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...more
On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to...more
8/8/2024
/ Arbitration ,
Arbitrators ,
Certiorari ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Final Rules ,
Health Care Providers ,
Insurance Industry ,
No Surprises Act (NSA) ,
Reimbursements ,
SCOTUS ,
U.S. Treasury
On July 19, the US District Court for the Northern District of Texas denied a motion to dismiss Blue Cross Blue Shield of Texas (BCBSTX), which claimed sovereign immunity in a suit brought by a group of providers. In so...more
In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by...more
On April 23, the US Department of Labor (DOL) released a final rule significantly expanding the definition of who qualifies as a fiduciary under the Employee Retirement Income Security Act (ERISA) (the Retirement Security...more
5/15/2024
/ Biden Administration ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Exemptions ,
Fiduciary ,
Final Rules ,
Internal Revenue Code (IRC) ,
Investment ,
Pensions ,
Prohibited Transactions ,
Retirement Plan ,
Securities and Exchange Commission (SEC)
In a recent opinion, E.W. v. Health Net Life Insurance Co., the US Court of Appeals for the Tenth Circuit clarified the elements that plaintiffs must plead to state claims under the Mental Health Parity and Addiction Equity...more
On December 18, 2023, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued a rule finalizing the 2024 non-refundable administrative fee parties must pay to access the arbitration...more
*This is the 12th article in a series analyzing the No Surprises Act and its implementation. To view the entire series, click here. A link to the proposed rule is here. As background, Congress passed the Act to prevent...more
On September 21, 2023, the US Departments of Treasury (DOT), Labor (DOL), and Health and Human Services (HHS) (the Departments) issued new rulemaking governing the administrative fee required to access the arbitration process...more
10/4/2023
/ Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Fees ,
Final Rules ,
No Surprises Act (NSA) ,
Proposed Regulation ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
On August 24, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rulemaking under the federal No Surprises Act (the Act). This marked...more
Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more
On August 3, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rules governing fee collection and claim batching under the federal...more
8/22/2023
/ Administrative Procedure Act ,
Arbitration ,
Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Dispute Resolution ,
Fees ,
Health Care Providers ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury
On July 25, 2023, the US Departments of Labor (DOL), Treasury (DOT), and Health and Human Services (HHS) (the Departments) released a much-anticipated interim final rule to ensure that group health plans comply with the...more
8/16/2023
/ Biden Administration ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Department of Transportation (DOT) ,
Interim Final Rules (IFR) ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Rules ,
Rulemaking Process ,
Substance Abuse
In the year following the implementation of the arbitration process established under the federal No Surprises Act (NSA), more than 330,000 disputes have been submitted for resolution. This figure far outpaces the predictions...more
In a recent decision, the US District Court for the District of Utah granted United Healthcare’s (UHC) motion for summary judgment on the plaintiff’s facial and as-applied claims under the Mental Health Parity Act. If...more
In parallel cases, health care providers are continuing to challenge rulemaking by the US Departments of Treasury, Labor, and Health and Human Services (the Departments) under the No Surprises Act (the Act). Having already...more
On February 6, 2023, health care providers scored a second significant victory when a federal court in Texas again vacated portions of the Biden Administration’s rules governing the arbitration procedures to resolve surprise...more
2/15/2023
/ Administrative Procedure Act ,
Arbitration ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Health Care Providers ,
No Surprises Act (NSA) ,
Rulemaking Process ,
Surprise Medical Bills ,
U.S. Treasury ,
Vacated
On December 5, 2022, the US District Court for the Middle District of North Carolina held that the North Carolina State Health Plan (NCSHP) constitutes a “Health Program or Activity” under the Affordable Care Act (ACA). In so...more
12/14/2022
/ Affordable Care Act ,
Bostock v Clayton County Georgia ,
Civil Rights Act ,
Employee Retirement Income Security Act (ERISA) ,
Gender Discrimination ,
Health Insurance ,
North Carolina ,
Rulemaking Process ,
SCOTUS ,
Summary Judgment ,
Transgender
In late September 2022, health care providers in Texas sued the Departments of Treasury, Labor, and Health and Human Services (collectively, the Departments) over a recently issued final rule implementing the federal No...more
Earlier this month, the US District Court for the Western District of Washington certified a class of individuals who were denied gender-affirming care by a third-party administrator, Blue Cross Blue Shield of Illinois...more
11/22/2022
/ Affordable Care Act ,
Anti-Discrimination Policies ,
Blue Cross ,
Blue Shield ,
Declaratory Relief ,
Employee Retirement Income Security Act (ERISA) ,
Gender Discrimination ,
Motion for Summary Judgment ,
Preliminary Injunctions ,
Religious Freedom Restoration Act (RFRA) ,
Transgender
On August 19, 2022, the US Departments of Health and Human Services, Labor, and Treasury, as well as the Office of Personnel Management, released a highly-anticipated final rule clarifying the procedures and considerations...more
On June 21, 2022, the Supreme Court concluded, in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641, 2022 WL 2203328 (U.S. June 21, 2022), that the terms of a benefit plan limiting...more
The Ninth Circuit Court of Appeals recently reversed the Northern District of California’s landmark decision against UnitedHealth Group Inc.’s behavioral health unit, United Behavioral Health (“UBH”), under which UBH had been...more
On February 23, 2022, in what is being heralded as a significant victory for health care providers, a federal court in Texas vacated portions of the Biden Administration’s rules governing the arbitration procedures to resolve...more
In December, the Supreme Court requested that U.S. Solicitor General Elizabeth Prelogar file a brief in John Doe 1 v. Express Scripts Inc., weighing in on whether the Court should hear a case about prescription drug costs. If...more
2/8/2022
/ Amicus Briefs ,
Drug Pricing ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Health Insurance ,
Healthcare ,
Petition for Writ of Certiorari ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
SCOTUS