0000002523 00000 n Jurisdiction Frequently Asked Questions | U.S. Department of Labor - DOL Are we subject to the equal employment laws enforced by OFCCP? States and CMS have worked closely to ensure compliance with the health insurance accountability and consumer protections in federal law. A health care entity becomes a federal contractor when it performs services that are used by the federal government, either through a direct contract with a federal government agency or an indirect arrangement with another entity that has a federal contract. He can be reached at daniel.anziska@troutman.com. @media (max-width: 992px){.usa-js-mobile-nav--active, .usa-mobile_nav-active {overflow: auto!important;}} p.usa-alert__text {margin-bottom:0!important;} Dennie Zastrow is an Associate in the Business Litigation practice group at Troutman Pepper. Although the proposed amendments to New Yorks Donnelly Act are not limited in application to the healthcare industry, the contemplated abuse of dominance provision could present significant increased enforcement risk for healthcare providers. Jurisdiction of Insurance Department; exception - Justia Law What is required after a life agent sells an insurance policy to an applicant without being appointed by the insurer? 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. After collection and review of policy forms for compliance with the respective market reform provisions, CMS will notify issuers of any concerns. Which entity has jurisdiction over health care coverage providers? Although only a few states currently require certain transactions be notified, this list will likely continue to grow. Select the appropriate response ( 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. State Flexibility Cycle I and II Grants will provide States with the opportunity to ensure their laws, regulations, and procedures are in line with Federal requirements, and enhance the States ability to effectively regulate their respective health insurance markets through innovative measures that support the pre-selected market reforms and consumer protections under Part A of Title XXVII of the Public Health Service (PHS Act). 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. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). No. PDF Regulatory Oversight of Health Insurance in California For questions and concerns regarding non-Federal governmental plans, please e-mail NonFed@cms.hhs.gov. 1980). TRICARE OFCCP believes it has jurisdiction over health care providers that participate as TRICARE network providers. OFCCP Issues Final Rule on TRICARE Participation and Covered Health Based on the difference between the new and original policy annual premiums, The California Insurance Code defines "policy" as a(n). 0000035664 00000 n HlW$5|y~8N3|-oOU93-.?G9b?w]vg,TTTu_>z#:HOTH%SO>cavF^OvK>R$l]aSbgu?sVdYpv|C}`,Z#MH#}-^U"} $sF'tq7i!G?>:835^27LX Yes. Before sharing sensitive information, make sure youre on a federal government site. 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 guidance on this topic, please consult OFCCPs FAQs on the Single Entity Test at https://www.dol.gov/agencies/ofccp/faqs/single-entity-test. Heres how you know. ERISA | U.S. Department of Labor - DOL 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. History of EBSA and ERISA | U.S. Department of Labor - DOL 15 U.S.C. 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. 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). which entity has jurisdiction over health care coverage providers Whether a state in which a party to the transaction is located or does business has any notification obligations. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be covered. .dol-alert-status-error .alert-status-container {display:inline;font-size:1.4em;color:#e31c3d;} In addition, business associates of covered entities must follow parts of the HIPAA regulations. This article first describes the legislation in Connecticut, Washington, California, Colorado and New York in more detail and then offers guidance for those entities considering entering into healthcare-related deals. 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. Final Exam Flashcards | Chegg.com It would make it unlawful under state law: for any person or persons to monopolize, or attempt to monopolize, or combine or conspire with any other person or persons to monopolize any business, trade or commerce or the furnishing of any service in this state.33. He represents clients in antitrust class action, consumer protection, and breach of contract litigations in federal and state court. .gov website belongs to an official government organization in the United States. which entity has jurisdiction over health care coverage providers This blog is intended to provide information generally and to identify general legal requirements. 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. .paragraph--type--html-table .ts-cell-content {max-width: 100%;} . Non-Federal governmental plans are not regulated the same way as insurance companies or private employer health plans. Region. Under Section 503, however, all government contracts must meet the dollar threshold amount of $50,000 for coverage. 