By continuing to use this site you consent to our use of cookies in accordance with our, Business Restructuring, Bankruptcy & Commercial Law, Business Reorganization and Restructuring, Commercial Contract Preparation and Disputes, Business Transactions & Corporate Counseling, Commercial Transactions and Property Acquisition, Compliance Counseling and Risk Management, Site Remediation and Brownfield Development, Nurse Practitioners and Registered Nurses, Corporate Governance & Compliance Investigations, Real Estate and Title Insurance Litigation, Tax Controversy, Criminal, White Collar Crimes. When selling a long term care insurance rider to an applicant, a life agent must take into consideration all of these factors, EXCEPT. Evidently not satisfied with the way in which the courts and federal enforcement agencies have applied Section 2 of the Sherman Act and seeking more expansive enforcement power over unilateral conduct, the proposed amendments include an ambiguous prohibition against activities of dominant firms that might be considered abus[ive]. Specifically, the amendments would make it unlawful under state law: for any person or persons with a dominant position in the conduct of any business, trade or commerce or in the furnishing of any service in this state to abuse that dominant position.34. {{currentYear}} American Bar Association, all rights reserved. Once it has been determined that a contractor or subcontractor is subject to OFCCP jurisdiction, the regulations implementing the civil rights requirements enforced by OFCCP apply to all of the contractors or subcontractors employees who are engaged in onsite construction, including those construction employees who work on a nonfederal or nonfederally assisted construction site. lock The term "health care providers," as used in the TRICARE Exemption and VAHBP Moratorium, is easily interpreted to include providers like blood banks, diagnostic labs, or ambulance services. If a State or local government has Government contracts, is it subject to the requirements of Executive Order 11246? If a business or organization has a Federal contract, subcontract, or federally assisted construction contract it may be subject to the requirements of Executive Order 11246. State Enforcers Expanding Premerger and Antitrust Jurisdiction Over 18116. No. Chapter 1 - The Business of Medicine Flashcards | Quizlet Jurisdiction Frequently Asked Questions | U.S. Department of Labor - DOL Under 45 CFR 146.145(a), a group health plan means an employee welfare benefit plan to the extent that the plan provides medical care (including items and services paid for as medical care) to employees (including both current and former employees) or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Non-Federal governmental plans can operate as self-funded plans, purchase a fully insured group insurance product, or consist of a mixture of self-funded and fully insured options. or Similarly, consumers will continue to contact the state for inquiries and complaints relating to the health insurance market reform requirements. Compliance Checkup: Affirmative Action: Is your health care entity subject to affirmative action laws. What is an "insurance broker" according to California Insurance Code? Washington alleged that the transactions combined the largest primary care and orthopedic service providers, resulting in reduced choice and higher prices for consumers. It is not intended as a form of, or as a substitute for legal advice. Accordingly, if your business or organization became a fund depository or an issuing and paying agent for savings bonds and notes on or after December 1, 2003, it would also be subject to the written AAP requirement under VEVRAA if the contract is for $150,000 or more. Therefore, if you serve as a depository for federal funds of $50,000 or more, or have an agreement valued at $50,000 or more to be an issuing and paying agent for savings bonds and notes, you would be obligated to develop and maintain a Section 503 AAP. The implementing regulations for Executive Order 11246 at 41 CFR 60-1.3, for VEVRAA at 41 CFR 60-300.2 and for Section 503 at 41 CFR 60-741.2, consistently define a government contract as any agreement or modification thereof between any contracting agency and any person for the purchase, sale or use of personal property or nonpersonal services. Regardless of how small a deal is, the parties need to understand the competitive implications. Insurer What type of license is required for an individual who charges a fee to review an insured's existing life insurance policy? Part 60-741.5(a).. .manual-search ul.usa-list li {max-width:100%;} website belongs to an official government organization in the United States. Region. Prior to enactment of the Affordable Care Act, sponsors of self-funded, non-Federal governmental plans were permitted to elect to exempt those plans from, or opt out of, certain provisions of the Public Health Service (PHS) Act. . ERISA requires plans to provide participants with plan information including important information . Potential covered contracts or subcontracts may include contracts related to Medicare Advantage (Part C) or Part D programs. What type of license is required for an individual who charges a fee to review an insured's existing life insurance policy? or Executive Order 11246, as amended (Executive Order) implementing regulations at 41 CFR 60-1.40(a) and 41 CFR 60-2.1(b) state, in relevant part, that any nonconstruction (Supply and Service) contractor that serves as a depository of government funds in any amount or a financial institution which is an issuing and paying agent for U.S. saving bonds and saving notes in any amount must develop an affirmative action program. Stat. Are health care providers like blood banks, diagnostic labs and ambulance services under the TRICARE Exemption and/or the scheduling moratorium for VAHBP providers? In addition to the premerger notification provision, SB 977 also targeted conduct by healthcare systems. RCW 19.390.080. Notably, unlike the federal premerger notification system under the Hart-Scott-Rodino