Heres how you know. Saving Bonds and savings notes; therefore, are we required to comply with Affirmative Action Program (AAP) obligations under Executive Order 11246, VEVRAA, and Section 503? As a reinsurer for the Federal Employees Group Life Insurance (FEGLI) program, are we a federal government subcontractor? 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. An official website of the United States government lEm 3. 15 U.S.C. TRICARE OFCCP believes it has jurisdiction over health care providers that participate as TRICARE network providers. 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 This antitrust safety zone will not apply if that hospital is less than 5 years old. Statements of Antitrust Enforcement Policy in Health Care. 0000017659 00000 n This definition includes any reinsurance agreement related to FEGLI. SB 977, at 1191(a)-(b). 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. Hb```f``d`c`d`@ Vv%`jLW1*,Pz=oJ'6$X!n&}kLU wF6Q&,fI_2N9Nx3}IOtMX5I.T|d{nRFB@ C T\1(YJJJ&pP5@4b1F8 `\`ig`h``sa`Hr``b`Hhjb`HMop Cy7N=`L7&j`}C@8U_ XElD,\Pbqn ; endstream endobj 109 0 obj 463 endobj 64 0 obj << /Type /Page /Parent 59 0 R /Resources 65 0 R /Contents [ 69 0 R 71 0 R 73 0 R 75 0 R 77 0 R 81 0 R 94 0 R 96 0 R ] /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Rotate 0 >> 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 RCW 19.390.080. The vast majority of states are enforcing the Affordable Care Act health insurance market reforms. %PDF-1.4 % Compliance Checkup: Affirmative Action: Is your health care entity subject to affirmative action laws. Each regional MAC. Are Federal Reserve Banks subject to the affirmative action and equal employment opportunity laws OFCCP enforces? .manual-search ul.usa-list li {max-width:100%;} Colorado is another state that is taking merger control into its own hands. 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. Health Care Market Participants, RCW 19.390, et seq.. For covered insurance contracts, does OFCCP use the insurance premium or the face value of the policy to determine whether a federal contractor is required to develop and maintain an Executive Order 11246 affirmative action plan (AAP)? 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 1974). As such, these entities may qualify for these two exceptions to OFCCP coverage for specific types of health care providers. 0000020767 00000 n Missouri 15 U.S.C. 0000020745 00000 n 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. 0000009656 00000 n or 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. 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. 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 proposed amendments to New Yorks Donnelly Act are not limited in application to the healthcare industry, the contemplated abuse of dominance provision could present significant increased enforcement risk for healthcare providers. website belongs to an official government organization in the United States. To do so, CMS will notify issuers in the state that they must submit policy forms to CMS for review. What entities are subject to the requirements of Executive Order 11246? 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. For example, Connecticut and Washington enacted and California has proposed legislation requiring premerger notification to their respective state attorney general offices of certain healthcare-related deals before consummation. The website for the Connecticut attorney general provides an Excel form and instructions for the submission. The Health Insurance Enforcement and Consumer Protections Grants will provide States with the opportunity to ensure their laws, regulations, and procedures are in line with Federal requirements and that States are able to effectively oversee and enforce these provisions. Issuers required to submit form filings to CMS will need to follow instructions posted under Training Resources below. How state reporting obligations affect deal timing. 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 [email protected]. 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. Long-term care is covered by Medicare Part C. 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 Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. .manual-search-block #edit-actions--2 {order:2;} or 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. The same regulations generally define a government subcontract as any agreement or arrangement between a contractor and any person (in which the parties do not stand in the relationship of an employer and an employee) for the purchase, sale or use of personal property or nonpersonal services which, in whole or in part, is necessary to the performance of any one or more contracts; or under which any portion of the contractors obligation under any one or more contracts is performed, undertaken or assumed. means youve safely connected to the .gov website. 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. 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. He can be reached at [email protected]. It is unclear what would constitute a dominant position under the proposed statute. 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. .agency-blurb-container .agency_blurb.background--light { padding: 0; } -Medicare is primarily funded by Federal payroll and self-employment taxes. Before sharing sensitive information, make sure youre on a federal government site. You can decide how often to receive updates. Is my company covered by the Scheduling Moratorium for Veterans Affairs Health Benefits Program (VAHBP) 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. and Dennie Zastrow, Esq., Troutman Pepper Hamilton Sanders, LLP, Philadelphia, PA According to the California Insurance Code, how is the word "may" interpreted? 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. 18. Yes. ( Currently, the size-of-transaction threshold is $94 million. 0000004716 00000 n This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies. Stat. No attorney client relationship is created or implied by this Blog. Under the federal merger control regime, both the FTC and DOJ Antitrust Division have the authority to investigate and challenge mergers. 0000013829 00000 n The HSR Act thresholds are adjusted annually and transactions and for which no exemptions apply must file a notification with the antitrust agencies and wait 30 days after making this submission before closing. An agency within the U.S. Department of Labor, 200 Constitution Ave NW 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. The basics: All contractors and subcontractors of the federal government must comply with legal requirements regarding affirmative action and non-discrimination. 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. A Member of TAGLaw a Worldwide Alliance of Independent Law Firms. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Even if not reportable to federal or state regulators, a deal can be challenged, and the parties should be prepared to advocate for their transaction. 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. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). See 41 CFR 60-1.5(a)(3), 60-300.4(a)(3), 60-741.4(a)(3). 2023 Brouse McDowell. Wyoming. Official websites use .govA 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). 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. .h1 {font-family:'Merriweather';font-weight:700;} 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. 0000035664 00000 n It's time to renew your membership and keep access to free CLE, valuable publications and more. ERISA requires plans to provide participants with plan information including important information . Based on the difference between the new and original policy annual premiums, The California Insurance Code defines "policy" as a(n). 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. At any time, a state that is willing and able may assume enforcement authority of the Affordable Care Act market reform standards. 41 CFR 60-741.2(i). -Doctors' services are covered by Medicare Part B. div#block-eoguidanceviewheader .dol-alerts p {padding: 0;margin: 0;} .usa-footer .grid-container {padding-left: 30px!important;} 0000002187 00000 n She can be reached at [email protected]. 0000027421 00000 n How do I know if my health care entity falls under the jurisdiction of OFCCP? Stat. 0000004738 00000 n 0000011859 00000 n Per SB 977, substantial market power can be shown by either (1) the conduct having a substantial anticompetitive effect, or (2) the health care system having substantial market share in one or more markets (with a system presumed to have substantial market power if it has greater than a 60% share). {{currentYear}} American Bar Association, all rights reserved. What is required after a life agent sells an insurance policy to an applicant without being appointed by the insurer? Which entity has jurisdiction over health care coverage providers? 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. 0000012163 00000 n Your practice or facility may not be subject to affirmative action laws, so read on to understand whether you should accept this provision in an agreement or not. A health care entity becomes a federal contractor when it performs services that are used by the federal government, either through a direct contract with a federal government agency or an indirect arrangement with another entity that has a federal contract. The information in this section will be of interest to state and local governmental employers that provide self-funded group health plan coverage to their employees, administrators of those group health plans, and employees and dependents who are enrolled, or may enroll, in those plans. .usa-footer .container {max-width:1440px!important;} Likewise, a teaching hospital doing research for a university that has a contract with the Federal government may be covered.. 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 0000001980 00000 n 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 Policy form review is one of the compliance tools used to confirm health insurance issuers' compliance with the provisions of the health insurance market reforms of the Affordable Care Act. Federal government work is performed in some other division in another state. 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. .table thead th {background-color:#f1f1f1;color:#222;} Part 60-741.5(a).. [CDATA[/* >