COVERED CALIFORNIANS Is an insurance company that supplies workers compensation insurance to a federal contractor subject to the requirements of Executive Order 11246? Is a hospital or other health care provider covered under the laws enforced by OFCCP as a result of the reimbursements it receives for medical care and services provided to Medicare or Medicaid patients? Holds government bills of lading, serves as a depository of federal funds, or is an issuing and paying agency for U.S. savings bonds and notes in any amount will be subject to requirements under one or more of the laws enforced by OFCCP. Pete is a life agent who has misappropriated fiduciary funds to his own use. Please note that a hospital or other health care provider may be a covered contractor because of other contractual arrangements, such as providing health care to active or retired military under a contract with the Department of Veterans Affairs or the Department of Defense. 1. 1980). Which entity has jurisdiction over health care coverage providers? ) Share sensitive information only on official, secure websites. SB 977, at 1191(a)-(b). .usa-footer .container {max-width:1440px!important;} What if my health care entity does fall under the jurisdiction of OFCCP? Brouse McDowell, A Legal Professional Association. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). The term "nonpersonal services" as used in this section includes fund depository. If California (or other states) pass the same or similar legislation, then parties will need to be prepared to explain these outcomes or will risk the deal being denied approval. Press Release from the California Office of the Attorney General, SB 977, at 1190.25(a). An in-network provider is a physician, hospital, or other health care provider with whom a health plan has negotiated a payment rate. Californias proposed bill put the onus on the parties to show the attorney general how the transaction would lead to clinical integration and increased or maintained access for underserved populations. Notice of Material Change Form. According to the California Insurance Code, what is the maximum penalty per violation for anyone who unwillfully commits an unfair method of competition? Secure .gov websites use HTTPSA Understanding these tools and the trend will allow healthcare entities and their counsel to better estimate their deal timelines and better prepare for and predict state intervention. In the event that a state notifies the Centers for Medicare & Medicaid Services (CMS) that it does not have statutory authority to enforce or that it is not otherwise enforcing one or more of the provisions of title XXVII, or if CMS determines that the state is not substantially enforcing the requirements, CMS has the responsibility to enforce these provisions in the state. The parties settled prior to trial with CHI Franciscan agreeing to have separate payor contracting for primary care and orthopedic services and to pay $2.5 million to the state. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. CMS has responsibility for enforcing these requirements in a state that is not enforcing the health insurance market reforms either through a collaborative arrangement with the state or by direct enforcement to ensure all residents of the state receive the protections of the Affordable Care Act. 0000035052 00000 n 0000012185 00000 n ol{list-style-type: decimal;} Currently, the Donnelly Act prohibits only anticompetitive activities from agreements or conspiracies, like federal laws Section 1 of the Sherman Act. Compliance Checkup: Affirmative Action: Is your health care entity subject to affirmative action laws. According to the California Insurance Code, how is the word "may" interpreted? In addition, pursuant to Section 7 of the Clayton Act, the federal antitrust laws prohibit acquisitions that may substantially lessen competition or tend to create a monopoly. Federal Reserve Bank of Boston v. Commissioner of Corporations and Taxation of the Commonwealth of Massachusetts, 499 F.2d 60 (1st Cir. According to PPACA, what is a health benefits exchange? Under Section 503 of the Rehabilitation Act of 1973, as amended (Section 503), a government contractor with 50 or more employees and a Government contract of $50,000 or more must develop a Section 503 AAP. Nonetheless, OFCCP has not conceded jurisdiction over healthcare providers that participate in TRICARE and FEHBP networks. In addition to identifying the parties, the notice must include the locations where healthcare services are provided by each party, the anticipated effective date, and a brief description of the nature and purpose of the material change.14 Washingtons attorney general can also request additional information (including documents, interrogatory responses, and oral testimony) within 30 days of the notice being submitted.15 Any party that