Adam V. Russo | June 30, 2010

My firm’s partner, India Minchoff, won a settlement known to be the biggest awarded settlement in Plymouth County history.  To learn more about the case, please see the article below.

Families Win Multimillion Lawsuit Against Hemlock Associates Of Lakeville

BOSTON — A civil rights trial against a homeowner’s association accused of discriminating against Jewish members has ended in a settlement that is believed to be the largest in Plymouth County history.

A jury found Tuesday that Hemlock Associates of Lakeville, Inc. violated the civil rights of Donald and Julie Prescott and Scott J. Hyman after a 10-day trial in Plymouth Superior Court. (more…)

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Adam V. Russo | June 30, 2010

SIIA, www.siia.org

The PPACA’s 2500-plus pages of statutory provisions, which become effective as early as September 23, 2010, call for more than 100 sets of regulations to be issued by federal agencies including the Department of Health and Human Services (HHS), Department of Labor (DOL) and Treasury Department. (more…)

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Adam V. Russo | June 30, 2010

U.S. Department of Health & Human Services, www.hhs.gov

I. Background

The Patient Protection and Affordable Care Act (Pub. L. 111-148), hereinafter referred to as the Affordable Care Act, was enacted on March 23, 2010. Section 1103(a), as amended by section 10102(b) of the same act, directs the Secretary to immediately establish a mechanism, including an internet website, through which a resident of, or small business in, any State may identify affordable health insurance coverage options in that State. (more…)

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Adam V. Russo | June 28, 2010

www.healthplanlaw.com

Here, there are no terms in the plan which allow it to be amended by inserting into the SPD such critical provisions as the administrator’s discretionary authority to interpret the plan or to determine eligibility for benefits. Indeed, this particular plan wholly fails to comply with § 1102(b)(3)’s requirement to include a procedure governing amendment of the plan. (more…)

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Adam V. Russo | June 28, 2010

Tennessee. The state senate has approved a bill that will allow hospitals in the state to pay a fee to avoid $659 million in TennCare cuts. Gov. Phil Bredesen had proposed cutting $201 million from TennCare, the state’s Medicaid program, to help balance the state’s budget. The cuts would be averted through the hospital assessment. For more information, visit http://www.state.tn.us/tenncare/.

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Adam V. Russo | June 28, 2010

South Carolina. The state house has cut $50 million from it $5 billion budget, and the cuts center primarily around health care. The cuts limit health care access for low-income children, end a drug program for AIDS patients as well as two programs that help patients purchase prescriptions, limit those on the state-run Medicaid program to three prescriptions a month, and eliminate state-funded cancer screenings. For more information, visit http://www.doi.sc.gov/.

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Adam V. Russo | June 28, 2010

Pennsylvania. Governor Edward Rendell has announced that the state’s insurance department is investigating Pennsylvania’s nine largest health insurance companies to determine the reasons behind controversial rate increases. Mr. Rendell is especially concerned with the extent to which the premium increases are driven by the use of “questionable health profiling tools.” These include the use of individualized medical questionnaires and drug profiling in the small group market, according to the state’s insurance commissioner. For more information, visit http://www.governor.state.pa.us.

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Adam V. Russo | June 28, 2010

Oregon. The state will add approximately 35,000 adults to the Oregon Health Plan, due to increased funding from legislation passed in 2009. The Oregon Department of Human Service’s Division of Medical Assistance Programs administers the plan, and estimates that about 140,000 adult state residents qualify based on their income. For more information, visit http://www.oregon.gov/DHS/healthplan/.

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Adam V. Russo | June 28, 2010

North Carolina. Gov. Bev Purdue’s budget recommends restoring $40 million for community mental health programs that was eliminated in last year’s budget. The proposal also includes $12 million for the state to buy more local private hospital beds for mental health patients who require short term care. Eliminating the $40 million last year drew widespread criticism from behavioral health officials and advocates. For more information, visit http://www.dhhs.state.nc.us/MHDDSAS/.