Antitrust Improvements Act (HSR),1 neither the Connecticut nor the Washington statute has a minimum size-of-transaction threshold. .gov Accordingly, non-Federal governmental plans are subject to the provisions of Part A of title XXVII of the PHS Act, including any changes made by the ACA. Californias proposed bill recently died in the legislature, but a new or similar version is likely to be introduced next year. She can be reached at megan.morley@troutman.com Our business operates as a fund depository, and an issuing and paying agent for U.S. .usa-footer .container {max-width:1440px!important;} The implementing regulations for VEVRAA and Section 503, found at 41 CFR 60-300.2 and 41 CFR 60-741.2, respectively, also define a government contract as any agreement or agreement modification between any contracting agency and any person for the purchase, sale or use of personal property or nonpersonal services. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). Dennie Zastrowis an Associate in the Business Litigation practice group at Troutman Pepper. He represents clients in antitrust class action, consumer protection, and breach of contract litigations in federal and state court. He also counsels clients on the HSR Act. He can be reached atdennie.zastrow@troutman.com. Yes. Which type of jurisdiction requires an insurer to have its rates accepted by the Insurance Department prior to using them? Long-term care is covered by Medicare Part C. The new Department of Managed Health Care (DMHC) primarily regulates health maintenance organizations (HMOs), while the California Department of Insurance (CDI) has jurisdiction over traditional health insurance. Policy form review is one of the compliance tools used to confirm health insurance issuers' compliance with the provisions of the health insurance market reforms of the Affordable Care Act. 0000002414 00000 n CMS will work cooperatively with the state to address any concerns. Pursuant to this authority, CMS may investigate and implement corrective action or impose civil monetary penalties for any non-Federal governmental plan that fails to comply with applicable PHS Act requirements. Some examples of non-Federal governmental plans are plans that are sponsored by states, counties, school districts, and municipalities. ) When that happens, CMS will work with the state to ensure an effective transition. @media (max-width: 992px){.usa-js-mobile-nav--active, .usa-mobile_nav-active {overflow: auto!important;}} The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 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. lock Department of Insurance HiCap MRMIP California life and health guarantee association Department of Insurance Insurance agents and brokers must make their insurance records available to the commissioner Only during the first month of the year only during the last month of the year Each regional MAC. However, it is reasonable to assume that proof of a dominant position would not require proof of market power because conduct by firms with market power is already addressed by the monopolization section of the amendments. For additional qualifications and requirements, please visit the U.S. Department of Labor Office of Federal Contract Compliance Programs website, at https://www.dol.gov/ofccp/ and ask your attorney to ensure your health care entity is in compliance. Sign up to get the latest information about your choice of CMS topics. We dont do any government work here. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Your Rights Under HIPAA | HHS.gov After collection and review of policy forms for compliance with the respective market reform provisions, CMS will notify issuers of any concerns. My company has contracts with the U.S. Department of Veterans Affairs to provide non-medical services. You can decide how often to receive updates. She represents clients in the healthcare industry on a full range of antitrust matters, including provider affiliations and acquisitions, contract negotiations between health systems and payors, litigation against competitors, and advocacy before federal and state enforcement agencies. .manual-search ul.usa-list li {max-width:100%;} 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 Under Section 503, however, all government contracts must meet the dollar threshold amount of $50,000 for coverage. Although only a few states currently require certain transactions be notified, this list will likely continue to grow. Like the Executive Order regulations, these regulations also state that the term "nonpersonal services" includes, but is not limited to the following services: Therefore, financial institutions with federal share and deposit insurance are considered to be government contractors. In California, the elderly can receive information about health related issues from? 0000008002 00000 n Many of the market reforms and consumer protections in Part A of title XXVII of the PHS Act are new provisions that became effective for plan years beginning in 2014. Final Exam Flashcards | Chegg.com 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? Compliance and Enforcement | CMS - Centers for Medicare & Medicaid Services For example, a hospital may be a covered contractor as a result of a contract with the Department of Veterans Affairs or the Department of Defense requiring the provision of medical services to active or retired military personnel. 