Mealey's Health Care / ACA
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September 28, 2020
CBO Won't Reconsider Short-Term Insurance Plan Calculations
WASHINGTON, D.C. — Recent research into short-term, limited-duration insurance (STLDI) plans differs significantly enough from Congressional Budget Office (CBO) standards that it does not require reevaluating whether most enrollees in such plans are receiving actual insurance coverage, the CBO said in a Sept. 25 report.
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September 25, 2020
Medicare May Recover From Montana Asbestos Settlements, Judge Says
BILLINGS, Mont. — Medicare may seek reimbursement under the secondary payer act from Montana residents' asbestos settlements because though the plaintiffs portray their settlements as involving only wrongful death, it appears they sought and released medical damages under survival claims, a federal judge in Montana said Sept. 23 (John Hagerty, et al. v. Alex Azar, et al., No. 19-123, D. Mont., 2020 U.S. Dist. LEXIS 174976).
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September 25, 2020
Appeals Court Upholds District Of Columbia ACA Exchange Tax
WASHINGTON, D.C. — The District of Columbia's tax on insurers that do not participate in the health insurance exchange does not violate the Patient Protection and Affordable Care Act (ACA) or nondelegation principles, a District of Columbia appellate panel said Sept. 24 (Unum Life Insurance Company of America, et al. v. District of Columbia, Nos. 17-TX-1296, 17-TX- 1297, 17-TX-1298, 17-TX-1299, 17-TX-1300, & 17-TX-1301, D.C. App., 2020 D.C. App. LEXIS 384).
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September 25, 2020
Insurer, Lactation Class Launch Appeals After Partial Class Certification Victory
SAN FRANCISCO — A group of women who claim that their insurer improperly denied coverage for lactation services under the Patient Protection and Affordable Care Act (ACA) filed a notice of appeal Sept. 23 challenging the partial denial of class certification after the parties stipulated to a judgment in light of the Ninth Circuit U.S. Circuit Court of Appeals' denial of interlocutory appeal. The insurer filed its own notice of appeal on Sept. 18 (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 20-16823, 9th Cir.)
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September 24, 2020
Judge: Deaf Woman's Claims Of Discrimination Under ACA, Other Statutes Proceed
CLEVELAND — Three discrimination claims are not duplicative even where they require similar analysis because they provide different relief, and a deaf woman's allegations that she requested but was never provided an interpreter while hospitalized for a broken neck survive, a federal judge in Ohio said Sept. 21 in denying summary judgment on Rehabilitation Act, Americans with Disabilities Act and Patient Protection and Affordable Care Act (ACA) claims (Alicia Tokmenko v. MetroHealth System, No. 8-2579, N.D. Ohio, 2020 U.S. Dist. LEXIS 172538).
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September 21, 2020
5th Circuit Won't Reinstate Medicare Recoupment Challenge
NEW ORLEANS — A Medicare provider fighting recoupment of payments had the opportunity to be heard in the first two of the four-step appeals process where it received a reduction in the amount owed, a Fifth Circuit U.S. Court of Appeals panel said Sept. 18 in affirming (Sahara Health Care Inc. v. Alex. M. Azar II, et al., No. 18-41120, 5th Cir., 2020 U.S. App. LEXIS 29927).
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September 17, 2020
Insurer's Liquidators Ask U.S. High Court To Hear Case Over Arbitration Issue
WASHINGTON, D.C. — The liquidator and special deputy liquidator of an insolvent health insurer on Aug. 28 asked the U.S. Supreme Court to hear their case on whether they should be compelled to arbitrate common-law tort claims against an actuarial firm based upon an arbitration provision in a preinsolvency agreement between the insurer and the firm (Doug Ommen, et al. v. Milliman, Inc., et al., No. 20-249, U.S. Sup., 2020 U.S. S. CT. BRIEFS LEXIS 2654).
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September 15, 2020
Parity Act, ERISA Claims Survive In Residential Treatment Case
SALT LAKE CITY — A family adequately alleges that an insurer imposed acute-care level standards on subacute-level mental health residential therapies that it would not in the medical or surgical setting, and the Mental Health Parity and Addiction Equity Act claim is not duplicative of Employee Retirement Income Security Act claims, a federal judge in Utah said Sept. 11 in denying a motion to dismiss (Theo M., et al. v. Beacon Health Options, et al., No. 19-364, D. Utah, 2020 U.S. Dist. LEXIS 166903).
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September 15, 2020
Judge Won't 'Hamstring' Plaintiffs' Parity Act Case, Grants Discovery
SALT LAKE CITY — A Mental Health Parity and Addiction Equity Act claim is factually and legally distinct from an Employee Retirement Income Security Act claim, and to limit discovery to the administrative record would "improperly hamstring" plaintiffs, a federal judge in Utah said Aug. 31 (Anne M., et al. v. United Behavioral Health, et al., No. 18-808, D. Utah, 2020 U.S. Dist. LEXIS 159453).
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September 15, 2020
Woman Wants Supreme Court Review Of 5th Circuit ACA Emotional Distress Ruling
WASHINGTON, D.C. — Discrimination often imposes only emotional distress, and such damages should be available under the Patient Protection and Affordable Care Act (ACA) and other laws precluding the conduct, a deaf and blind woman allegedly denied an interpreter by her medical provider told the U.S. Supreme Court on Aug. 21 in a petition for writ of certiorari (Jane Cummings v. Premier Rehab Keller PLLC, et al., No. 20-219, U.S. Sup.).
