May 21, 2019

New Healthcare Law Resource for Attorneys and Business Leaders

According to Law Week Colorado, attorneys and business leaders trying to chop through the healthcare industry thicket have a new resource.

The Missouri offices of Husch Blackwell have created an online resource, Healthcare Law Insights, that offers information about legislative, legal, and administrative issues that affect the current healthcare industry. The blog features articles and commentary from healthcare attorneys who monitor the reforms, laws, and emerging trends.

“We launched (the site) to equip healthcare executives, compliance officers, owners, and managers with relevant legal information to keep up to date with the constantly changing health law environment,” said Curt Chase, chair of the firm’s healthcare department.

Visitors to the site can search by keyword, select posts about a specific category, access additional industry resources, and subscribe to ongoing updates by RSS feed or email.

Affordable Care Act Upheld by the United States Supreme Court

According to SCOTUSBlog, the United States Supreme Court has upheld the entirety of President Obama’s health care reform law known as the Affordable Care Act. Chief Justice Roberts joined the Court’s four left-leaning justices and penned the opinion, validating the individual mandate as a tax rather than under the Commerce Clause. For a more detailed evaluation, visit SCOTUSBlog for continuing analysis throughout the day.

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

It’s Final! Summary of Benefits and Coverage Required After September 23, 2012

Editor’s Note: This article was provided by Holland & Hart LLP. For other legal update articles from the firm, click here.

One of the provisions of Health Care Reform that is sure to impact employers is the required four-page summary of benefits and coverage. Often called the “SBC,” this form is in addition to the existing requirement to issue summary plan descriptions (“SPDs”). Until recently, the effective date for issuing the SBC was March 23, 2012. Thankfully, new guidance gives employers until at least September 23, 2012 to comply.

According to final regulations published February 14, 2012, insurance companies must provide SBCs to individual policy holders and to their insured employer plans starting September 23, 2012. Employer plans (self-funded and insured) must provide an SBC for open enrollment periods on or after that date (for calendar year plans, this will be for the 2013 plan year).

Along with the SBC, these new regulations require employer medical plans to provide employees and beneficiaries with a uniform glossary of terms commonly used in health insurance coverage (such as co-payment, deductible, home health care, etc.). In addition, the regulations include a new requirement to provide 60 days’ advance notice of material modifications. These provisions are also effective for open enrollments after September 23, 2012.

Federal Health Care Reform to Be Reviewed by the Supreme Court

On Monday, November 14, 2011, the United States Supreme Court agreed hear oral argument regarding the constitutionality of last year’s federal health care reform law, the Patient Protection and Affordable Care Act. The justices announced their decision to hear issues from state appeals in a brief order issued Monday.

SCOTUSblog reports that oral arguments are likely to be held in March. A ruling is expected to be issued in June.

Setting the stage for a historic constitutional confrontation over federal power, the Supreme Court on Monday granted three separate cases on the constitutionality of the new federal health care law, and set aside 5 1/2 hours — probably in March — for oral argument.  The Court, however, did not grant all of the issues raised and it chose issues to review only from three of the five separate appeals before it.  It is unclear, at this point, whether all of the cases will be heard on a single day.

The Court will hold two hours of argument on the constitutionality of the requirement that virtually every American obtain health insurance by 2014, 90 minutes on whether some or all of the overall law must fail if the mandate is struck down, one hour on whether the Anti-Injunction Act bars some or all of the challenges to the insurance mandate, and one hour on the constitutionality of the expansion of the Medicaid program for the poor and disabled.   The Court chose those issues from appeals by the federal government, by 26 states, and by a business trade group.  It opted not to review the challenges to new health care coverage requirements for public and private employers.  It left untouched petitions by a conservative advocacy group, the Thomas More Law Center, and three of its members, and by Liberty University and two of its employees.

Accepting the constitutional dispute on its very first examination of the cases brought to it speedily by lawyers, the Court wrote three separate orders outlining how it would deal with the cases.  That meant that they would not be grouped together, but that they likely will be heard close together, if not back-to-back on a single day.

The allotment of 5 1/2 hours for oral argument appeared to be a modern record; the most recent lengthy hearing came in a major constitutional dispute over campaign finance law in 2003, but that was only for 4 hours.   The length of time specified for the health care review was an indication both of the complexity of the issues involved, and the importance they hold for the constitutional division of power between national and state governments.