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. Local Coverage Determinations are administered by whom? Barbara Sicalidesis a Partner in the Business Litigation practice group at Troutman Pepper. She represents clients in the healthcare industry on a full range of antitrust matters, including provider affiliations and acquisitions, contract negotiations between health systems and payors, litigation against competitors, and advocacy before federal and state enforcement agencies. She can be reached atbarbara.sicalides@troutman.com. Even if states do not have premerger notification requirements, they still can challenge transactions. Health Insurance Counseling and Advocacy Program (HiCAP). Washington, DC 202101-866-4-USA-DOL1-866-487-2365www.dol.gov, Office of Federal Contract Compliance Programs, Office of Administrative Law Judges OFCCP Collection, Significant Guidance Documents (formerly "Guidance Documents"), Functional Affirmative Action Programs (FAAP), Notification of Construction Contract Award Portal, Opening Doors of Opportunity for All Workers Poster. He represents clients in antitrust class action, consumer protection, and breach of contract litigations in federal and state court. He counsels clients on antitrust issues with respect to mergers and acquisitions; litigates boycott, monopolization, and patent misuse cases; and advises clients on distribution, joint venture, and licensing strategies. These efforts show that states are taking a more active role in the investigation and enforcement of the antitrust laws, especially in the healthcare sector. Therefore, federal contractors in the State of California must comply with the Executive Order and its affirmative action requirements. RCW 19.390.040. Dennie Zastrow is an Associate in the Business Litigation practice group at Troutman Pepper. The website for the Connecticut attorney general provides an Excel form and instructions for the submission. which entity has jurisdiction over health care coverage providers HHS Argues Covered Entities Cannot Intervene in 340B Drug Pricing Case. In 2017, Washington sued CHI Franciscan over two consummated deals with orthopedic providers in Kitsap county. The term "nonpersonal services" includes, but is not limited to, the following services: This definition thus explicitly includes agreements for insurance. 0000001958 00000 n Generally speaking, once it has been determined that a business or organization is subject to the equal employment opportunity requirements enforced by OFCCP, all of the businesss or organizations establishments or facilities will be subject to the same regulatory requirements, regardless of where the federal contract is to be performed. 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. Theres little concrete guidance on this complex issue, but heres what we do know about common areas of concern: The provider agreements, pursuant to which hospitals and other health care providers receive reimbursement for services covered under Medicare Parts A and B, and the provider agreements that hospitals and other health care facilities have entered into with State Medicaid agencies, are not covered Government contracts under the laws enforced by OFCCP. The term "health care providers," as used in the TRICARE Exemption and VAHBP Moratorium, is easily interpreted to include providers like blood banks, diagnostic labs, or ambulance services. For example, Connecticut and Washington enacted and California has proposed legislation requiring premerger notification to their respective state attorney general offices of certain healthcare-related deals before consummation. ol{list-style-type: decimal;} -Medicare is primarily funded by Federal payroll and self-employment taxes. 1980). The term "nonpersonal services" as used in this section includes fund depository. 0000001980 00000 n States and CMS have worked closely to ensure compliance with the health insurance accountability and consumer protections in federal law. 0000017602 00000 n These states can then use the information gathered from these notifications for their investigative and enforcement functions possibly challenging the transactions. may have jurisdiction over a health care provider receiving Medicare reimbursements if the health care provider also holds a separate covered federal contract or subcontract. The same regulations generally define a government subcontract as any agreement or arrangement between a contractor and any person (in which the parties do not stand in the relationship of an employer and an employee) for the purchase, sale or use of personal property or nonpersonal services which, in whole or in part, is necessary to the performance of any one or more contracts; or under which any portion of the contractors obligation under any one or more contracts is performed, undertaken or assumed. Importantly, however, even if a merger is not reportable under the HSR Act, the federal antitrust regulators still can become aware of (via customer complaints, news reports, trade publications, and the like), investigate, and challenge the transaction. Moreover, SB 977 not only would have applied to transactions among non-profit healthcare entities but also to acquisitions and affiliations by private equity groups and hedge funds with healthcare investments. All contractors and subcontractors who hold a federal contract in excess of $10,000 are subject to regulatory requirements under one or more of the laws enforced by OFCCP depending upon the amount of the contract. Although the legislative session ended without the State Assembly taking action, it is likely that the same or a similar bill could be reintroduced in 2021.29. Whether to voluntarily notify state enforcers. @media only screen and (min-width: 0px){.agency-nav-container.nav-is-open {overflow-y: unset!important;}} 0000015627 00000 n Even if the parties carry their burden of demonstrating such benefits, the attorney general would still have the discretion to deny his or her consent if he or she finds there is a substantial likelihood of anticompetitive effects that outweigh the benefits of anticipated clinical integration and/or increased services to an underserved population. 