Main Menu Back to Page
{ Banner Image }

Showing 48 posts in Insurance.

What’s Next After Health Care Bill’s Failure in Congress?

Affordable Care ActDespite controlling the presidency, and both houses of Congress, the Republican’s bid to repeal and replace the Affordable Care Act (ACA) failed. The Republican’s replacement bill - the American Health Care Act (AHCA) - was pulled before proceeding to a vote in the U.S. House of Representatives, as it apparently lacked the votes to pass. Here’s what businesses need to know now that this (first?) attempt to repeal the ACA failed. Read More ›

Categories: Compliance, Insurance

Michigan’s Health Insurance Claims Assessment Act is Upheld Once Again

health insurance claims assessmentMichigan’s tax on paid health care claims is not preempted by ERISA, according to a decision by the United States Court of Appeals for the Sixth Circuit. On remand from the United States Supreme Court, the federal appellate court held that the Health Insurance Claims Assessment Act does not impermissibly interfere with the uniform administration of group health plans or impose additional burdens on self-insured plans and third-party administrators. Read More ›

Categories: 6th Circuit Court of Appeals, Insurance, News & Events, Tax

Health Insurance Rate Increases Approved for 2016

health insurance rate increasesOn Tuesday, August 18, the Michigan Department of Insurance and Financial Services (“DIFS”) announced that it has approved health insurance rate increases that average 6.5 percent for the individual market and 1 percent for the small group market. 

Each year, DIFS is responsible for reviewing rate changes proposed by health insurers to determine whether such changes comply with state and federal laws. As part of its review this year, DIFS considered public comments that were submitted after the requested rate changes were posted. DIFS approved all rate changes as requested after determining that such changes were actuarially supported. Read More ›

Categories: Insurance, News & Events

Health Care Trends

health care trendsRural hospitals across the United States struggling to stay open

According to the National Rural Health Association, approximately 50 hospitals in the rural United States have closed since 2010. The number of annual closures is growing. Congressional healthcare budget cuts and policy changes significantly affect rural hospitals because rural hospitals often have a disproportionate number of patients who are covered under Medicare, Medicaid or who are uninsured. A number of factors affect and pose challenges to rural hospitals. One challenge is the difficulty of attracting talent, which often means paying more to healthcare professionals in order to recruit them for employment at a rural hospital.  Other challenges facing rural hospitals include:

  • changing demographics;
  • advances in medical practice that the hospital may be unable to implement;
  • new federal regulations and standards that create additional compliance related pressure; and
  • lower reimbursement rates for Medicare and Medicaid.

Closures of rural hospitals may force individuals to travel long distances for medical care, which may lead to an increase in mortality rates. The closures may discourage business ventures in rural areas due to the increased costs associated with not having a healthcare facility nearby. Metropolitan hospital closings have increased recently, but the existence of medical care alternatives in metropolitan areas typically reduces the effects that closures have on patients.  Read More ›

Categories: Health Care Reform, Hospitals, Insurance, News & Events, Physicians, Tax

New Legislation Makes Concierge Medicine a Viable Business Model In Michigan

concierge medicineThe Affordable Care Act ("ACA") authorizes the innovative payment model referred to as direct primary care, and more commonly known as “concierge medicine.” Under the direct primary care model, patients can access comprehensive coverage of basic healthcare services for a flat monthly fee.  Such services generally include guaranteed same-day or next-day visits with no waiting times. Concierge medicine is becoming increasingly popular in states where it is allowed. Read More ›

Categories: Billing/Payment, Health Care Reform, Insurance, Providers

2015 Michigan Health Law Update

On March 12, 2015 Foster Swift Attorney Jennifer Van Regenmorter co-presented the Michigan Health Law Update (“Annual Update”) at the 21st Annual Health Law Institute. The Annual Update provides an overview of the most significant Michigan-specific health law developments from the past year, many of which have been covered on this blog. This article will summarize the highlights from this year’s Annual Update. Read More ›

Categories: Hospitals, Insurance, Licensing, Medicare/Medicaid, News & Events, Privacy

Supreme Court to Weigh in on Providers’ Rights to Sue for Medicaid Reimbursements

The Medicaid program, a public insurance program serving approximately 66 million low-income Americans, is at risk for losing participating providers who claim they are not being compensated fairly for their services. On January 19, 2015, the Supreme Court heard arguments in Armstrong v. Exceptional Child Center, a case that could impact the rights of healthcare providers to sue states for higher Medicaid payments. Five private companies brought suit against the director of Idaho’s health department, arguing that the state unfairly reimbursed them at rates set in 2006, despite the fact that higher rates have since been approved by the Centers for Medicare and Medicaid Services (“CMS”).

Federal law provides that state Medicaid programs must ensure payments are “sufficient to enlist enough providers,” but states have discretion to decide what that means. 42 U.S.C. § 1396a(a)(30)(A) (the “Medicaid Statute”).  Central to this case is whether providers have a cause of action that allows them to seek enforcement of a federal statute. Read More ›

Categories: Insurance, Medicare/Medicaid, Providers

"Right to Try" Becomes a Reality in Michigan

PrescriptionOn Friday, October 17, Governor Rick Snyder signed the Right to Try Act, which allows patients to try experimental drugs and other treatments before they have been approved by the Food and Drug Administration (FDA). The law gives patients with advanced illnesses access to drugs that successfully cleared Phase 1 of an FDA approval. Phase 1 testing seeks to establish a drug's safety and profile and evaluates possible side effects. It involves 20-80 volunteers and lasts approximately one year. Read More ›

Categories: Hospitals, Insurance, Physicians, Providers

Michigan Allowed to Move Dual Eligibles to Managed Care

managed careApproximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.

A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges. Read More ›

Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers

Obama Administration Makes Changes to Medicare to Accommodate Same-Sex Marriages

Obama Administration Makes Changes to Medicare to Accommodate Same-Sex MarriagesOn Thursday, April 3, 2014, the Obama administration announced that it was taking steps to bring its Medicare rules in line with the United States Supreme Court's ruling in US v. Windsor. Specifically, the Department of Health and Human Services (“HHS”) announced that same-sex marriages would be recognized for determining Medicare entitlement and eligibility. Read More ›

Categories: Employee Benefits, Insurance, Medicare/Medicaid, Providers