Colorado is one of the twenty-six states joining Florida in challenging the law.

Governor Hickenlooper Announces Appointments to Colorado Health Benefits Exchange Board

On Wednesday, June 29, 2011, Governor John Hickenlooper announced his appointments to the first Colorado Health Benefits Exchange Board, which was created by SB 11-200, Health Benefit Exchange, sponsored by Senate President Pro-tem Betty Boyd, D-Lakewood, and House Majority Leader Amy Stephens, R-Monument.

The Colorado Health Exchange will be an independent public entity not affiliated with any existing state agency or department and initially funded by gifts, grants,and donations. The exchange will be governed by nine board members, the majority of whom will be individuals and business representatives who are not directly affiliated with the insurance industry. The board will hire the exchange’s executive director.

The members appointed by the Governor and the Senate and House Majority and Minority leadership are:

  • Richard T. Betts, of Telluride; term to expire 2013. Betts is the owner of ASAP Accounting & Payroll, Inc.
  • Eric Grossman, of Englewood; term to expire 2013. Grossman is a vice president of TriZetto.
  • Robert S. Ruiz-Moss, of Lone Tree; term to expire 2013. Ruiz-Moss is the chief executive officer of Anthem Blue Cross.
  • Elizabeth Soberg, of Centennial; term to expire 2013. Soberg is the chief executive officer of UnitedHealthcare of Colorado.
  • Gretchen Hammer, of Denver; term to expire 2015. Hammer is the executive director for the Colorado Coalition for the Medically Underserved.
  • Stephen ErkenBrack, of Grand Junction; term to expire 2015. ErkenBrack is the president of Rocky Mountain Health Plan.
  • Arnold Salazar, of Alamosa; term to expire 2015. Salazar is the executive director of Colorado Health Partnerships, LLC.
  • Nathan Wilkes, of Arapahoe; term to expire 2015. Wilkes is the founder and principal consultant, Headstorms, Inc.
  • Dr. Michael Fallon, of Denver; term to expire 2015. Fallon is an emergency room physician.

The full press release from the Governor’s Office concerning these board appointments can be found here.

State Board of Health Amends Rules Regarding the Naming of Health Care Entities

The Colorado State Board of Health has amended the rules that outline the criteria regarding licensed health care entity names. The requirement that an entity’s name identify the services for which it is licensed has been eliminated. The license fee has also been lowered for processing an entity’s request to change its name or address. “These changes have been discussed with a consortium of licensed health care entities, which supports the proposal.”

The fee to change the name or address of a health care entity has been lowered from $360 to $75.

The purpose of the proposed amendments is to better reflect the changing face of health care and the anticipated expansion of health care delivery systems under the Affordable Care Act.

A hearing on the amended rules will be held on Wednesday, August 17, 2011 at the Department of Public Health and Environment, Building A, Sabin-Cleere Conference Room, 4300 Cherry Creek Drive South, Denver, Colorado 80246, beginning at 10:00 am.

The Board encourages all interested persons to participate in the hearing by providing written data, views, or comments, or by making oral comments at the hearing.

The Board requests submission of written materials no later than August 3, 2011 to allow the Board sufficient time to review the comments prior to the meeting. Persons wishing to submit written comments or views should submit them following the guidelines provided here.

Full text of the proposed changes with line edits to the rules can be found here. Further information about the rules and hearing can be found here.

Governor Hickenlooper Vetoes Bill Changing the Child Health Plan Plus Program

On Tuesday, Governor John Hickenlooper vetoed SB 11-213, stating that the bill poses adverse consequences on children’s access to health insurance through the Child Health Plan Plus program. The Governor determined that while the policy intent may be sound, the practical impact the legislation has would negatively impact children in low-income families.

Hickenlooper pledged to work with the Joint Budget Committee and the General Assembly to develop a better approach to changes in the program. He also said that the Department of Health Care Policy and Financing will increase the annual enrollment fee through their regular, rule-making process, and conduct a comprehensive analysis of cost-sharing in the program.