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Adam V. Russo | June 28, 2010

New York. Governor David Patterson recently signed a bill into law that reinstates the New York State Insurance Department’s authority to review and approve health insurance premium increases before they take effect. The law will apply to all rate increases taking effect on or after Oct. 1, 2010. Since 2000, New York had regulated health insurance premiums under a law that limited the state’s ability to disapprove health insurance premium increases and allowed the insurance industry to self-regulate. The new law also requires health insurers to spend more of every premium dollar on medical costs and not administrative expenses. Under the federal Patient Protection and Affordable Care Act, health insurers will be required to report justifications for “unreasonable” rates increases, as well as the percentage of premiums spent on claims, quality of care, taxes, and administrative costs. In addition, the Department of Health and Human Services recently announced the availability of $51 million in Health Insurance Premium Review grants under the Affordable Care Act. For more information, visit http://www.ins.state.ny.us/.

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Adam V. Russo | June 28, 2010

Missouri. Gov. Jay Nixon recently signed a bill that requires health insurance companies in the state to speed up claims payments to doctors, hospitals, and other health care providers. The legislation was prompted by a 2009 report from the Missouri Department of Insurance that showed health care providers across the state were dealing with significant payment delays in the claims filed with insurance companies for treatment of patients. The report showed more than 26% of claims at Missouri hospitals are past due by 90 days or more. In addition, the state legislature has sent the governor a bill requiring Missouri health insurers to cover therapies and treatments for autism. When Mr. Nixon signs the bill, the autism provisions will go into effect on January 1. For more information, visit http://insurance.mo.gov/.

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Adam V. Russo | June 28, 2010

Massachusetts. The state senate has approved a bill that would require wealthy hospitals to pay $100 million in a one-time contribution to help small businesses pay for health insurance premiums. The bill would let businesses with 50 or fewer workers form cooperatives to purchase insurance at a lower cost. The money paid by wealthier hospitals is estimated to save small businesses 2.5% in premium costs. Another provision of the bill requires that insurers spend 90% of premium dollars on care and 10% or less on administrative costs. For more information, visit http://www.mass.gov/legis/.

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Adam V. Russo | June 28, 2010

Maine. The Maine Superior Court upheld a Maine official’s decision to deny a profit margin for a Wellpoint, Inc. unit in a health insurance rate request. Anthem Blue Cross and Blue Shield proposed a rate increase of 18.1%, but the state only allowed a 10.9% increase, which was the same increase allowed in 2009. The court noted that the approved 2009 rate for Anthem Blue Cross and Blue Shield’s individual health insurance line met the state’s legal standard and wasn’t inadequate. The 10.9% increase became effective on July 1, 2009. The ruling may resonate in other states where regulators are battling premium hikes. For more information, visit http://www.maine.gov/pfr/insurance/.

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Adam V. Russo | June 28, 2010

Florida. The state legislature is ready to cut Medicaid funding for nursing homes and is considering cuts to numerous other health programs to balance the budget. The proposed 7% cut to Medicaid payments rates for nursing homes totals approximately $200 million. Nursing homes likely would be able to offset at least part of the $200 million in cuts during the 2010-11 fiscal year, which starts July 1. Among other things, nursing homes expect to receive additional money because of an increase in a nursing-home tax that draws down more federal matching money. For more information, visit http://www.dcf.state.fl.us/programs/access/medicaid.shtml.

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Adam V. Russo | June 28, 2010

Colorado. Gov. Bill Ritter recently signed eight health care bills into law. The bills included one to mandate that individual and small group health insurance policies cover contraception and pregnancy. Other bills included the establishment of a reward system for Coloradans who report Medicaid fraud, and the establishment of an advisory committee to make recommendations to start an all-payer claims database. For more information, visit http://www.colorado.gov/GOVERNOR.

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