Mealey's Health Care / ACA

  • October 16, 2017

    President Trump Ceases ACA Cost-Sharing Payments To Insurers

    WASHINGTON, D.C. — President Donald Trump authorized his administration to immediately cease making Patient Protection and Affordable Care Act (ACA) cost-sharing payments in an Oct. 13 statement.

  • October 12, 2017

    Parties To ACA Medicaid Backlog Suit Brief Court On Relief’s Appropriateness

    WASHINGTON, D.C. — The District of Columbia and plaintiffs filed supplemental briefs with a federal appeals court on Oct. 10, addressing whether a settlement decree reached almost a decade ago provided an appropriate vehicle for a judge to impose new injunctive relief in a case challenging Patient Protection and Affordable Care Act (ACA)-created delays in processing Medicaid applications (Oscar Salazar, et al. v. District of Columbia, et al., Nos. 16-7065, 16-7085, 16-7100, D.C. Cir.).

  • October 12, 2017

    President Signs Order Allowing Associations To Offer Health Insurance

    WASHINGTON, D.C. — President Donald Trump on Oct. 12 signed an executive order directing his administration to investigate ways the government could facilitate allowing small businesses, individuals and associations to join together to purchase health insurance.

  • October 12, 2017

    Judge Dismisses UCL Claim, But Rejects Health Insurer’s ERISA Preemption Stance

    SAN FRANCISCO — A substance abuse treatment center’s three surviving claims involve a provider-insurer relationship outside ERISA’s scope, but the provider’s unfair competition law (UCL) claims seek relief available through other means and are not among the surviving causes of action, a federal judge in California held Oct. 10 (Summit Estate Inc. v. Cigna Healthcare of California Inc., et al., No. 17-3871, N.D. Calif., 2017 U.S. Dist. LEXIS 167462).

  • October 12, 2017

    California Sues Over Newly Issued ACA Contraceptive Mandate Rules

    SAN FRANCISCO — Newly issued regulations allowing religious and moral objectors to evade the Patient Protection and Affordable Care Act (ACA) contraceptive mandate are illegal, the State of California claims in an Oct. 10 complaint (State of California, et al. v. Don J. Wright, et al., No. 17-5783, N.D. Calif.).

  • October 11, 2017

    Lactation Coverage Plaintiffs Say ACA Ruling Doesn’t Require Appeal

    SAN FRANCISCO — A judge’s ruling that an insurer violated the ACA’s lactation services coverage mandate when an insured can’t find, or isn’t told of the availability of, such services does not warrant appellate review, plaintiffs told a federal judge in California on Sept. 28 (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

  • October 10, 2017

    Provider Group Claims Insurer Violates ACA By Paying Only Insureds

    BRIDGEPORT, Conn. — An insurer refuses to pay anyone but patients in retaliation for a medical provider group’s decision to reject an agreement providing for “unfairly low reimbursement rates,” in violation of the Patient Protection and Affordable Care Act (ACA), plaintiffs allege in an Oct. 5 complaint (Hartford Healthcare Corp., et al. v. Anthem Health Plans Inc., et al., No. 17-1686, D. Conn.).

  • October 6, 2017

    Judge Finds Health Insurer’s Pre-Authorizations Support Contract Claims

    FORT LAUDERDALE, Fla. — A substance abuse treatment provider’s allegations that an insurer pre-authorized treatment only to retroactively decline payment supports contract and Florida trade practices claims, a federal judge held Oct. 3 (Chiron Recovery Center LLC v. AmeriHealth HMO of New Jersey Inc., et al., No. 16-82043, S.D. Fla., 2017 U.S. Dist. LEXIS 163487).

  • October 6, 2017

    Government Rule Expands Groups Excluded From ACA Contraceptive Mandate

    WASHINGTON, D.C. — Federal officials on Oct. 6 issued interim final rules permitting moral and religious objectors to opt out of the Patient Protection and Affordable Care Act’s contraceptive mandate, conceding that the existing rule violated the law.  The rule follows up on a May directive from President Donald Trump to relax regulations to address conscience-based objections to the rule.

  • October 6, 2017

    Pennsylvania Top Court Finds Autism-Coverage Law Extends To In-School Treatment

    HARRISBURG, Pa. — A law’s ambiguous reference to exclusions while mandating that health insurance policies cover autism treatment is sufficiently vague to negate a policy’s provision excluding in-school treatment, a divided Pennsylvania Supreme Court held Oct. 5 (Anthony Burke, et al. v. Independence Blue Cross, No. 23 EAP 2016, Pa. Sup.).

  • October 5, 2017

    Judge Mostly Allows Out-Patient Surgery Plaintiffs’ Suit Against Insurers

    NEW YORK — Allegations that an insurer’s sudden decision to cease covering certain out-of-network outpatient surgery fees does not comply with plan documents are sufficient to support a claim, a federal judge in New York held Sept. 11 (The Medical Society of the State of New York, et al. v. UnitedHealth Group Inc., et al., 16-5265, S.D. N.Y.).

