Eighth Circuit Issues Decision on Bundling and Exclusive Dealing

The Eighth Circuit has issued a significant antitrust decision addressing bundled rebates and the law surrounding exclusionary contracts. In Southeast Missouri Hospital v. C.R. Bard, Inc. (No. 09-3325, Aug. 17, 2010), the Eighth Circuit affirmed the district court's grant of summary judgment dismissing a …

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Can a new early retiree medical plan apply for certification under the Early Retiree Reinsurance Program?

Since June 29, 2010, the Department of Health and Human Services (HHS) has been accepting applications for plan certification under the Early Retiree Reinsurance Program (ERRP).  Some plan sponsors that previously did not provide any group health benefits to early retirees are now thinking about starting to offer …

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CMS’ Confusion Over LTCF Dialysis Continues

CMS permits home dialysis in a long-term care facility (“LTCF”)—that much is clear.  But that is about as much clarity as there is, and the newly released Final Prospective Payment System (“PPS”) rule for End Stage Renal Disease (“ESRD”) does not make things much better. In 2004, CMS issued two …

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Comments on “Grandfathered” Plan Regulations

Although the interim final regulations implementing the “grandfather” provisions of PPACA that were released on June 17, 2010, provided some guidance on what types of changes to a grandfathered plan would result in loss of grandfathered status, many questions remain for plan sponsors currently trying to decide …

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Unanswered Questions for Employers and Health Plans

Despite all the guidance that has been issued on health care reform, there are still many unanswered questions.  Employers and health plans would welcome additional guidance on the following: For W-2 reporting of health care coverage, does the reporting apply to non-employees, such as retiree, surviving …

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The Sixty Day Rule: Reporting & Returning Overpayments Under PPACA

Among numerous changes to the Medicare and Medicaid Program Integrity Provisions, Section 6402 the Patient Protection and Affordable Care Act (“PPACA”) contains urgent requirements for reporting and returning overpayments. The new provision requires certain entities – including providers, suppliers, …

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