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. What entities are subject to the requirements of Executive Order 11246? Daniel Anziksais a Partner in the Business Litigation practice group at Troutman Pepper. 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. He can be reached atdaniel.anziska@troutman.com. Connecticuts legislation, enacted in 2014, requires that certain transactions between physician group practices and hospitals, captive professional entities, medical foundations, or other group practices be reported to the states attorney general.6 Under the law, a group practice can be as small as two physicians operating through the same entity, and transactions that cause a material change to the structure or business of a group practice need to be reported no less than 30 days prior to consummation.7 Transactions constituting a material change are broadly defined and include: (1) merger, consolidation, or other affiliation of a group practice with a hospital, hospital system, or another group practice that results in a practice with eight or more physicians; (2) acquisition of all or substantially all of the assets, stock, or equity interests of a group practice by a hospital, hospital system, or another group practice that results in a practice with eight or more physicians; and (3) employment of all or substantially all of the physicians in a group practice by a hospital, hospital system, or another group practice that results in a practice with eight or more physicians.8 Under the statute, the parties must provide to the attorney general a description of the nature of the proposed relationship and information regarding the physicians, entities, and service locations involved.9 In addition, the statute requires any hospital system or other healthcare provider conducting business in Connecticut that files a premerger notification under the HSR Act to provide written notice of that filing to the Connecticut attorney general.10 lock 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. Given the narrow geographic market definition applied to providers and the fact that high market concentration among specialists or service lines (e.g., Level 1 Trauma) often exists, physician groups and hospitals will need to proceed with caution when taking actions that are likely to harm their actual or potential competitors. This definition thus explicitly includes agreements for insurance, which would cover FEGLI contracts. .manual-search ul.usa-list li {max-width:100%;} The Health Insurance Enforcement and Consumer Protections Grant program will provide $25.5 million in grant funds to assist States in implementing and/or planning the following provisions of Part A of Title XXVII of the Public Health Service (PHS) Act: The State Flexibility to Stabilize the Market Grant Program, comprised of - (State Flexibility Cycle I and II Grants,) will provide a funding source to enhance the role of States in planning and implementing several of the Federal market reforms and consumer protections. Covered entities taking reasonable steps to limit use or disclosure of PHI . Chapter 1 - The Business of Medicine Flashcards | Quizlet Under the federal merger control regime, both the FTC and DOJ Antitrust Division have the authority to investigate and challenge mergers. Are health care providers like blood banks, diagnostic labs and ambulance services under the TRICARE Exemption and/or the scheduling moratorium for VAHBP providers? Therefore, even small transactions, which might have gone unnoticed by federal enforcers, could be subject to antitrust scrutiny by state enforcement agencies. 0000011315 00000 n Proposed amendments to New York States antitrust statute the Donnelly Act would expand that law to capture unilateral conduct generally treated as competitively neutral or even procompetitive under current federal antitrust laws. 0000014828 00000 n The term "nonpersonal services" includes, but is not limited to, the following services: This definition thus explicitly includes agreements for insurance. Part 60-250.5(a) and Part 60-300.5(a), and 41 C.F.R. The site is secure. 0000004716 00000 n Share sensitive information only on official, secure websites. 0000027421 00000 n 0000012163 00000 n See 41 CFR 60-1.5(a)(3), 60-300.4(a)(3), 60-741.4(a)(3). https:// Your Rights Under HIPAA | HHS.gov 0000002545 00000 n If a request for additional information was issued, then the attorney general had 45 days from substantial compliance with the request to grant or deny approval of the transaction. Secure .gov websites use HTTPSA Despite Congressional Action OFCCP Signals Intent to Continue 0000018799 00000 n ERISA. This policy is based on the decision of DOLs Administrative Review Board (ARB) in OFCCP v. Bridgeport Hospital, ARB Case No. Since the effective date of a transaction can have a myriad of implications (financing, tax, contractual, regulatory, etc. 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 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? Department of Insurance: How is an agent's first year commission calculated for a replacement long-term policy? Recent Changes to the Definition of Sex Discrimination Under Section 1557 of the Patient Protection and Affordable Care Act, Eleventh Circuit Holds that the Government Need Not Prove a Payees Motivation for Accepting a Payment Under the Anti-Kickback Statute, Representations and Warranties Insurance: An Essential Component of Healthcare Mergers and Acquisitions, American Bar Association CMS will work cooperatively with the state to address any concerns. .manual-search-block #edit-actions--2 {order:2;} 0000001958 00000 n 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. Yes. 