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Unsurprisingly, The No Surprises Act Has Surprises: Part II

On December 9, the American Medical Association (AMA) and the American Hospital Association (AHA) (the Associations) filed a lawsuit in the U.S. District Court for the District of Columbia challenging the proposed regulations...more

HHS Issues Second Set of Regulations Implementing the No Surprises Act

On September 30, U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, as well as the Office of Personnel Management, issued another interim final rule — “Requirements Related to Surprise Billing: Part II”...more

Sixth Circuit Reverses Antitrust Preliminary Injunction Ordering Health Insurer to Keep Hospital in Its Network

Introduction - On August 10, the Sixth Circuit issued its opinion in St. Luke's Hospital et al. v. ProMedica Health System, Inc., reversing an unusual preliminary injunction under Section 2 of the Sherman Act that ordered...more

US Chamber of Commerce Files Lawsuit Challenging HHS's Health Plan Price Transparency Rule

The federal government’s push for greater price transparency in health care has been highly controversial among health care stakeholders. In 2020, the American Hospital Association (AHA) unsuccessfully challenged HHS’s “Price...more

HHS Issues Interim Final Rule for the No Surprises Act

On July 1, U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, as well as the Office of Personnel Management, issued an interim final rule implementing the No Surprises Act (Act) and requesting...more

New State Law Eliminates All Copays, Coinsurance, and Deductibles for Mental Health and Substance Use Disorder Services

Patient access to behavioral health and substance use disorder services has increasingly become the subject of legislation. Although the federal Mental Health Parity and Addiction Equity Act (MHPAEA), introduced in 2008,...more

D.C. Circuit Upholds Short Term Plans as Alternative to ACA Plans

On July 17, 2020, a panel majority of the D.C. Circuit Court of Appeals upheld a rule issued by the Department of Treasury, the Department of Labor, and the Department of Health and Human Services (collectively, the...more

Supreme Court Finds Insurers Entitled To Millions In ACA Payments

On April 27, the U.S. Supreme Court held that the federal government is on the hook for $12 billion it failed to pay insurers under the Affordable Care Act (ACA) risk-mitigation program known as the Risk Corridors Program. ...more

Surprise Medical Bill Legislation: The Devil Is in the Details

Congress has been working for months to pass legislation protecting patients from surprise medical bills that arise when insured patients unknowingly receive out-of-network (OON) care, usually when receiving emergency medical...more

New York and New Jersey Consider Health Insurance Reforms

Increasing uncertainty and hostility surrounding the federal Affordable Care Act (ACA) have resulted in a burst of health insurance reforms at the state level. For example, Washington recently passed a law creating a public...more

Washington Becomes First State to Create Public Option Health Insurance

On May 13, 2019, Washington Gov. Jay Inslee signed Senate Bill 5526 into law, creating the first public option health insurance product for the individual market in the United States. ...more

Bipartisan Senate Group Pushes Bill to Protect Patients from Surprise Medical Bills

In September 2018, we wrote about a draft U.S. Senate bill aimed to protect patients from surprise medical bills, the “Protecting Patients from Surprise Medical Bills Act.” ...more

PA AG: UPMC Is Prioritizing Profits Over Patients

The University of Pittsburgh Medical Center (UPMC) – one of Pennsylvania’s largest health systems – is refusing to negotiate a contract with Highmark – one of Pennsylvania’s largest insurers....more

With the ACA Individual Mandate in Question, States Consider Adopting Their Own

A task force led by Democratic lawmakers in Delaware has recommended that the state adopt its own individual mandate to bolster the financial stability of its Affordable Care Act (ACA) exchange marketplace....more

Iowa Farm Bureau Health Plans to Deny Coverage for Preexisting Conditions

As litigation surrounding the Affordable Care Act and its mandates abounds, the Iowa Farm Bureau announced three new health plans that will deny coverage to individuals with preexisting conditions (a denial prohibited under...more

Bipartisan Senate Group Leads Charge to Protect Consumers From 'Surprise Medical Bills'

In a departure from the otherwise stark division across party lines when it comes to health care, a new bipartisan effort has emerged to protect consumers from “surprise medical bills” for out-of-network charges. ...more

Another One Bites the Dust: CMS Quashes Ohio's Plan to Waive ACA Requirements, For Now

We have recently seen an uptick in state initiatives designed to skirt requirements under the Affordable Care Act (ACA). We last wrote about Idaho’s failed attempt to permit health insurers to sell noncompliant plans, which...more

Iowa Emerges as Latest State to Challenge ACA Through Noncompliant Plans

We recently wrote about Idaho’s failed attempt to permit health insurers to sell policies that did not comply with Affordable Care Act (ACA) requirements for the individual insurance market. ...more

CMS Thwarts Idaho's Attempts to Skirt Affordable Care Act, But Provides a Path Forward

Last month, we reported that Idaho announced a controversial plan to allow insurers to sell policies that do not comply with certain ACA requirements — a move that some feared would set a precedent for other states. ...more

States Launch a New Challenge to the ACA: Noncompliant Health Plans

In the wake of recent failures to repeal the Affordable Care Act, one state has decided to take matters into its own hands. Idaho recently announced a controversial plan to allow insurers to sell policies that do not comply...more

Federal Court Strikes DOJ's Risk Adjustment False Claims Act Case - For Now

On October 5, a federal district court in California dealt a significant setback to the government’s efforts to extend False Claims Act (FCA) liability to Medicare risk adjustment submissions....more

Health Care Providers Should Review Assignment of Benefit Forms After 9th Cir. Decision

A federal appeals court recently brushed aside the claims of several health care providers, in large part because of the language in the assignment forms signed by their patients. The opinion from the U.S. Court of Appeals...more

House Votes to Repeal Antitrust Exemption for Health Insurers Under the Mccarran-Ferguson Act

On March 22, the U.S. House of Representatives passed the Competitive Health Insurance Reform Act of 2017, which would repeal the current limited federal antitrust immunity for health insurers. The bill would amend the...more

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