Health Care Law Blog

Determination of Affordability and Minimum Value Under PPACA

The Patient Protection and Affordable Care Act ("PPACA") requires "large employers" to provide affordable health coverage of a minimum value to full-time employees and their dependents starting in 2014.  A large employer failing to do so may be subject to penalties.

Coverage is considered affordable to an employee if the employee portion of the self-only premium for the employer's lowest-cost coverage does not exceed 9.5% of the employee's household income, but only if the lowest-cost coverage provides a minimum value.  Read More ›

Categories: Employee Benefits, Health Care Reform

Posted by: Johanna M. Novak

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National Practitioner Data Bank

Hospitals are required to report certain adverse clinical privileging actions and medical malpractice payments to the National Practitioner Data Bank (NPDB).  Since the NPDB was established by the Health Care Quality Improvement Act (HCQIA) in 1986, compliance with these reporting obligations has been largely entrusted to hospitals with little enforcement action by the United States Department of Health and Human Services.  There are now reports that the federal government has begun auditing compliance by hospitals with the NPDB reporting requirements. Read More ›

Categories: Audits, Compliance, Hospitals, Physicians

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Blue Cross Changes on the Horizon?

Changes to the health insurance market in Michigan may soon be changing due to the Michigan House of Representatives’ approval of Senate Bills 1293 and 1294 (the “Senate Bills”) on December 6, 2012.  The introduction of the Senate Bills follow Governor Snyder’s proposed overhaul of BCBSM discussed here and directly address the corporate organization and continued operation of Blue Cross Blue Shield of Michigan (“BCBSM”) in our state.  In brief, the Senate Bills authorize BCBSM to establish, own, operate and merge with a nonprofit mutual disability insurer.  They also generally prohibit BCBSM from using “Most Favored Nation Clauses” in provider contracts beginning February 1, 2013.  While the Senate Bills are not final until Governor Snyder signs them into law, given his previous support it is likely he will give his approval. A more detailed analysis of the Senate Bills will be provided if the Governor does indeed sign them into law.

Categories: Billing/Payment, Insurance, Regulatory

Posted by: Mindi M. Johnson

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