Industry Updates

On September 9, the U.S. Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) released a final rule to strengthen implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) (the Final Rule). The Departments say they aim to further the fundamental purpose of MHPAEA to ensure that health plan enrollees are not subject to greater restrictions when seeking mental health and substance use disorder (MH/SUD) benefits than when they seek...By: Manatt, Phelps & Phillips, LLP

The US Departments of the Treasury, Labor, and Health and Human Services (the Departments) recently issued much-anticipated final regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). The newly issued final regulations update the 2013 final regulations principally to reflect the changes to MHPAEA enacted by the Consolidated Appropriations Act, 2021 (CAA 2021), which requires plans and issuers to formally analyze and compare nonquantitative treatment limitations (NQTLs) as...By: McDermott Will & Emery

On September 9, 2024, the US Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) finalized a rule titled Requirements Related to the Mental Health Parity and Addiction Equity Act. The rule makes several changes related to mental health (MH) parity for group and individual health plans, including:......By: McDermott+

In this increasingly litigious and regulatory intense environment, D&O Looking Ahead provides a bridge to help you stay on top of the evolving D&O risk landscape.  – Priya Huskins The streak of good news in D&O litigation risk ends this year, with a rise in class action filings and bigger settlements....By: Woodruff Sawyer

The 340B Drug Pricing Program continues to provide critical support for covered entities, although the program is subject to ongoing scrutiny and congressional, judicial, and industry pressures. Certain key guidance documents issued by the Health Resources and Services Administration (HRSA) were recently rejected by the courts, and additional cases are pending. Congress may ultimately decide the direction of the program. With the 340B program remaining a key economic driver for many in the...By: Foley & Lardner LLP

Last week, the Departments of Labor, Treasury, and Health and Human Services finalized regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Although the final regulations step back from certain burdensome aspects of the proposed rules (which we blogged about here), compliance with the final rules will require action from virtually all group health plans that cover mental health and substance use disorder (MH/SUD) benefits before the end of the year....By: Proskauer - Employee Benefits & Executive

The Superior Court of Connecticut, applying Connecticut law, granted an insurer’s motion for summary judgment, finding that a D&O policy did not afford coverage for a settlement that resulted in a consent judgment against the insureds. Ghio v. Liberty Ins. Underwriters Co., 2024 WL 3949196 (Conn. Super. Ct. Aug. 23, 2024). The court held that the settlement was restitutionary in nature and therefore was not insurable....By: Wiley Rein LLP

House Bill 2490 has been introduced and it is best to quote from the sponsoring legislator’s words: [S]ome employers and insurers require claimants to sign side agreements forcing them to resign, preventing them from ever reapplying for work again or requiring confidentiality agreements to settle a claim . . . My legislation would amend the Workers’ Compensation Act to prohibit employers from requiring such side agreements as a condition of a workers’ compensation settlement and would penalize...By: Weber Gallagher Simpson Stapleton Fires &

At least 10 states have implemented, or are in the process of implementing, a community reinvestment requirement in which Medicaid managed care organizations (MCOs) are required to reinvest in the communities they serve to improve health....By: Manatt, Phelps & Phillips, LLP

In J&S Welding, Inc. v. Liberty Mutual Insurance Company, the U.S. Court of Appeals reviewed a summary judgment ruling in favor of co-defendant West American Insurance Company (“West American”), issued by the U.S. District Court for the Western District of Tennessee. The 6th Circuit held that the property policy’s cosmetic damage exclusion applied to bar coverage because the insured, J&S Welding, Inc. (“Insured”), failed to disclose or produce any expert evidence to rebut the conclusions of the...By: Cozen O'Connor

In light of the recent heavy rainfall in the UAE, both insurers and businesses must understand the legal framework outlined in Federal Law No. 5/1985 on Civil Transactions Law or Civil Code. This law provides comprehensive guidelines on insurance contracts, defining the rights, obligations, and procedures for both insured parties and insurers....By: Awatif Mohammad Shoqi Advocates & Legal

On September 9, the US Departments of Labor, Treasury, and Health and Human Services (the Departments) jointly released a final rule to ensure that group health plans comply with the Mental Health Parity and Addiction Equity Act (MHPAEA). The final rule, which spans over 530 pages, limits the ability of group health plans to restrict coverage for mental health and substance use disorders compared to medical and surgical care. The final rule largely tracks the Departments’ July 2023 joint...By: ArentFox Schiff

Heritage Property & Casualty Ins. Co., Appellant v. Sunset Villas Phase III Condominium Association, Inc., Appellee, Fla. 3rd DCA, 3D23-1672, May 15, 2024, Appeal from non-final order from Miami-Dade Co. Lower Tribunal No. 19-18121 - Heritage Property & Casualty appealed an order compelling a commercial Hurricane Irma claim to appraisal. Heritage contended appraisal was premature because an evidentiary hearing was first required to determine whether Sunset Villas satisfied post-loss conditions....By: Marshall Dennehey

House Education & the Workforce Health, Employment, Labor, and Pensions Subcommittee Holds Hearing on ERISA’s 50th Anniversary. Members and witnesses assessed how the Employee Retirement Income Security Act of 1974 (ERISA) and employer-sponsored health insurance are affected by increasing healthcare costs and regulatory changes....By: McDermott+

In a market known for volatility, public company D&O (directors & officers) insurance has certainly lived up to its reputation in recent years—pricing has been on a roller coaster, fluctuating between skyrocketing increases and precipitous drops. The hard and soft market cycles have caused participants’ D&O program limits and cost to yo-yo up and down, leaving many to long for a period of calm and stability....By: Woodruff Sawyer

