When that happens, CMS will work with the state to ensure an effective transition. RCW 19.390.080. The site is secure. /*-->*/. Part 60-1.4(a), 41 C.F.R. A person compensated for transacting insurance on behalf of another person with an insurer. 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. Further, except for universities and medical facilities, a state or local government agency, instrumentality, or subdivision that has a government contract is exempt from the requirement to develop and maintain a written affirmative action program. 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. 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? P.A. 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. 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. p.usa-alert__text {margin-bottom:0!important;} 0000015627 00000 n SB 977, at 1191(a)-(b). Region. RCW 19.390.040. 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. 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. What is Medi? . 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. .gov As a reinsurer for the Federal Employees Group Life Insurance (FEGLI) program, are we a federal government subcontractor? Federal contracts and subcontracts are exempt from the requirements of the equal opportunity clause with regard to work performed outside the United States by employees who were not recruited within the United States. Long-term care is covered by Medicare Part C. .manual-search ul.usa-list li {max-width:100%;} You may wish to consult the elaws Advisor if you have additional questions about coverage. 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 0000017602 00000 n OFCCPs policy is that the receipt of reimbursements from a health insurance carrier that provides a health benefits plan under the FEHB Program, for the medical services provided to federal employees or their dependents, will not provide a basis for coverage of the hospital or other health care provider under the laws enforced by OFCCP. 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. 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. Although specifics regarding the content of the notice were not provided in SB 977, the bill did state that the notice should contain information sufficient for the attorney general to assess the nature of the transaction and whether it will lead to clinical integration or an increase or maintenance of access to underserved populations.23 Once the notice was received, the attorney general would have 60 days to consent to the transaction, grant a waiver, or issue a request for additional information from the parties. OFCCP uses VAHBP providers as an umbrella term to encompass health care providers that contract with the U.S. Department of Veterans Affairs, including those in Veterans Affairs Community Care Networks, as well as Veterans Care Agreements created pursuant to 2018 VA MISSION Act. As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. Heres how you know. Since the effective date of a transaction can have a myriad of implications (financing, tax, contractual, regulatory, etc. According to the California Insurance Code, what is the maximum penalty per violation for anyone who unwillfully commits an unfair method of competition? 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. Californias proposed bill recently died in the legislature, but a new or similar version is likely to be introduced next year. Some examples of non-Federal governmental plans are plans that are sponsored by states, counties, school districts, and municipalities. Local Coverage Determinations are administered by whom? 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. If your entity is a federal contractor or subcontractor, you must be sure to maintain affirmative action program compliance. The .gov means its official. What is the purpose of the Pre-Existing Condition Insurance Plan (PCIP)? If a contractor performs work outside of the United States, is it subject to OFCCPs jurisdiction under the authorities it enforces? 0000020745 00000 n If a State or local government has Government contracts, is it subject to the requirements of Executive Order 11246? A Member of TAGLaw a Worldwide Alliance of Independent Law Firms. Press Release from the California Office of the Attorney General, SB 977, at 1190.25(a). COVERED CALIFORNIANS 0000006386 00000 n It is not intended as a form of, or as a substitute for legal advice. 0000035742 00000 n Generally speaking, any business or organization that: Yes, if the contracts meet the threshold for coverage. As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. When selling a long term care insurance rider to an applicant, a life agent must take into consideration all of these factors, EXCEPT. 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. Yes. or What is reinsurance example? 0000022775 00000 n 0000020767 00000 n Indeed, under Connecticuts statute, a hospital acquiring a group practice of two physicians must be reported. Barbara Sicalides is a Partner in the Business Litigation practice group at Troutman Pepper. In addition to the premerger notification provision, SB 977 also targeted conduct by healthcare systems. An official website of the United States government 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. 