility or creativity in implementing Medicaid programs can apply for waivers from the Secretary of Health and Human Services (HHS). According to the Medicaid and CHIP Payment Access Commission (MACPAC), waiver use is quite extensive—resulting in “wide variations in program design, covered services, and eligible populations among states and even within states.” As of September 2017, 33 states account for 41 approved waivers, and 18 states have 21 total pending waivers. The scope of these waivers traditionally broadens eligibility and creates new programs in states where Medicaid needs are not expressly recognized by federal law. Current pending applications suggest, however, that states seeking waivers now do so as a means to circumvent Medicaid program requirements they disagree with.
Can Congress Regulate Big Pharma?
Drug companies need to fund the research and development necessary to create better products. This means that pharmaceutical companies have fought for years to maintain control over the prices of said drugs. But this standard is being challenged with a new bill that was introduced to the House of Representatives on June 25, 2018.
Market Giants Move to Redesign Healthcare
In January 2018, Warren Buffet, Jamie Dimon, and Jeff Bezos announced that Berkshire Hathaway, JP Morgan Chase, and Amazon would partner together to form a non-profit company aimed at improving the United State healthcare system and combating ever-increasing costs. The idea for the project came about from the ongoing discussion between the three CEOs regarding providing healthcare for their, collectively, approximately 840,000 employees. Even though details are scarce, given the importance of the issue and the prominent names attached to this project, the press, the public, and the market have reacted accordingly. In other words, people are scrambling to figure out what this might mean for their companies and our healthcare system as a whole.