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. Part 60-741.5(a).. 0000009656 00000 n Therefore, federal contractors in the State of California must comply with the Executive Order and its affirmative action requirements. ERISA requires plans to provide participants with plan information including important information . This strategy must be considered carefully, but can be beneficial depending on the acquiring providers risk tolerance, market concentration, and the extent and number of competitive overlaps between the affiliating providers. Whether California (or another state) enacts legislation requiring state approval of transactions. c^J\o$GP%O4KI/7u51 d .bv Gq KA7P0:Bb:l8!'rY)%n&ecPA\Ma!1Wh%HiQ#dIs|?#Cy@ ,t].mTj 4Z4F tJ 'E4ijO)- qv,x ` ^~S.z7s]X',i,F`+'*ms/(:~G/*)3=@D$v.bLh`CEd-hl2c&QicBIRFj!/lyTTb9%1k+~K@PAnb Which entity has jurisdiction over health care coverage providers? 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. Yes. 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. 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. 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. 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 . 0000016173 00000 n As a reinsurer for the Federal Employees Group Life Insurance (FEGLI) program, are we a federal government subcontractor? -Doctors' services are covered by Medicare Part B. 0000002414 00000 n or 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. 6-4-107(3), which provided that the attorney general shall not challenge any merger or acquisition under the provisions of this section which has been reviewed by any federal department, agency, or commission under section 7A of the federal Clayton Act and for which all applicable waiting periods have expired or have been terminated without a challenge to such merger or acquisition by that department, agency, or commission. The Act took effect on August 5, 2020 (90 days after final adjournment of the general assembly). Stat. Health Insurance Counseling and Advocacy Program (HiCAP). The amendments proposed to the Donnelly Act, if enacted, would dramatically expand the reach of New Yorks state antitrust laws and the ability of the attorney general to pursue claims under state law that it previously was only able to bring under federal law. 0000007980 00000 n 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 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. Texas 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. An Act Concerning Notice of Acquisitions, Joint Ventures, Affiliations of Group Medical Practices and Hospital Admissions, Medical Foundations, and Certificates of Need, P.A. As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. 18(a). Although self-funded, non-Federal governmental plans may still opt out of certain provisions of the PHS Act, they are not exempt from other requirements of the law including the restrictions on annual limits and other provisions of the Patients Bill of Rights. See 41 CFR 60-1.5(a)(3), 60-300.4(a)(3), 60-741.4(a)(3). She can be reached at megan.morley@troutman.com 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. For example, Washingtons reporting statute requires that the notice be submitted 60 days prior to close, which is 30 days longer than the federal HSR waiting period. Yes. necessary rule applies to. 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. Heres how you know. In the event that a state notifies the Centers for Medicare & Medicaid Services (CMS) that it does not have statutory authority to enforce or that it is not otherwise enforcing one or more of the provisions of title XXVII, or if CMS determines that the state is not substantially enforcing the requirements, CMS has the responsibility to enforce these provisions in the state. Notwithstanding any other provision of law to the contrary, and except as provided herein, any person or other entity which provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether such coverage is by direct 2. The basics: All contractors and subcontractors of the federal government must comply with legal requirements regarding affirmative action and non-discrimination. 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. 0000048160 00000 n If California (or other states) pass the same or similar legislation, then parties will need to be prepared to explain these outcomes or will risk the deal being denied approval. 6-4-107(1). 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. Official websites use .govA He can be reached at daniel.anziska@troutman.com. CDI has jurisdiction under the CaliforniaInsurance Code over all other types of health insurance,including plans that offer traditional health insuranceproducts, such as indemnity plans, and some PPOplans.7 Many more Californians with health coveragefall under the jurisdiction of DMHC than CDI, asshown in Table 1. All rights reserved. . lEm 3. 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. p.usa-alert__text {margin-bottom:0!important;} According to the California Insurance Code, what is the maximum penalty per violation for anyone who unwillfully commits an unfair method of competition? 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. Federal Reserve Bank of Boston v. Commissioner of Corporations and Taxation of the Commonwealth of Massachusetts, 499 F.2d 60 (1st Cir. 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. Specifically, the amendments would add a provision virtually identical to Section 2 of the Sherman Act. The ARB determined that the reimbursement agreement did not provide a basis for coverage of the hospital under the laws enforced by OFCCP. RCW 19.390.040. No, Federal Reserve Banks are not subject to OFCCPs equal employment opportunity and affirmative action laws because they are federal entities and not federal contractors. 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. If a State or local government has Government contracts, is it subject to the requirements of Executive Order 11246? 0000008002 00000 n 0000016504 00000 n For providers serving rural areas, the attorney general would have the authority to waive these standards.22 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. 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. 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. 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. 