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. As a reinsurer for the Federal Employees Group Life Insurance (FEGLI) program, are we a federal government subcontractor? 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. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). OFCCP v. Safeco Insurance Co. of America, Secretary of Labors Decision, July 31, 1984. 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. 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. 0000008002 00000 n Whether to voluntarily notify state enforcers. Yes. 0000018799 00000 n -Long-term care is covered by Medicare Part C. -Hospice is covered by Medicare Part A. At any time, a state that is willing and able may assume enforcement authority of the Affordable Care Act market reform standards. Those entities involved in healthcare-related deals not only need to understand their obligations and risks under the federal antitrust laws but also how involvement by state enforcers may affect their transactions. Likewise, a teaching hospital doing research for a university that has a contract with the federal government may be covered. 4212 (VEVRAA). She can be reached at barbara.sicalides@troutman.com. 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. Watch out for this language! Currently, the Donnelly Act prohibits only anticompetitive activities from agreements or conspiracies, like federal laws Section 1 of the Sherman Act. Federal Reserve Bank of Boston v. Commissioner of Corporations and Taxation of the Commonwealth of Massachusetts, 499 F.2d 60 (1st Cir. 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. OFCCP uses VAHBP providers as an umbrella term to encompass health care providers that contract with the U.S. Department of Veterans Affairs, including those in Veterans Affairs Community Care Networks, as well as Veterans Care Agreements created pursuant to 2018 VA MISSION Act. 18. Which of the following is NOT a primary objective of insurance regulation? On March 20, 2020, Governor Jared Polis of Colorado signed SB20-064 into law.30 The legislation repealed Colo. Rev. 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. 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. Since the effective date of a transaction can have a myriad of implications (financing, tax, contractual, regulatory, etc. According to the California Insurance Code, how is the word "may" interpreted? .table thead th {background-color:#f1f1f1;color:#222;} 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 TRICARE Exemption, the entity must hold a TRICARE subcontract (rather than a prime contract) and hold no other covered agreements. For example, the FTC typically investigates transactions involving healthcare providers, whereas the DOJ reviews insurance-related deals. Share sensitive information only on official, secure websites. How do I know if my health care entity falls under the jurisdiction of OFCCP? Colo. Rev. Potential covered contracts or subcontracts may include contracts related to Medicare Advantage (Part C) or Part D programs. #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;} The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The following states have notified CMS that they do not have the authority to enforce or are not otherwise enforcing the Affordable Care Act market reform provisions. 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. 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. 0000002523 00000 n 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. If a State or local government has Government contracts, is it subject to the requirements of Executive Order 11246? -Medicare is primarily funded by Federal payroll and self-employment taxes. Notice of appointment must be submitted to the Commissioner. . Federal government websites often end in .gov or .mil. 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. 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. Once it has been determined that a contractor or subcontractor is subject to OFCCP jurisdiction, the regulations implementing the civil rights requirements enforced by OFCCP apply to all of the contractors or subcontractors employees who are engaged in onsite construction, including those construction employees who work on a nonfederal or nonfederally assisted construction site. Health Care Clearinghousesentities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa. In addition, business associates of covered entities must follow parts of the HIPAA regulations. lEm 3. 0000011859 00000 n Importantly, however, even if a merger is not reportable under the HSR Act, the federal antitrust regulators still can become aware of (via customer complaints, news reports, trade publications, and the like), investigate, and challenge the transaction. Liberty Mutual Insurance Co. v. Friedman, 639 F. 2d 164 (4th Cir. Overseeing the insurance industry and protecting the state's insurance consumers is the responsibility of the California Department of Insurance (CDI). .h1 {font-family:'Merriweather';font-weight:700;} The parties settled prior to trial with CHI Franciscan agreeing to have separate payor contracting for primary care and orthopedic services and to pay $2.5 million to the state. The term "nonpersonal services" includes, but is not limited to, the following services: This definition thus explicitly includes agreements for insurance. How the proposed transaction affects competition. trailer << /Size 110 /Info 60 0 R /Root 63 0 R /Prev 113598 /ID[<316761acfb838f940b729f6e746b7375><0433f655088ef2546be3616a7ff69e33>] >> startxref 0 %%EOF 63 0 obj << /Type /Catalog /Pages 59 0 R /Metadata 61 0 R /PageLabels 58 0 R >> endobj 108 0 obj << /S 360 /L 533 /Filter /FlateDecode /Length 109 0 R >> stream Employment-related group health plans may be either "insured" (purchasing insurance from an issuer in the group market) or "self-funded." Such advice should always come from in-house or retained counsel. c^J\o$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? What if my health care entity does fall under the jurisdiction of OFCCP? If your entity is a federal contractor or subcontractor, you must be sure to maintain affirmative action program compliance. Are Federal Reserve Banks subject to the affirmative action and equal employment opportunity laws OFCCP enforces? These states can then use the information gathered from these notifications for their investigative and enforcement functions possibly challenging the transactions. Part 60-741.5(a).. The proposed statute defines clinical integration as a reduction in costs to the benefit of consumer care and outcomes or an increase in the quality of care.. This definition thus explicitly includes agreements for insurance, which would cover FEGLI contracts. .gov 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. For questions and concerns regarding non-Federal governmental plans, please e-mail NonFed@cms.hhs.gov. What is Pete guilty of? Executive Order 11246, as amended (Executive Order) implementing regulations at 41 CFR 60-1.40(a) and 41 CFR 60-2.1(b) state, in relevant part, that any nonconstruction (Supply and Service) contractor that serves as a depository of government funds in any amount or a financial institution which is an issuing and paying agent for U.S. saving bonds and saving notes in any amount must develop an affirmative action program. 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. 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. Health Care Market Participants, RCW 19.390, et seq.. Non-Federal governmental plans are not regulated the same way as insurance companies or private employer health plans. 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). Yes. He can be reached at dennie.zastrow@troutman.com. 41 CFR 60-741.2(i)(4). Hospital, physician, and private equity industry groups, however, opposed the legislation. 0000024410 00000 n The Scheduling Moratorium for VAHBP Providers only applies to providers of health care and does not extend to contractors that hold a separate, independent non-health-care-related contract. You can decide how often to receive updates. The new threshold applies to contracts entered on or after December 1, 2003. The Colorado attorney general is now authorized to challenge transactions when the effect of such acquisition may be to substantially lessen competition or may tend to create a monopoly regardless of whether the Federal Trade Commission (FTC) or the Department of Justice (DOJ) challenged the transaction within the HSR waiting period.32 Importantly, the legislation merely gives the attorney general the authority to challenge proposed acquisitions it neither imposes any additional filing requirements on parties nor creates a standard that differs from that applied under federal law -- Section 7 of the Clayton Act. 0000022775 00000 n 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. Long-term care is covered by Medicare Part 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.
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