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? 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. 0000007980 00000 n 0000009634 00000 n 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 An agency within the U.S. Department of Labor, 200 Constitution Ave NW Holds a single federal contract, subcontract, or federally assisted construction contract in excess of $10,000.00; Has federal contract or subcontracts that combined total in excess of $10,000.00 in any 12month period; or. This election was authorized under section 2721(b)(2) of the PHS Act, which is now designated as section 2722(a)(2) of the PHS Act (42 USC 300gg-21(a)(2)). As a result of the enactment of the Federal Employees' Retirement System Act of 1986 (FERSA), EBSA has fiduciary and auditing oversight of the Thrift Savings Plan that was established by this Act. 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. 1974). 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. Healthcare providers are responsible for developing ____ ____ and policies and procedures regarding privacy in their practices. Accordingly, healthcare providers and counsel to such providers should consider the following: As states are taking a more active role in antitrust investigations and enforcement, it is important for healthcare entities, investors in the healthcare space, and their counsel to keep an eye on this trend and how it impacts their deals and conduct. 0000020767 00000 n Financial institutions with federal share and deposit insurance are considered to be government contractors within the meaning of the regulations implementing Executive Order 11246, as amended (Executive Order); Section 503 of the Rehabilitation Act of 1973, as amended (Section 503); and the Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. Which entity has jurisdiction over health care coverage providers? 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. Our business operates as a fund depository, and an issuing and paying agent for U.S. 4212, and Section 503 of the Rehabilitation Act of 1973 (Section 503), as amended. It is unclear what would constitute a dominant position under the proposed statute. 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. In 2017, Washington sued CHI Franciscan over two consummated deals with orthopedic providers in Kitsap county. #views-exposed-form-manual-cloud-search-manual-cloud-search-results .form-actions{display:block;flex:1;} #tfa-entry-form .form-actions {justify-content:flex-start;} #node-agency-pages-layout-builder-form .form-actions {display:block;} #tfa-entry-form input {height:55px;} You may wish to consult the elaws Advisor if you have additional questions about coverage. Title XXVII of the Public Health Service Act (PHS Act) contemplates that states will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with health insurance market reforms. 12 The healthcare material change notice requirement applies when (1) both parties are Washington entities or (2) one party is a Washington entity and the other is an out-of-state entity that generates $10 million or more in revenue from healthcare services for patients residing in Washington.13 Transactions meeting these criteria must be reported regardless of size. State Enforcers Expanding Premerger and Antitrust Jurisdiction Over Likewise, a teaching hospital doing research for a university that has a contract with the Federal government may be covered.. 15 U.S.C. You can decide how often to receive updates. Which entity has jurisdiction over health care coverage providers? Moreover, given the countrys focus on access to and the affordability of healthcare, it would not be surprising if other states attempt to enact antitrust legislation targeting healthcare affiliations. and Dennie Zastrow, Esq., Troutman Pepper Hamilton Sanders, LLP, Philadelphia, PA 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. What is Medi? We use cookies on our website. An official website of the United States government If my company is a federal contractor in the State of California, does Californias Proposition 209 mean that I do not need to meet the requirements of Executive Order 11246? .usa-footer .container {max-width:1440px!important;} 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. If the transaction also triggers the HSR filing requirements, the parties can satisfy Washingtons premerger notification requirement by submitting a copy of the HSR filing to the Washington attorney general. 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. 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. Moreover, if this Blog in any way seems to contradict advice of counsel, counsel's opinion should control over anything written herein. Similarly, consumers will continue to contact the state for inquiries and complaints relating to the health insurance market reform requirements. 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