Jeremy Earl
Subscribe to Jeremy Earl's PostsJeremy Earl represents a broad range of healthcare organizations, with a focus on managed care legal issues. His clients include health insurers, HMOs, healthcare provider organizations, pharmacy benefit managers and administrative service providers to managed care organizations. Jeremy is a practice area leader for the Managed Care Group.Read Jeremy Earl's full bio.
CMS Proposes to Prohibit Overrides in Medicare Advantage
By Mary Moll Alexandre, Jeremy Earl, Kate McDonald and Fabiola Díaz Vera on Jan 16, 2024
Posted In Employee Benefits, Health and Welfare Plans
On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the Medicare Advantage and Part D programs. Among other proposals, CMS proposed significant changes to longstanding rules on permissible payment structures for agents and brokers. Specifically, CMS proposes to prohibit “overrides” or administrative fees paid to agents and...
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ERISA Preemption Developments in Managed Care
By Jeremy Earl and Kate McDonald on Apr 13, 2023
Posted In Employee Benefits, Health and Welfare Plans
For plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA), the doctrine of federal ERISA preemption over state statutes, regulations or administrative schemes has been a central subject of litigation since the inception of the statute. In December 2020, the US Supreme Court issued a decision on the...
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How Telehealth Adoption May Drive Increase in Value-Based Care
By Marshall E. Jackson, Jr. and Jeremy Earl on Jul 20, 2022
Posted In Benefit Controversies, Digital Health, Employee Benefits, Health and Welfare Plans
The COVID-19 pandemic has ushered in significant changes to the healthcare industry, specifically the transition from a fee-for-service model to a value-based care model, and digital health has proved to be a driver of value-based care models. In this Westlaw Today article, McDermott Partners Marshall E. Jackson, Jr. and Jeremy Earl suggest that increased use...
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CMS Aims to Stabilize Exchanges but Does Not Address Issuers’ Biggest Questions
By Ankur J. Goel, Jeremy Earl and Seth Schneer on May 16, 2017
Posted In Health and Welfare Plans
CMS recently released a final rule with the goal of stabilizing Exchange markets for 2018. The agency also issued several significant guidance documents where CMS extended the deadlines for 2018 rate and Exchange qualified health plan application submissions, adopted a good faith compliance standard for 2018 and delegated additional plan certification responsibilities to states. While...
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Trump Administration Takes First Steps to Support Exchanges, but Key Questions Remain
By Ankur J. Goel, Jeremy Earl and Seth Schneer on Mar 2, 2017
Posted In Health and Welfare Plans
In an effort to stabilize the Exchanges and encourage issuer participation, the Centers for Medicare & Medicaid Services (CMS) recently extended the federal Exchange application and rate filing deadlines and published a proposed rule affecting the individual health insurance market and the Exchanges. While issuers will likely see these actions as encouraging signs of the...
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How Congress, President-Elect Trump Might Proceed on Promise to Repeal, Replace ACA
By Ankur J. Goel, Jeremy Earl and Kate McDonald on Nov 14, 2016
Posted In Health and Welfare Plans
President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act (ACA). This campaign promise, which echoes a familiar refrain from Republicans since ACA’s passage, is more complex than it may seem. There are pathways to quickly “repealing” key elements of ACA such as the individual mandate and its subsidies, but this could...
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King v. Burwell Decision Upholds Subsidies in Federal Exchanges
By Ankur J. Goel, Eric Zimmerman, H. Guy Collier and Jeremy Earl on Jul 2, 2015
Posted In Benefit Controversies, Employee Benefits, Fiduciary and Investment Issues, Health and Welfare Plans, Labor
On June 25, 2015, the Supreme Court of the United States ruled in King v. Burwell that the Affordable Care Act (ACA) requires premium tax credits to be made available in states that use a federal exchange. The case challenged an Internal Revenue Service (IRS) regulation allowing tax credits in federal exchanges. The Supreme Court upheld the...
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2015 Notice of Benefit and Payment Parameters
By Anthony A. Bongiorno, Ankur J. Goel and Jeremy Earl on Apr 3, 2014
Posted In Health and Welfare Plans
The Centers for Medicare & Medicaid Services’ Final Notice of Benefit and Payment Parameters for 2015 contains numerous alterations to premium stabilization programs, cost-sharing requirements and employee counting provisions to account for lower-than-anticipated enrollment through the Exchanges and the Obama Administration’s decision to permit individuals to “keep their current plan” through 2016. All of these...
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