The Department will evaluate changes in the program this summer and fall and deliver recommendations to the Joint Budget Committee on or before November 1, 2011. According to the Governor:

“The focus will be to implement a change that is minimally disruptive, administratively efficient, effective and elegant, and supports the goal of ensuring that kids have access to coverage.”

In recent weeks, many Colorado hospitals, health organizations, and individuals have urged Hickenlooper to veto the bill.

Click here for the Governor’s press release and letter to the General Assembly regarding his veto of SB 11-213 – Concerning enrollee cost-sharing for children enrolled in the children’s basic health plan, and making an appropriation therefor.

Governor and Bipartisan Support Behind Senate Bill to Create Health Benefits Exchange

On Monday, Governor John Hickenlooper announced bipartisan support to introduce legislation that would create the Colorado Health Benefits Exchange. The governor was joined at the announcement by Senate President Pro-tem Betty Boyd, D-Lakewood, and House Majority Leader Amy Stephens, R-Monument.

Details of the Colorado-based health exchange were outlined in SB 11-200, introduced in the Senate following the announcement. The exchange is intended to facilitate the access to and enrollment in health plans in the individual market in Colorado and include a small business health options program to assist small employers in facilitating the enrollment of their employees in health plans offered in the small employer market. The intent of the Colorado health benefit exchange is to increase access, affordability, and choice for individuals and small employers in purchasing health insurance in Colorado.

The bill creates a nonprofit unincorporated public entity known as the Health Benefits Exchange. A board of directors will govern the operation of the exchange. While the exchange is an instrumentality of the state, its debts and liabilities will not constitute debts and liabilities of the state, and neither the exchange nor the board will be an agency of the state. The exchange will foster a competitive marketplace for insurance and will not solicit bids or engage in the active purchasing of insurance. All carriers authorized to conduct business in Colorado may be eligible to participate in the exchange.

Other core components of the bill include:

  • The Colorado Health Benefits Exchange shall initially be funded by gifts, grants and donations, and shall apply for establishment grants pursuant to Section 1311 of the federal Affordable Care Act.
  • The Colorado Health Benefits Exchange shall be governed by a board consisting of nine members who are permanent Colorado residents. The majority of the board members will be individuals and business representatives who are not directly affiliated with the insurance industry.
  • Of the nine members, five shall be appointed by the Governor, and one each appointed by: the President of the Senate; the Speaker of the House; the Minority Leader of the House; and the Minority Leader of the Senate. These appointments should be coordinated to ensure a broad representation of identified skill sets.
  • Each person appointed to the board shall have demonstrated expertise in at least two of the following areas: (a) individual health insurance coverage; (b) small business health insurance coverage; (c) health benefits administration; (d) health care finance; (e) administering a public or private health care delivery system; (f) purchasing health insurance coverage; (g) health care consumer navigation or assistance; (h) health care economics or health care actuarial sciences; (i) information technology; (j) starting a small business with 50 or fewer employees; and (k) expert in the provision of health care service.
  • Creates a new legislative committee of 10 members that meet five times a year. The committee will review and approve grants and an initial work plan.
  • The Board shall hire an executive director to administer the Colorado Health Benefits Exchange who is approved by legislative committee.
  • The Board shall provide an annual report to the House and Senate Committees of reference.
  • The Colorado Health Benefits Exchange operations shall comply with sunshine laws and ethics requirements.

Click here to hear to read the full press release regarding the introduction of the bill, and click here to listen to audio from Monday’s press conference.

SB 11-168: Creating the Colorado Health Care Authority to Design a Cooperative

On February 14, 2011, Sen. Irene Aguilar, D-Denver, and Rep. John Kefalas, D-Fort Collins, introduced SB 11-168 – Concerning the creation of the Colorado health care authority for the purpose of designing a health care cooperative. This summary is published here courtesy of the Colorado Bar Association’s e-Legislative Report.

