which entity has jurisdiction over health care coverage providers

Compliance Checkup: Affirmative Action: Is your health care entity 0000018777 00000 n Long-term care is covered by Medicare Part C. 18116. Likewise, a teaching hospital doing research for a university that has a contract with the Federal government may be covered.. 0000001980 00000 n The same holds true under Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, 38 U.S.C. 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. 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. It is unclear what would constitute a dominant position under the proposed statute. In order to be eligible for the TRICARE Exemption, the entity must hold a TRICARE subcontract (rather than a prime contract) and hold no other covered agreements. Our business operates as a fund depository, and an issuing and paying agent for U.S. 12 The healthcare material change notice requirement applies when (1) both parties are Washington entities or (2) one party is a Washington entity and the other is an out-of-state entity that generates $10 million or more in revenue from healthcare services for patients residing in Washington.13 Transactions meeting these criteria must be reported regardless of size. How do I know if my health care entity falls under the jurisdiction of OFCCP? After collection and review of policy forms for compliance with the respective market reform provisions, CMS will notify issuers of any concerns. 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. 42 U.S.C. 0000004716 00000 n 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. No, as a federal contractor in the State of California you will still need to meet the requirements of Executive Order 11246. In 2017, Washington sued CHI Franciscan over two consummated deals with orthopedic providers in Kitsap county. In addition to the premerger notification provision, SB 977 also targeted conduct by healthcare systems. These states can then use the information gathered from these notifications for their investigative and enforcement functions possibly challenging the transactions. Share sensitive information only on official, secure websites. 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. Therefore, even small transactions, which might have gone unnoticed by federal enforcers, could be subject to antitrust scrutiny by state enforcement agencies. Currently, the size-of-transaction threshold is $94 million. Before sharing sensitive information, make sure youre on a federal government site. Given the importance and rising costs of healthcare as well as a concern about whether federal authorities have the same interests and incentives to enforce the antitrust laws, recently states have taken actions to be better informed about, challenge, or prevent healthcare affiliations. 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. Any person or other entity, including a provider sponsored organization that operates under the Medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act . 0000020767 00000 n 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. We use cookies on our website. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 15 U.S.C. 15 U.S.C. The term "nonpersonal services" as used in this section includes fund depository. This was the subject of ongoing litigation against a Florida hospital, but in 2014, OFCCP dismissed this case and announced a five-year moratorium for affirmative action enforcement. and Dennie Zastrow, Esq., Troutman Pepper Hamilton Sanders, LLP, Philadelphia, PA What is Medi? 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. According to the California Insurance Code, what is the maximum penalty per violation for anyone who unwillfully commits an unfair method of competition? 0000035585 00000 n 0000007980 00000 n means youve safely connected to the .gov website. 0000035052 00000 n An official website of the United States government. The statutory framework for enforcement of non-Federal governmental plans was established in Part A of title XXVII of the PHS Act with the enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 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? Megan Morleyis a Senior Attorney in the Business Litigation practice group at Troutman Pepper. 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. She can be reached atmegan.morley@troutman.com. Under the federal merger control regime, both the FTC and DOJ Antitrust Division have the authority to investigate and challenge mergers. 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. 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. The basics: All contractors and subcontractors of the federal government must comply with legal requirements regarding affirmative action and non-discrimination. Region. Secure .gov websites use HTTPSA This definition thus explicitly includes agreements for insurance, which would cover FEGLI contracts. 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. Dennie Zastrow is an Associate in the Business Litigation practice group at Troutman Pepper. 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. Press Release from the California Office of the Attorney General, SB 977, at 1190.25(a). It is not intended as a form of, or as a substitute for legal advice. which entity has jurisdiction over health care coverage providers #block-googletagmanagerfooter .field { padding-bottom:0 !important; } A person compensated for transacting insurance on behalf of another person with an insurer. Self-Funded, Non-Federal Governmental Plans | CMS Are Federal Reserve Banks subject to the affirmative action and equal employment opportunity laws OFCCP enforces? OFCCP will use the insurance premium to determine if the covered insurance contract meets the $50,000 threshold requirement necessary to obligate the federal contractor to develop and maintain an Executive Order 11246 AAP, not the face value of the policy. 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. 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. For additional qualifications and requirements, please visit the U.S. Department of Labor Office of Federal Contract Compliance Programs website, at https://www.dol.gov/ofccp/ and ask your attorney to ensure your health care entity is in compliance. The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. When that happens, CMS will work with the state to ensure an effective transition. 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. 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. This definition includes any reinsurance agreement related to FEGLI. No attorney client relationship is created or implied by this Blog. Even if states do not have premerger notification requirements, they still can challenge transactions. 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. Thus, the agreement to serve as a federal funds depository is a "government contract.". Jurisdiction Frequently Asked Questions | U.S. Department of Labor - DOL Is CMS a regulatory agency? Currently, the Donnelly Act prohibits only anticompetitive activities from agreements or conspiracies, like federal laws Section 1 of the Sherman Act. .manual-search-block #edit-actions--2 {order:2;} 0000002523 00000 n 0000018799 00000 n SB 977 required the California attorney general to reject a transaction if the parties failed to show that it will result in a substantial likelihood of clinical integration, a substantial likelihood of increasing or maintaining the availability and access of services to an underserved population, or both.21 Even if the parties demonstrated clinical integration and increased access, the legislation gave the attorney general the discretion to reject a transaction if there was a substantial likelihood that the transaction would lead to anticompetitive effects, such as increased prices, diminished quality or access, and reduced choice, that outweigh any benefits of a substantial likelihood of clinical integration or an increase or maintenance of services to an underserved population. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be a covered federal contractor. Hospital, physician, and private equity industry groups, however, opposed the legislation. 15 U.S.C. Which of the following is NOT a primary objective of insurance regulation? The vast majority of states are enforcing the Affordable Care Act health insurance market reforms. https:// lock Washington, DC 202101-866-4-USA-DOL1-866-487-2365www.dol.gov, Office of Federal Contract Compliance Programs, Office of Administrative Law Judges OFCCP Collection, Significant Guidance Documents (formerly "Guidance Documents"), Functional Affirmative Action Programs (FAAP), Notification of Construction Contract Award Portal, Opening Doors of Opportunity for All Workers Poster.

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