fails to submit the requisite notice faces penalties of up to $200 per day.16, Californias proposed SB 977 would have required healthcare systems, private equity firms, and hedge funds to provide notice to and receive approval from the states attorney general before closing acquisitions or changes of control with other healthcare facilities and providers.17 The proposed bill covered a wide range of healthcare affiliations, including: (1) the direct or indirect purchases through leases, transfers, exchanges, options to acquire assets, or creation of a joint venture by a healthcare system, private equity group, or hedge fund of a material amount of the assets of a healthcare facility or provider; or (2) any agreement, association, partnership, joint venture, or other arrangement that results in a change of governance or control at a provider or facility by a healthcare system.18 The legislation would have expanded the existing notification requirements, which apply only to transactions with nonprofit health providers.19 The California attorney general announced that the legislation was needed to combat anticompetitive behavior in the healthcare sector, which he claimed is a growing concern and responsible for higher rates and decreased quality of care in California.20 Under this collaborative approach, if the state finds a potential violation and is unable to obtain voluntary compliance from an issuer, it will refer the matter to CMS for possible enforcement action. Hb```f``d`c`d`@ Vv%`jLW1*,Pz=oJ'6$X!n&}kLU wF6Q&,fI_2N9Nx3}IOtMX5I.T|d{nRFB@ C T\1(YJJJ&pP5@4b1F8 `\`ig`h``sa`Hr``b`Hhjb`HMop Cy7N=`L7&j`}C@8U_ XElD,\Pbqn ; endstream endobj 109 0 obj 463 endobj 64 0 obj << /Type /Page /Parent 59 0 R /Resources 65 0 R /Contents [ 69 0 R 71 0 R 73 0 R 75 0 R 77 0 R 81 0 R 94 0 R 96 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> endobj 65 0 obj << /ProcSet [ /PDF /Text ] /Font << /F1 90 0 R /F2 83 0 R /F3 85 0 R /F4 84 0 R /F5 88 0 R /F6 78 0 R >> /ExtGState << /GS1 102 0 R /GS2 103 0 R >> /ColorSpace << /Cs6 66 0 R /Cs8 67 0 R /Cs9 89 0 R >> >> endobj 66 0 obj [ /ICCBased 107 0 R ] endobj 67 0 obj [ /Separation /PANTONE#205777#20U 66 0 R 104 0 R ] endobj 68 0 obj 2093 endobj 69 0 obj << /Filter /FlateDecode /Length 68 0 R >> stream 62 0 obj << /Linearized 1 /O 64 /H [ 1401 579 ] /L 114966 /E 50989 /N 8 /T 113608 >> endobj xref 62 48 0000000016 00000 n A TRICARE provider that holds another covered contract, such as a prime contract or a subcontract apart from the TRICARE provider contract, would still need to comply with OFCCPs requirements. Therefore, federal contractors in the State of California must comply with the Executive Order and its affirmative action requirements. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies. Section 2707 - Non-discrimination under Comprehensive Health Insurance Coverage (Essential Health Benefits Package) Section 2713 - Coverage of Preventive Health Services Section 2718 - Bringing down the Cost of Health Care Coverage (MLR) Section 2719 - Appeals Process Section 2726 - Parity in Mental Health and Substance Use Disorder Benefits 4212, and Section 503 of the Rehabilitation Act of 1973 (Section 503), as amended. 0000018200 00000 n 0000045440 00000 n There are circumstances where explaining the benefits of and reasons for a transaction before an agency formulates its independent view can streamline and shorten the timeline of a likely inevitable investigation as well as providing greater certainty to the parties. A person compensated for transacting insurance on behalf of another person with an insurer. {{currentYear}} American Bar Association, all rights reserved. Your practice or facility may not be subject to affirmative action laws, so read on to understand whether you should accept this provision in an agreement or not. All rights reserved. Share sensitive information only on official, secure websites. lock Which of the following actions is NOT allowed by Health Insurance Counseling and Advocacy Program (HiCAP) counselors? Secure .gov websites use HTTPSA As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. The Affordable Care Act has given Americans new rights and benefits, by helping more children get health coverage, ending lifetime and most annual limits on care, allowing young adults under 26 to stay on their parents' health insurance, and giving patients access to recommended preventive services without cost. 0000002187 00000 n The term "nonpersonal services" includes, but is not limited to, the following services: This definition thus explicitly includes agreements for insurance. If you have any doubts about your entitys status, be sure to ask your Brouse attorney for assistance in evaluating whether you need to comply with affirmative action requirements. CMS will form a collaborative arrangement with any state that is willing and able to perform regulatory functions but lacks enforcement authority. You may wish to consult the elaws Advisor if you have additional questions about coverage. Whether California (or another state) enacts legislation requiring state approval of transactions. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. A. LCDs only have jurisdiction . Megan Morleyis a Senior Attorney in the Business Litigation practice group at Troutman Pepper. She advises healthcare clients on the antitrust implications of transactions, defends hospital systems against allegations of antitrust wrongdoing, and prepares pre-merger notification filings for healthcare deals. She can be reached atmegan.morley@troutman.com. 15 U.S.C. The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. The South Carolina Lifeand Accident and Health Insurance Guaranty Association(SCLAHIGA) may cover certain direct life insurance policies, accident and health insurance policies, annuity contracts, and contracts supplemental to life, accident, and health insurance policiesand contracts under South Carolina law. The amendments proposed to the Donnelly Act, if enacted, would dramatically expand the reach of New Yorks state antitrust laws and the ability of the attorney general to pursue claims under state law that it previously was only able to bring under federal law. .gov The ARB determined that the reimbursement agreement did not provide a basis for coverage of the hospital under the laws enforced by OFCCP. Specifically, the amendments would add a provision virtually identical to Section 2 of the Sherman Act. 0000009656 00000 n OFCCP will use the insurance premium to determine if the covered insurance contract meets the $50,000 threshold requirement necessary to obligate the federal contractor to develop and maintain an Executive Order 11246 AAP, not the face value of the policy. Is CMS a regulatory agency? 0000016173 00000 n 0000018799 00000 n https:// For a list of provisions that are applicable to non-Federal governmental plans both grandfathered and non-grandfathered please see the checklists available at the Other Resources link on this page. The Patient Protection and Affordable Care Act, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010, (collectively known as the Affordable Care Act)(ACA) reorganized, amended, and added to the provisions of Part A of title XXVII of the PHS Act. Which entity has jurisdiction over health care coverage providers? 41 CFR 60-741.40(a). Similarly, under federal antitrust policy, rural hospital transactions would often, if applied, fall within the FTC and DOJ Antitrust Divisions small hospital safety zone criteria: The Agencies will not challenge any merger between two general acute-care hospitals where one of the hospitals (1) has an average of fewer than 100 licensed beds over the three most recent years, and (2) has an average daily inpatient census of fewer than 40 patients over the three most recent years, absent extraordinary circumstances. The State Flexibility Cycle I Grant program will provide $8.6 million in grant funds and the State Flexibility Cycle II Grant program will provide $19.6 million in grant funds to assist States in implementing and/or planning the following provisions of Part A of Title XXVII of the PHS Act: Sign up to get the latest information about your choice of CMS topics. Yes. Instead, the Antitrust Division typically seeks criminal penalties only for agreements between or among competitors to fix prices or allocate customers or markets. Covered entities taking reasonable steps to limit use or disclosure of PHI . .gov 1974). Watch out for this language! An entity to which individuals and small businesses can have access to affordable health coverage According to the California Insurance Code, who is responsible for submitting a life agent's appointment? The purpose of the HSR Act is to allow federal authorities an opportunity to review, in advance of closing, transactions exceeding a certain size in order to determine whether they might adversely affect competition. If your entity is not subject to affirmative action requirements, make sure you dont inadvertently agree to comply in any contract you may have with a federal contractor. ( .table thead th {background-color:#f1f1f1;color:#222;} What is Medi? An Act Concerning Notice of Acquisitions, Joint Ventures, Affiliations of Group Medical Practices and Hospital Admissions, Medical Foundations, and Certificates of Need, P.A. In order to be eligible for the VAHBP Moratorium, the entity must hold an agreement (prime or subcontract) to provide services or supplies to VAHBP beneficiaries and hold no other covered agreements. Washington alleged that the transactions combined the largest primary care and orthopedic service providers, resulting in reduced choice and higher prices for consumers.

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