She can be reached at [email protected] The proposed statute defines clinical integration as a reduction in costs to the benefit of consumer care and outcomes or an increase in the quality of care.. 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. 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. 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. 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. 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. 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. 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. Federal government work is performed in some other division in another state. https://www.dol.gov/agencies/ofccp/faqs/single-entity-test, Scheduling Moratorium for VAHBP Providers. Washington alleged that the transactions combined the largest primary care and orthopedic service providers, resulting in reduced choice and higher prices for consumers. The Affordable Care Act made a number of changes, with the result that sponsors of self-funded, non-Federal governmental plans can no longer opt out of as many requirements of Title XXVII. Brouse McDowell, A Legal Professional Association. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} All of these statements concerning Medicare are true EXCEPT. Barbara Sicalides is a Partner in the Business Litigation practice group at Troutman Pepper. If a state informs CMS that it does not have authority to enforce one or more of the provisions of the Affordable Care Act, and the state has not entered into a collaborative arrangement, CMS has the responsibility to directly enforce the relevant provisions in the state with respect to health insurance issuers in the group and individual markets. 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. However, in 2015, the FAR implemented an inflationary adjustment for VEVRAA, increasing the threshold amount from $100,000 to $150,000. 0000002414 00000 n RCW 19.390.040. Watch out for this language! 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. PCIP was created by the PPACA for people rejected by private health insurers due to pre-existing conditions, The cost of services charged by the Health Insurance Counseling Advocacy Program (HiCap) is, Any changes in background information that occur after a producer application has been submitted or a license has been issued MUST be reported to the Insurance Commissioner within. Covered entities taking reasonable steps to limit use or disclosure of PHI . 0000018480 00000 n Federal government websites often end in .gov or .mil. Long-term care is covered by Medicare Part C. Notice of Material Change Form. Indeed, under Connecticuts statute, a hospital acquiring a group practice of two physicians must be reported. 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. Which entity has jurisdiction over health care coverage providers? Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). 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. . As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. 1. Part 60-250.5(a) and Part 60-300.5(a), and 41 C.F.R. 14-168(d). The term "nonpersonal services" includes, but is not limited to, the following services: This definition thus explicitly includes agreements for insurance. 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. Stat. Reinsurance entities that have subcontracted with the prime contractor to FEGLI are considered to be government subcontractors within the meaning of the regulations implementing Executive Order 11246, as amended, the Vietnam Era Veterans Readjustment Assistance Act of 1974 (VEVRAA), as amended, 38 U.S.C. Some examples of non-Federal governmental plans are plans that are sponsored by states, counties, school districts, and municipalities. 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. Yes. 0000020767 00000 n [Your company] shall abide by the equal employment opportunity and affirmative action requirements set forth in 41 C.F.R. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be covered. Currently, the Donnelly Act prohibits only anticompetitive activities from agreements or conspiracies, like federal laws Section 1 of the Sherman Act. https:// Oklahoma .gov 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. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be a covered federal contractor. 18116. {{currentYear}} American Bar Association, all rights reserved. or You can decide how often to receive updates. Whether California (or another state) enacts legislation requiring state approval of transactions. This antitrust safety zone will not apply if that hospital is less than 5 years old. Statements of Antitrust Enforcement Policy in Health Care. What if my health care entity does fall under the jurisdiction of OFCCP? All rights reserved. No, an insurance company that supplies workers compensation insurance to a federal contractor does not need to meet the requirements of Executive Order 11246; however, if such insurance company has a separate covered federal contract or subcontract other than providing worker compensation insurance, they may be subjected to the requirements of Executive Order 11246. 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. What is required after a life agent sells an insurance policy to an applicant without being appointed by the insurer? 15 U.S.C. 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. 0000017659 00000 n The same holds true under Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. Healthcare providers are responsible for developing ____ ____ and policies and procedures regarding privacy in their practices. 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. 1980). What is Medicaid? 0000001958 00000 n 18(a). 15 U.S.C. 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. 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. 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? .manual-search ul.usa-list li {max-width:100%;} ) Health Care Market Participants, RCW 19.390, et seq.. . Is my company covered by the Scheduling Moratorium for Veterans Affairs Health Benefits Program (VAHBP) Providers? 0000017602 00000 n Further, it is unclear what conduct would rise to the level of a prohibited abuse. On March 20, 2020, Governor Jared Polis of Colorado signed SB20-064 into law.30 The legislation repealed Colo. Rev. .manual-search-block #edit-actions--2 {order:2;} 0000024410 00000 n HHS has jurisdiction over public sector group health plans (referred to as "non-Federal governmental plans"), while the Departments of Labor and the Treasury have jurisdiction over private group health plans. This policy is based on the decision of DOLs Administrative Review Board (ARB) in OFCCP v. Bridgeport Hospital, ARB Case No. He can be reached at [email protected]. The site is secure. Share sensitive information only on official, secure websites. -Doctors' services are covered by Medicare Part B. lock 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. In addition, some businesses or organizations that do not independently hold Government contracts/subcontracts may still be covered under the laws enforced by OFCCP if they are considered a "single entity" with a related business or organization that holds such contracts. Part 60-741.5(a).. 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. No attorney client relationship is created or implied by this Blog. Dennie Zastrow is an Associate in the Business Litigation practice group at Troutman Pepper. These three programs enforced by the Office of Federal Contract Compliance Programs (OFCCP) require equal employment opportunity by government contractors. The legislation only applies to mergers commenced on or after the applicable effective date of this act.31 -Medicare is primarily funded by Federal payroll and self-employment taxes. Therefore, even small transactions, which might have gone unnoticed by federal enforcers, could be subject to antitrust scrutiny by state enforcement agencies. Federal Reserve Bank of Boston v. Commissioner of Corporations and Taxation of the Commonwealth of Massachusetts, 499 F.2d 60 (1st Cir. 0000012185 00000 n When selling a long term care insurance rider to an applicant, a life agent must take into consideration all of these factors, EXCEPT. 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.
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