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 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. Is my company covered by the Scheduling Moratorium for Veterans Affairs Health Benefits Program (VAHBP) Providers? How the proposed transaction affects competition. The site is secure. .dol-alert-status-error .alert-status-container {display:inline;font-size:1.4em;color:#e31c3d;} 4212, and Section 503 of the Rehabilitation Act of 1973 (Section 503), as amended. Region. In addition to inserting language virtually identical to the Sherman Act Section 2s monopolization, attempt to monopolize and conspiracy to monopolize prohibition,4 the pending proposed legislation seeks to add a vague prohibition of firms with a dominant position abus[ing] that dominant position.5 In such instances, OFCCP uses a "single entity" test to determine whether the businesses or organizations are so closely related that they constitute a single entity for purposes of OFCCP jurisdiction. 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 However, the requirements of Executive Order 11246 apply only to the agency, instrumentality or subdivision of the State or local government that participates in work on or under the Government contract or subcontract. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be a covered federal contractor. No, as a federal contractor in the State of California you will still need to meet the requirements of Executive Order 11246. 0000024410 00000 n Perhaps equally concerning, the proposed amendments appear to permit criminal penalties for violations of the abuse of dominance prohibition.35 This is puzzling given that federal law technically provides for criminal penalties for monopolization claims, but as a matter of policy, the Department of Justice Antitrust Division does not seek criminal penalties for monopolizing conduct. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} 42 U.S.C. 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. Oklahoma Share sensitive information only on official, secure websites. > 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 California Senate Bill 977 (SB 977), proposed earlier this year, required written notification to and the consent of the states attorney general before consummation for most healthcare affiliations or change of control transactions.2 Under SB 977, the attorney general would be required to deny consent for transactions that would not lead to (a) clinical integration or (b) the increase or maintenance of access to healthcare in underserved populations. 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 Californias proposed bill recently died in the legislature, but a new or similar version is likely to be introduced next year. 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. 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. According to the California Insurance Code, how is the word "may" interpreted? 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Coventry Life and Health Insurance Company, East Missouri (PDF), Coventry Life and Health Insurance Company, West Missouri (PDF), UnitedHealthCare Insurance Company, Texas (PDF), In-Person Assistance in the Health Insurance Marketplaces, The Mental Health Parity and Addiction Equity Act (MHPAEA), Self-Funded, Non-Federal Governmental Plans, Federal Market Conduct Examination (Oversight Group) Checklist (PDF), Blue Cross and Blue Shield of Alabama (PDF), Allegiance Life and Health Insurance Company, Inc., Montana (PDF), Health Insurance and Consumer Protections Grant Fact Sheet (PDF), Health Insurance and Consumer Protections Grant Map: State-by-State Summary of Health Insurance and Consumer Protections Grants, State Flexibility to Stabilize the Market Cycle I Grant Map: State-by-State Summary of State Flexibility to Stabilize the Market Grantsfor Cycles I and II, Fact Sheet: The State Flexibility to Stabilize the Market Cycle I Grant Program (PDF), Fact Sheet: The State Flexibility to Stabilize the Market Cycle II Grant Program (PDF), Information Related to COVID19 Individual and Small Group Market Insurance Coverage, FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19), FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19), FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19), Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency, FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets, FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation, Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV), 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 2726 - Parity in Mental Health and Substance Use Disorder Benefits, Section 2702 Guaranteed Availability of Coverage, Section 2703 Guaranteed Renewability of Coverage, Section 2707 Non-discrimination under Comprehensive Health Insurance Coverage (Essential Health Benefits Package). Whether a state in which a party to the transaction is located or does business has any notification obligations. We use cookies on our website. Although not discussed in this Article, federal antitrust law also forbids agreements that restrain trade, including, for example, price-fixing conspiracies among competitors, under Sherman Act Section 1. Likewise, a teaching hospital doing research for a university that has a contract with the Federal government may be covered.. https:// .usa-footer .container {max-width:1440px!important;} 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. 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? After collection and review of policy forms for compliance with the respective market reform provisions, CMS will notify issuers of any concerns. An official website of the United States government 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. https://www.dol.gov/agencies/ofccp/faqs/single-entity-test, Scheduling Moratorium for VAHBP Providers. Which entity has jurisdiction over health care coverage providers? What is Medicaid? Therefore, even small transactions, which might have gone unnoticed by federal enforcers, could be subject to antitrust scrutiny by state enforcement agencies. RCW 19.390.080. 0000015627 00000 n 0000004738 00000 n Are we subject to the equal employment laws enforced by OFCCP? 4212 (VEVRAA). 0000017052 00000 n 1974). 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)). However, in 2015, the FAR implemented an inflationary adjustment for VEVRAA, increasing the threshold amount from $100,000 to $150,000. 0000011859 00000 n 0000035742 00000 n The Public Health Service Act (PHS Act) section 2791(d)(8)(C) defines the term Non-Federal governmental plan as a governmental plan that is not a Federal governmental plan. 0000017659 00000 n 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.

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