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 $50,000 or more must develop a Section 503 AAP. 14-168(c) (2014). Is my company covered by the Scheduling Moratorium for Veterans Affairs Health Benefits Program (VAHBP) Providers? Pete is a life agent who has misappropriated fiduciary funds to his own use. The new threshold applies to contracts entered on or after December 1, 2003. With respect to Washington, since January 1, 2020, provider transactions that constitute a material change must be reported to the state attorney general no less than 60 days prior to consummation.11 Under the statute, a material change includes an acquisition, merger, or contracting affiliation. See 41 CFR 60-1.5(a)(3), 60-300.4(a)(3), 60-741.4(a)(3). z#:HOTH%SO>cavF^OvK>R$l]aSbgu?sVdYpv|C}`,Z#MH#}-^U"} $sF'tq7i!G?>:835^27LX 2023 Brouse McDowell. Although Washington has not challenged a healthcare transaction since the implementation of the reporting requirement earlier this year, the state has done so in the past. 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. 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. 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. Your membership has expired - last chance for uninterrupted access to free CLE and other 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. 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. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be a covered federal contractor. Regardless of how small a deal is, the parties need to understand the competitive implications. Like the TRICARE Exemption, a health care provider providing services to beneficiaries of a VAHBP that also holds another covered contract outside the scope of VAHBP would still need to comply with all of OFCCPs requirements. 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Proposition 209 amended Californias constitution to prohibit the state from discriminating against or granting preferential treatment to any individual or group on the basis of race, sex, color, ethnicity, or national origin in the operation of public employment, public education or public contracting. Wyoming. The proposed bill made it unlawful for a healthcare system with substantial market power to engage in conduct that had a substantial tendency to cause anticompetitive effects, including increased prices, diminished quality or access, and reduced choice.26 Moreover, a system with substantial market power was presumed to be in violation of the law if it engaged in tying (i.e., conditioning the sale of one service on the sale of a second service) or exclusive dealing.27 Violations of this provision could result in civil fines of $ 1 million, or twice the gross gain to the healthcare system or gross loss to any other party multiplied by two, whichever is greater; treble damages; interest; costs; attorneys fees; and injunctive relief.28 1. All of these statements concerning Medicare are true EXCEPT. Watch out for this language! . 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. OFCCP v. Safeco Insurance Co. of America, Secretary of Labors Decision, July 31, 1984. 0000008002 00000 n .manual-search ul.usa-list li {max-width:100%;} Based on the difference between the new and original policy annual premiums: Before an insurer is allowed to test an individual for HIV, what must be completed . 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. 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. Washington alleged that the transactions combined the largest primary care and orthopedic service providers, resulting in reduced choice and higher prices for consumers. lock Texas 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. She can be reached at megan.morley@troutman.com Part 60-741.5(a).. .paragraph--type--html-table .ts-cell-content {max-width: 100%;} According to the California Insurance Code, who is responsible for submitting a life agent's appointment? 0000002523 00000 n 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. 0000017052 00000 n The Scheduling Moratorium for VAHBP Providers only applies to providers of health care and does not extend to contractors that hold a separate, independent non-health-care-related contract. Specifically, the amendments would add a provision virtually identical to Section 2 of the Sherman Act. 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. 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. 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. After collection and review of policy forms for compliance with the respective market reform provisions, CMS will notify issuers of any concerns. 0000012163 00000 n #block-googletagmanagerheader .field { padding-bottom:0 !important; } She can be reached at barbara.sicalides@troutman.com. Similarly, consumers will continue to contact the state for inquiries and complaints relating to the health insurance market reform requirements. . This enforcement framework, in place since 1996, ensures that consumers in all states have protections of the Affordable Care Act and other parts of the PHS Act. 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. The ARB determined that the reimbursement agreement did not provide a basis for coverage of the hospital under the laws enforced by OFCCP. 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. Are health care providers like blood banks, diagnostic labs and ambulance services under the TRICARE Exemption and/or the scheduling moratorium for VAHBP providers? 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. 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. 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. 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.
