On February 23, a Texas federal court vacated several key portions of an interim final rule (Rule) governing the No Surprises Act's (Act) independent dispute resolution (IDR) process. The court's decision has been lauded by...more
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
On October 28, the Texas Medical Association (TMA), a trade association that represents more than 55,000 physicians and medical students, filed a lawsuit in the Eastern District of Texas challenging key portions of CMS’s...more
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
On August 13, the D.C. Circuit revived the CMS 2014 Medicare Advantage Overpayment Rule in deciding UnitedHealthcare Ins. Co. v. Becerra, a ruling that could have broad implications for Medicare Advantage (MA) insurers. See...more
The Pennsylvania Supreme Court issued an order and opinion on August 17 holding that medical peer review documents do not need to be generated by a “peer review committee” to be protected under the Pennsylvania Peer Review...more
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
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
Facial recognition technology (FRT) has become the new normal for many of us. We use it to unlock our phones or to sign into various apps. But unlocking our cell phones is just one of the many ways we may experience FRT;...more
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
In the span of just a few weeks, both the Pennsylvania Supreme Court and the U.S. Court of Appeals for the Third Circuit issued decisions significantly expanding liability under Pennsylvania’s Unfair Trade Practices and...more
On December 21, Congress passed the $900 billion spending and COVID-19 relief package — the Consolidated Appropriations Act, 2021 (CAA) — which President Trump signed on December 27. Although the CAA’s monetary relief...more
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
7/28/2020
/ Affordable Care Act ,
Chevron Deference ,
COBRA ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Essential Health Benefits ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Preexisting Conditions ,
U.S. Treasury
On June 23, the U.S. District Court for the District of Columbia dismissed a challenge to a federal rule requiring hospitals to disclose prices they privately negotiated with insurers....more
6/26/2020
/ Affordable Care Act ,
Arbitrary and Capricious ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Final Rules ,
First Amendment ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Price Transparency ,
Public Disclosure ,
Secretary of HHS ,
Service Charges
A group of Michigan-based health care providers and one of their patients are the latest to assert constitutional claims related to COVID-19 shutdown orders. Unlike other businesses challenging shutdown orders, these...more
While the Pennsylvania legislature considers one of the most aggressive bills in the country to force insurers to provide coverage for COVID-19 business interruption claims, Pennsylvania’s Insurance Commissioner on Monday...more
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
5/3/2020
/ Affordable Care Act ,
Appropriations Bill ,
Court of Federal Claims ,
Damages ,
Government Payments ,
Health Insurance ,
Insurance Industry ,
Maine Community Health Options v. United States ,
Reimbursements ,
Remand ,
Repeal ,
Reversal ,
Risk Corridors Statute ,
SCOTUS ,
Tucker Act
Pennsylvania recently joined the movement to introduce legislation that would override insurance policy language and require carriers that have issued commercial liability policies — specifically policies covering business...more
Some states are loosening their licensing and regulatory requirements to allow more patients to access telehealth services during the COVID-19 pandemic....more
A group of New Jersey lawmakers recently introduced the Patient Protection Act (A5369, S3816), which would make it more difficult for doctors to transfer or refer patients to out-of-state providers or facilities....more
The Pennsylvania Supreme Court has adopted a new, expanded standard for preserving the protections of the attorney work-product doctrine, codified at Pennsylvania Rule of Civil Procedure 4003.3. This decision has implications...more
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
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
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
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