%PDF-1.4 % Is CMS a regulatory agency? Heres how you know. 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. Are all construction contractors and subcontractors subject to the laws enforced by OFCCP? 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. 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. 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. 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. How state reporting obligations affect deal timing. On March 20, 2020, Governor Jared Polis of Colorado signed SB20-064 into law.30 The legislation repealed Colo. Rev. 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). Health care system consolidation: Attorney General approval and enforcement, California Senate Bill 977 (2020). This definition thus explicitly includes agreements for insurance, which would cover FEGLI contracts. Covered entities taking reasonable steps to limit use or disclosure of PHI . For example, the FTC typically investigates transactions involving healthcare providers, whereas the DOJ reviews insurance-related deals. To do so, CMS will notify issuers in the state that they must submit policy forms to CMS for review. In addition, business associates of covered entities must follow parts of the HIPAA regulations. My company has contracts with the U.S. Department of Veterans Affairs to provide non-medical services. Under 45 CFR 146.145(a), a group health plan means an employee welfare benefit plan to the extent that the plan provides medical care (including items and services paid for as medical care) to employees (including both current and former employees) or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. Non-Federal governmental plans can operate as self-funded plans, purchase a fully insured group insurance product, or consist of a mixture of self-funded and fully insured options. In the past, the U.S. Department of Labors Office of Federal Contract Compliance Programs (OFCCP) has aggressively argued that health care providers that participate in one of three federal health care programs Medicare, TRICARE, and the Federal Employee Health Benefits Program are federal subcontractors. She can be reached at megan.morley@troutman.com Which entity has jurisdiction over health care coverage providers? 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. #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;} ERISA requires plans to provide participants with plan information including important information . 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. What type of license is required for an individual who charges a fee to review an insured's existing life insurance policy? Are health care providers like blood banks, diagnostic labs and ambulance services under the TRICARE Exemption and/or the scheduling moratorium for VAHBP providers? Health Insurance Counseling and Advocacy Program (HiCAP). p.usa-alert__text {margin-bottom:0!important;} Your membership has expired - last chance for uninterrupted access to free CLE and other benefits. How the proposed transaction affects competition. Is my company covered by the Scheduling Moratorium for Veterans Affairs Health Benefits Program (VAHBP) Providers? 0000027421 00000 n Balance Billing by Health Care Providers: Assessing Consumer 62 0 obj << /Linearized 1 /O 64 /H [ 1401 579 ] /L 114966 /E 50989 /N 8 /T 113608 >> endobj xref 62 48 0000000016 00000 n 0000011315 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. Under Section 503, however, all government contracts must meet the dollar threshold amount of $50,000 for coverage. Which entity has jurisdiction over health care coverage providers? ( December 15, 2020 State Enforcers Expanding Premerger and Antitrust Jurisdiction Over Healthcare Transactions: Guidance for This Growing Trend By Barbara Sicalides, Esq., Daniel Anziska, Esq., Megan Morley, Esq. Instead, the Antitrust Division typically seeks criminal penalties only for agreements between or among competitors to fix prices or allocate customers or markets. may have jurisdiction over a health care provider receiving Medicare reimbursements if the health care provider also holds a separate covered federal contract or subcontract. -Long-term care is covered by Medicare Part C. -Hospice is covered by Medicare Part A. 0000001980 00000 n . 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. This antitrust safety zone will not apply if that hospital is less than 5 years old. Statements of Antitrust Enforcement Policy in Health Care. In addition, pursuant to Section 7 of the Clayton Act, the federal antitrust laws prohibit acquisitions that may substantially lessen competition or tend to create a monopoly. Generally, whether a deal is reviewed by the FTC or DOJ depends on the industry and the agencys history of investigations in that industry. 0000004738 00000 n 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 Issuers required to submit form filings to CMS will need to follow instructions posted under Training Resources below. An official website of the United States government 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. Accordingly, a hospital or other health care provider is not covered under the laws enforced by OFCCP if its only relationship with the federal government is as a participating provider under Medicare Parts A and B and Medicaid. The decision in Bridgeport Hospital concerned only the contractual obligations assumed by an insurance carrier that has contracted to provide a fee-for-service health benefits plan to federal employees; it does not address the contractual obligations assumed by providers of other types of plans under the FEHB Program, (e.g., a Health Maintenance Organization). It is unclear what would constitute a dominant position under the proposed statute. Part 60-741.5(a).. Final Exam Flashcards | Chegg.com 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)). In order to be eligible for the VAHBP Moratorium, the entity must hold an agreement (prime or subcontract) to provide services or supplies to VAHBP beneficiaries and hold no other covered agreements. 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. An agency within the U.S. Department of Labor, 200 Constitution Ave NW If your entity is a federal contractor or subcontractor, you must be sure to maintain affirmative action program compliance. Share sensitive information only on official, secure websites. 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. 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. Wyoming. For questions and concerns regarding non-Federal governmental plans, please e-mail NonFed@cms.hhs.gov. Generally speaking, any business or organization that: Yes, if the contracts meet the threshold for coverage. 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. 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. Jurisdiction of Insurance Department; exception - Justia Law Federal government websites often end in .gov or .mil. What is an "insurance broker" according to California Insurance Code? website belongs to an official government organization in the United States. It is not intended as a form of, or as a substitute for legal advice. 15 U.S.C. 18(a). 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. No. 1974). Barbara Sicalidesis a Partner in the Business Litigation practice group at Troutman Pepper. She represents clients in the healthcare industry on a full range of antitrust matters, including provider affiliations and acquisitions, contract negotiations between health systems and payors, litigation against competitors, and advocacy before federal and state enforcement agencies. She can be reached atbarbara.sicalides@troutman.com. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). 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. Is a health care provider covered under laws enforced by OFCCP because of reimbursements for services to federal employees, retirees, or their dependents from an insurance carrier that participates in the federal Employee Health Benefits Program (FEHB)? Washington State Office of the Attorney General Past Cases (last visited Nov. 19, 2020), https://www.atg.wa.gov/past-cases. What entities are subject to the requirements of Executive Order 11246? To the extent that CMS and a state agree on a collaborative approach, the state will perform the same regulatory functions with respect to the Affordable Care Act market reform provisions as it does to ensure compliance with state law, and will seek to achieve voluntary compliance from issuers if the state finds a potential violation. All contractors and subcontractors who hold a federal contract in excess of $10,000 are subject to regulatory requirements under one or more of the laws enforced by OFCCP depending upon the amount of the contract. Question: What Government Agency Regulates Health Care Billing 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. 0000048160 00000 n Thus, the agreement to serve as a federal funds depository is a "government contract.". To learn more about how we use cookies and how to change your cookies settings if you do not want cookies on your computer, please see our updated Privacy Statement. CMS will form a collaborative arrangement with any state that is willing and able to perform regulatory functions but lacks enforcement authority. 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. 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 contents of this document do not have the force and effect of law and are not meant to bind the public in any way. For providers serving rural areas, the attorney general would have the authority to waive these standards.22 The same holds true under Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. 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. Press Release from the California Office of the Attorney General, SB 977, at 1190.25(a). 0000017659 00000 n 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 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. .h1 {font-family:'Merriweather';font-weight:700;} 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. SB 977, at 1191(a)-(b).