Representation and warranty insurance (“RWI”) is an increasingly important feature of private company M&A transactions. Every other year since 2005 the ABA has released its Private Target Mergers and Acquisitions Deal Point Studies (the “ABA studies”). Originally Published in Bloomberg Law....By: Goulston & Storrs PC

On September 9, 2024, the U.S. Department of Labor (the “DOL”), the U.S. Department of the Treasury and the U.S. Department of Health and Human Services (“HHS”) jointly released regulations entitled “Requirements Related to the Mental Health Parity” (the “Parity Rule”) in coordination with the Biden-Harris Administration....By: Shipman & Goodwin LLP

In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce reimbursement rates paid to providers for out-of-network healthcare services....By: Goodwin

Hurricane Francine proved to be a true reminder that hurricane preparedness is critically important. With this unique weather event, Hurricane Francine formed in the southern Gulf and within 48 hours was knocking on the Louisiana coastline as a Category 2 hurricane. As seen below, once Hurricane Francine came ashore, she proved to be unpredictable and turned a primary wind event into a historic rain event for Southeast Louisiana and Mississippi....By: Adams and Reese LLP

DFS has developed a draft pre-proposal notice regarding proposed amendments to 11 NYCRR 52 (Insurance Regulation 62) which, if adopted, would amend the minimum standards for form, content, and sale of health insurance in New York. The proposal also modifies standards for policyholder disclosures. The proposal applies to both Article 43 and Article 44 “insurers”, which means both accident and health insurers and HMOs. The proposal, if adopted, would require that insurers request information...By: Bressler, Amery & Ross, P.C.

Many corporations pay significant amounts for directors and officers liability policies.  Commonly referred to as D&O policies, these policies usually involve three sides.  Directors and officers are likely to have the most interest in "Side A" coverage which insures against claims against them when the corporation is unable or is not permitted to indemnify them.  Sides B & C, on the other hand, benefit the corporation.  Side B reimburses the corporation for its indemnity obligations to...By: Allen Matkins

On June 17, 2024, the final rule for Medicare Part D introduced new health IT standards, mandating the adoption of NCPDP SCRIPT Standard version 2023011 by January 1, 2028, while the NCPDP Formulary and Benefit (F&B) Standard version 60 and NCPDP Real-Time Prescription Benefit (RTPB) Standard version 13 must be implemented by January 1, 2027. These updates aim to improve the interoperability between prescribers, pharmacies, and payers by enhancing data exchange related to prescriptions,...By: Ankura

Medical Device Manufacturer THD Pays $700,000 to Resolve FCA Allegations - On September 6, the US Attorney’s Office for the District of Maryland announced that THD America, Inc., and its parent company, THD SpA of Italy, agreed to pay $700,000 to resolve False Claims Act (FCA) allegations....By: ArentFox Schiff

On June 26, the Centers for Medicare & Medicaid Services (CMS) released the Notice of Funding Opportunity (NOFO) for the Transforming Maternal Health (TMaH) Model. TMaH is ten-year delivery and payment model designed to test whether effective implementation of evidence‑informed interventions, sustained by a value-based payment (VBP) model, can improve maternal outcomes and reduce Medicaid and Children's Health Insurance Program (CHIP) expenditures....By: Manatt, Phelps & Phillips, LLP

Wenzel v. Homeowners Choice Prop. & Cas. Ins. Co., Fla. 4th DCA, 4D2023-0088, Apr. 24, 2024 - Following a jury trial, the circuit court entered a directed verdict for the insurer and set aside the jury’s verdict, concluding the insured failed to provide the insurer with prompt notice of the loss. The reviewing court determined that the evidence submitted to the jury was susceptible to different reasonable inferences as to whether the insurer was prejudiced by the delay in reporting the loss....By: Marshall Dennehey

Citizens Prop. Ins. Corp. v. Barberan, Fla. 2nd DCA, 2D22-2744, Apr. 3, 2024 - In April, the Second District Court of Appeal affirmed the lower court’s ruling that a statutory change, which added a definition for the term “structural damage” to a particular statute governing insurance coverage for sinkhole losses (Florida Statute § 627.706), did not alter an insureds’ burden of proof to establish that sinkhole damage to their home occurred during the period when the property had insurance...By: Marshall Dennehey

On August 27, the government filed a motion indicating that it intends to seek Supreme Court review of the U.S. Court of Appeals for the Fifth Circuit’s decision in Braidwood Management v. Becerra. In June, the Fifth Circuit ruled that the law requiring commercial health plans to cover without cost sharing certain preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) is unconstitutional because the manner of the USPSTF’s appointment violates the Constitution’s...By: Manatt, Phelps & Phillips, LLP

A state appellate court in Pennsylvania recently affirmed a trial court’s summary judgment ruling addressing a franchisor’s claims for indemnification in a personal injury dispute. Sunoco (R&M), LLC v. Pa. Nat'l Mut. Cas. Ins. Co., --- A.3d ---, 2024 WL 3688402 (Pa. Super. Ct. Aug. 7, 2024)....By: Lathrop GPM

Insurance buyers enjoyed favorable market conditions across most segments of the commercial lines market in the first half of 2024. D&O and Cyber led the way in premium decreases, even benefiting companies with claims activity. The Property market is also improving; while rates are still rising, the increases are significantly smaller. Companies with good loss experience and high-quality risk management might even see a flat renewal. However, on the Casualty side, auto, general liability and...By: Woodruff Sawyer

California’s Fourth Appellate District published its opinion in Audish v. Macias, clarifying the collateral source rule in personal injury cases. The Court built on the foundation provided by Howell v. Hamilton Meats & Provisions, Inc. finding that evidence concerning a plaintiff’s eligibility for future benefits, like Medicare, is not barred under the collateral source rule. This major development may lead to reduced damages, as the defense will be able to put on evidence that a plaintiff is...By: Kennedys