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 (VEVRAA) as under Section 503 for any government contractor with 50 or more employees and a contract of $50,000 or more to serve as a depository of federal funds or as an issuing and paying agent for savings bonds and notes, if the Government contract was entered into before December 1, 2003. Non-Federal governmental plans are not regulated the same way as insurance companies or private employer health plans. trailer << /Size 110 /Info 60 0 R /Root 63 0 R /Prev 113598 /ID[<316761acfb838f940b729f6e746b7375><0433f655088ef2546be3616a7ff69e33>] >> startxref 0 %%EOF 63 0 obj << /Type /Catalog /Pages 59 0 R /Metadata 61 0 R /PageLabels 58 0 R >> endobj 108 0 obj << /S 360 /L 533 /Filter /FlateDecode /Length 109 0 R >> stream Instead, the Antitrust Division typically seeks criminal penalties only for agreements between or among competitors to fix prices or allocate customers or markets. ( #block-googletagmanagerheader .field { padding-bottom:0 !important; } Health care system consolidation: Attorney General approval and enforcement, California Senate Bill 977 (2020). In Colorado, legislators recently expanded the states ability to challenge all mergers, not only healthcare transactions, by repealing a statutory provision that curbed its enforcement power.3 Although Colorado did not create a system for premerger notification, it did give the Colorado attorney general the ability to challenge transactions regardless of whether the federal antitrust authorities object to those deals. These three programs enforced by the Office of Federal Contract Compliance Programs (OFCCP) require equal employment opportunity by government contractors. which entity has jurisdiction over health care coverage providers 131E-176 (13) that has an electronic health Covered Entities for purposes of HIPAA include health care providers who submit claims using electronic "standard transactions" as well as health plans and health care clearinghouses. -Doctors' services are covered by Medicare Part B. 41 CFR 60-741.2(i). Per SB 977, substantial market power can be shown by either (1) the conduct having a substantial anticompetitive effect, or (2) the health care system having substantial market share in one or more markets (with a system presumed to have substantial market power if it has greater than a 60% share). In the past, the U.S. Department of Labors Office of Federal Contract Compliance Programs (OFCCP) has aggressively argued that health care providers that participate in one of three federal health care programs Medicare, TRICARE, and the Federal Employee Health Benefits Program are federal subcontractors. 1-888-4LA-CARE (1-888-452-2273)Provider Information. You may wish to consult the elaws Advisor if you have additional questions about coverage. 0000027421 00000 n Free Flashcards about Financial Test - StudyStack 0000004716 00000 n 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. 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. Saving Bonds and savings notes; therefore, are we required to comply with Affirmative Action Program (AAP) obligations under Executive Order 11246, VEVRAA, and Section 503? This antitrust safety zone will not apply if that hospital is less than 5 years old. Statements of Antitrust Enforcement Policy in Health Care. 15 U.S.C. Colorado is another state that is taking merger control into its own hands. Are we subject to the equal employment laws enforced by OFCCP? He can be reached at dennie.zastrow@troutman.com. The provider agreements, pursuant to which hospitals and other health care providers receive reimbursement for services covered under Medicare Parts A and B, and the provider agreements that hospitals and other health care facilities have entered into with State Medicaid agencies, are not covered government contracts under the laws enforced by OFCCP. Notice of Material Change Form. CMS will form a collaborative arrangement with any state that is willing and able to perform regulatory functions but lacks enforcement authority. The information in this section will be of interest to state and local governmental employers that provide self-funded group health plan coverage to their employees, administrators of those group health plans, and employees and dependents who are enrolled, or may enroll, in those plans. 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. Despite Congressional Action OFCCP Signals Intent to Continue Heres how you know. In order to be eligible for the TRICARE Exemption, the entity must hold a TRICARE subcontract (rather than a prime contract) and hold no other covered agreements. 0000002187 00000 n For your additional information, there is an interactive electronic tool called the Federal Contract Compliance Advisor, also referred to as elaws Advisor, to assist federal contractors and subcontractors in understanding basic coverage and the requirements for compliance with the laws administered by OFCCP. Further, the VAHBP Moratorium is not a complete exclusion from OFCCPs authority as it only relieves an entity from being neutrally scheduled for a compliance evaluation. A representation may be altered or withdrawn, state program that offers health coverage to California residents who are not able to obtain coverage due to pre-existing conditions. OFCCP Issues Final Rule on TRICARE Participation and Covered Health Although the extent of the states future role in antitrust and healthcare affiliations, and, whether a change in the federal administration will affect that role, remains unclear, there is no doubt that a number of states have added or are considering adding to their available enforcement tools, giving them more opportunities to intervene. 0000035664 00000 n Since the effective date of a transaction can have a myriad of implications (financing, tax, contractual, regulatory, etc. 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. 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. Any person or other entity, including a provider sponsored organization that operates under the Medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act . A. However, these time frames could be extended if the attorney general decided to hold a public meeting about the transaction or if the parties substantially changed the deal.24 Parties could appeal the attorney generals determination to deny approval for a transaction via writ of mandate to a California superior court.25 The same holds true under Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. If a contractor performs work outside of the United States, is it subject to OFCCPs jurisdiction under the authorities it enforces? .gov lock 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.