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September 15, 2020
Judge Says Texas Law Amendments Come Too Late For Medical Billing Case
HOUSTON — Because Texas medical providers' underpayment lawsuit targets insurers' behavior before amendments adding "usual and customary" language to state law governing payments, the claims are preempted, a federal judge in Texas said Aug. 17 (ACS Primary Care Physicians Southwest P.A., et al. v. UnitedHealthCare Insurance Co., et al., No. 20-1282, S.D. Texas.).
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September 11, 2020
Amici Urge Rehearing Of Ruling Condoning ACA Short-Term Plans
WASHINGTON, D.C. — A rule expanding short-term insurance plans attempts to blur the difference between those plans and comprehensive Patient Protection and Affordable Care Act-compliant plans, to the detriment of nearly all parties, two states and a collection of advocacy groups said Sept. 8 in urging rehearing of a ruling allowing the rule to stand (Association for Community Affiliated Plans, et al. v. United States Department of Treasury, et al., No. 19-5212, D.C. Cir.).
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September 10, 2020
Court Affirms Expert, Record-Only Review Rulings In ERISA Mental Health Case
BOSTON — An insurer and district court did not err in relying on experts who referenced 24-hour care when determining that residential treatments were not medically necessary, and review in Employee Retirement Income Security Act cases is limited to the administrative record and does not require live testimony or cross-examination, a First Circuit U.S. Court of Appeals panel held Sept. 9 (Jane Doe v. Harvard Pilgrim Health Care Inc., et al., No. 19-1879, 1st Cir.).
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September 09, 2020
Residential Treatment Denial Meets Arbitrary And Capricious Standard, Judge Says
SALT LAKE CITY — An insurer is entitled to review of its Employee Retirement Income Security Act benefit decision under the arbitrary and capricious standard, and under that standard demonstrated sufficient evidence in defense of its denial of benefits for residential treatments, a federal judge in Utah said Sept. 3 in granting judgment to the insurer (Mark M., et al. v. United Behavioral Health, No. 18-18, D. Utah, 2020 U.S. Dist. LEXIS 162455).
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September 04, 2020
4th Circuit Upholds Maryland Injunction In Title X Abortion Case
BALTIMORE — A Title X rule limiting physicians' abortion communications and requiring separate facilities for such services is arbitrary and capricious because the government ignored substantial concerns about the impact and the rule violates Patient Protection and Affordable Care Act (ACA) regulations precluding barriers to care, a divided en banc Fourth Circuit U.S. Court of Appeals said Sept. 3 (Mayor and City Council of Baltimore v. Alex M. Azar II, et al., Nos. 19-1614, 20-1215, 4th Cir., 2020 U.S. App. LEXIS 28127).
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September 04, 2020
LGBTQ Health Providers Partially Prevail In ACA Discrimination Rule Challenge
WASHINGTON, D.C. — A federal agency's apparent disregard for the potential impact Bostock v. Clayton County, Georgia could have on the validity of a Patient Protection and Affordable Care Act (ACA) rule excluding sex stereotyping and gender identity from the definition of discrimination and the harm LGBTQ health providers face from the rule's fallout warrant partially enjoining the rule, a federal judge in the District of Columbia said Sept. 2 (Whitman-Walker Clinic, et al. v. U.S. Department of Health and Human Services, et al., No. 20-1630, D. D.C., 2020 U.S. Dist. LEXIS 159951).
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September 03, 2020
9th Circuit Vacates Judgment In ERISA Residential Benefits Case
SEATTLE — A judge granted judgment in a residential treatment coverage case based on a theory that no party pursued, a Ninth Circuit U.S. Court of Appeals panel said Sept. 1 in vacating judgment in an Employee Retirement Income Security Act case (Todd R., et al. v. Premera Blue Cross Blue Shield of Alaska, No. 19-35475, 9th Cir., 2020 U.S. App. LEXIS 27831).
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September 03, 2020
Judge: Competition Law, Other Claims Fall Short In Surgery Compensation Suit
LOS ANGELES — A surgery provider fails to adequately support California unfair competition law and other claims arising from an insurer's alleged underpayment, a federal judge in California said Aug. 28 in granting dismissal (Avanguard Surgrey Center LLC v. Cigna Healthcare of California Inc., No. 20-3405, C.D. Calif., 2020 U.S. Dist. LEXIS 156826).
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September 02, 2020
Judge Finds Washington Lacks Standing To Challenge ACA Discrimination Rule
SEATTLE — In light of Washington state's own argument that Bostock v. Clayton County requires that sex discrimination laws cover discrimination based on gender identity and sexual orientation, the state cannot show an injury on which to challenge a Patient Protection and Affordable Care Act (ACA) rule, a federal judge in the state said Aug. 28 in denying a preliminary injunction (Washington v. United States Department of Health and Human Services, et al., No. 20-1105, W.D. Wash., 2020 U.S. Dist. LEXIS 159271).
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August 31, 2020
Federal Judge Dismisses Insureds' Out-Of-Network Underpayment Class Action
LOS ANGELES — Class action allegations claiming violation of the Employee Retirement Income Security Act and Racketeer Influenced Corrupt Organizations Act in the alleged underpayment for out-of-network mental health and substance abuse treatments are not adequately supported and must be dismissed, a federal judge in California said Aug. 26 (LD, et al. v. United Behavioral Health, et al., No. 20-2254, N.D. Calif., 2020 U.S. Dist. LEXIS 155224).