  • October 4, 2017

    Daughter Didn’t Suffer Discrimination, Lacks ACA Standing, Judge Says

    NEW ORLEANS — Associational standing for Patient Protection and Affordable Care Act (ACA) discrimination claims applies only where the individual suffered discrimination because of association with a disabled individual, a federal judge in Louisiana held Sept. 29 in finding that a daughter lacked standing to pursue claims based on discrimination her hearing-impaired mother allegedly experienced (Katrina Rivers Labouliere, et al. v. Our Lady of the Lake Foundation, et al., No. 16-785, M.D. La.).

  • October 3, 2017

    Judge Finds Insurer’s Payments For Spine Surgery Complied With Plan Provisions

    NEWARK, N.J. — Because an insurer appears to have paid a provider 150 percent of the Medicare rate for his services in compliance with plan provisions, the medical professional’s Employee Retirement Income Security Act claim fails, a federal judge in New Jersey held Sept. 13 in granting summary judgment (Professional Orthopaedic Associates P.A., et al. v. Horizon Blue Cross Blue Shield of New Jersey, No. 14-4731, D. N.J.).

  • October 3, 2017

    Judge Finds Post-Surgery Assignment Of Rights Barred By Health Insurance Plan

    NEWARK, N.J. — Waiting until after surgery to obtain a patient’s benefit rights does not render a health insurance’s anti-assignment provision unenforceable, a federal judge in New Jersey held Sept. 21 (Rahul Shah, M.D., et al. v. Blue Cross Blue Shield of Alabama, et al., No. 17-700, D. N.J., 2017 U.S. Dist. LEXIS 154090).

  • October 2, 2017

    ACA, UCL Claims Against Health Care Provider Survive In Transgender Case

    SAN DIEGO — Allegations that an emergency health care provider touted its compassion toward those with gender dysphoria and then repeatedly referred to a transgender boy as female support his mother’s Patient Protection and Affordable Care Act (ACA) and California unfair competition law claims, a federal judge in California held Sept. 27 (Katharine Prescott, et al. v. Rady Children’s Hospital – San Diego, No. 16-2408, S.D. Calif., 2017 U.S. Dist. LEXIS 160259).

  • September 29, 2017

    Kentucky Court Finds Insurer’s Motion To Dismiss Didn’t Waive Arbitration Clause

    FRANKFORT, Ky. — An insurer’s motion seeking dismissal of a hospital’s action alleging underpayment for emergency care services did not waive a contract’s arbitration provision, a Kentucky appeals court held Sept. 28 (Wellcare Health Insurance Co. of Kentucky Inc. v. Trigg County Hospital Inc., No. 2016-CA-001954-MR, Ky. App., 2017 Ky. App. LEXIS 566).

  • September 29, 2017

    Cervical Fusion Provider’s Suit Against Insurer Largely Survives Dismissal

    NEWARK, N.J. — A health insurer’s motion to dismiss based on a plan’s anti-assignment provision and the alleged existence of administrative remedies requires evidence outside the scope of the pleadings, a federal judge in New Jersey held Sept. 27 in largely allowing a lawsuit to proceed (Rahul Shah, M.D., et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 17-166, D. N.J.).

  • September 28, 2017

    Court Orders More Briefing On Whether ACA Changes Warrant New Injunctive Relief

    WASHINGTON, D.C. — A day after hearing oral arguments about whether changes wrought by the Patient Protection and Affordable Care Act (ACA)’s changes to Medicaid eligibility processes can serve as the basis for reimplementing expired provisions of a 1999 settlement agreement, the federal appellate court panel hearing the case on Sept. 26 asked the parties for more briefing on standing and rules granting relief from judgment (Oscar Salazar, et al. v. District of Columbia, et al., Nos. 16-7065, 16-7085, 16-7100, D.C. Cir.).

  • September 26, 2017

    Federal Court Challenge To State Court Health Care Rulings Fails, Judge Says

    WASHINGTON, D.C. — The shareholder of a low-income health care provider placed into rehabilitation after changes wrought by the Patient Protection and Affordable Care Act (ACA) impermissibly seeks to challenge state law rulings in a federal district court, a judge in the District of Columbia held Sept. 7 (D.C. Healthcare Systems Inc., et al. v. District of Columbia, et al., No. 16-1644, D. D.C., 2017 U.S. Dist. LEXIS 145030).

  • September 26, 2017

    Judge Finds Preemption In Federal Employee’s Lactation Coverage Case

    NEW YORK — A woman’s state law class action claiming that her insurer’s plan documents deceptively advertise and negligently misrepresent the availability of in-network lactation assistance providers sufficiently invokes federal law to warrant preemption, a federal judge in New York held Sept. 22 (Jacqueline Wyka Mahajan, et al. v. Blue Cross Blue Shield Association, No. 16-6944, S.D. N.Y., 2017 U.S. Dist. LEXIS 155365).