The bill creates the Colorado health care authority. The mission of the authority is to design the Colorado health care cooperative to be the benefits administrator and payer for health care services. The authority shall recommend a cooperative to the general assembly and, if approved, it shall be referred to the voters by referred measure.
The president of the senate, the speaker of the house, and the governor shall each appoint members to the board of directors of the authority who shall employ an administrator and other officers to help design and develop the cooperative. The cooperative will be designed in collaboration with parties who may be affected by the cooperative. The bill requires that the board make recommendations concerning specific elements to become part of the cooperative, including:

  • Election of board members to the cooperative;
  • Health care services that will be part of the cooperative;
  • Payment systems for the cooperative;
  • Regulation and evaluation of health care services;
  • Methods for coordinating alternate insurance plans with the cooperative;
  • Benefit design and provider rates and reimbursement;
  • Maintaining a marketplace with health care choices;
  • Cooperative members’ participation in their health care;
  • Development of information technology for the cooperative;
  • Data collection to determine best practices;
  • Transparency of the financial operation of the cooperative; and
  • Health and wellness maintenance and education.

The board is required to include a financing recommendation to the general assembly based on projected costs and federal waivers and includes available state and local government revenues. The bill contains other specified options that the board may include in its recommended financing package. The board is required to design a method for refunding savings to members of the cooperative and to employers. The board is required to develop a plan to deal with budget shortfalls.

The bill specifies services that must be included in a benefits package designed by the board. The bill specifies that the cooperative shall serve as secondary insurance to any other insurance. The board is authorized to seek gifts, grants, and donations to implement the authority and the board to design the cooperative and is required to seek federal funds and grants available for the cooperative. The board is required to seek input and collaborate with the department of public health and environment, the department of health care policy and financing, and the general assembly to seek waivers, exemptions, and agreements from the federal government for funding for the authority and the cooperative. Assigned to the Business, Labor, and Technology Committee, the bill is scheduled for review by that committee on Monday, February 28 at 1:30 p.m.

Since this summary, the bill passed out of the Business, Labor, and Technology Committee on February 28.

Summaries of other featured bills can be found here.

2010 Colorado Health Insurance Report Released by DORA

The Commissioner of Insurance’s 2010 Annual Health Insurance Report was released on Tuesday and contains information about the present state of health insurance in Colorado, including the cost of health insurance and the factors that drive the cost of health insurance premiums on an individual and group basis.

The report identifies where insured Coloradans get their health insurance, whether the number of uninsured residents is going up or down, and how Colorado compares statistically with the rest of the country.

The full report can be found here.

HHS Awards Colorado $1 Million to Build Health Insurance Marketplace

Today, the U.S. Department of Health and Human Services awarded Colorado nearly $1 million to help plan, develop, and establish health insurance exchanges within the state. Exchanges are a key component of the Affordable Care Act passed last spring. The exchanges will serve as a competitive, consumer-centered private health insurance marketplace, putting more control and greater choice in the hands of individuals and small businesses, according to a press release from the governor’s office. The system creates, in essence, one-stop-shopping where consumers can compare and purchase health insurance coverage.

“Health insurance exchanges are a first step in transparency and lower costs,” Gov. Bill Ritter said. “These exchanges will allow consumers and small businesses to have the same purchasing power as big employers, and get a fairer deal when it comes to their health care. Although state exchanges are not required to be operational until 2014, this planning grant begins the path forward. Exchanges will take what is now a very complicated and confusing process and turn it into a simple, easy-to-navigate experience that benefits consumers, not insurance companies.”

See the full press release for more information about the grant and the future of health insurance in Colorado.

Colorado Center on Law and Policy Analyzes Health Care Reform’s Effect on Colorado

Ed. note: This post was originally posted at our sister site, The Learned Lawyer.

Attorney Elisabeth Arenales, director of the Health Care Program at the Colorado Center on Law and Policy, recently sat down with Colorado Public Radio to discuss the new insurance regulations going into effect this week stemming from the Health Care Reform legislation.

Colorado should begin to see more of the effects of the Affordable Care Act at the now six-month milestone since passage. Colorado families can begin to cover their young adult members until age 26, helping to cover the single largest group of uninsured people in the state. So far, more than 8,000 seniors have received rebate checks to avoid the Medicare doughnut hole, a step on the way to preventing the 47,000 seniors who hit the hole last year from doing so again. Tax credits for small businesses will also go into effect, helping approximately 90,000 businesses provide affordable health insurance for their employees.

These and other benefits of the Affordable Care Act are discussed by Ms. Arenales here, along with new obstacles imposed by insurance companies. The Center’s complete report can be found here.