U.S. District Court Holds Department of Health and Human Services’ Price Transparency Rule is Constitutional

In November 2019, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services, issued a Rule entitled Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals … Continued

Balance Billing and COVID-19

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”). The CARES Act has many components, one of which was to make $175 billion in Provider Relief Funds available to hospital facilities and other medical providers. To use the funds, the hospitals and providers must … Continued

Data and More Data; Good Data or Not so Good Data?

Good reliable data is necessary for public authorities, aided by medical professionals, to formulate sound strategies for dealing with COVID-19. An understanding of the progression of the pandemic, infection rates, death rates, and other data points will drive community efforts, treatments, outcomes, and economic decisions. But do we have good data concerning COVID-19? What is … Continued

Tossing Aside the Rule of Law, an “Op Ed” By James F. Koehler

Are we tossing aside the rule of law as we respond to the COVID-19 pandemic? I’m beginning to wonder. I can’t help but think the state-by-state designations of essential businesses have been arbitrary, inconsistent, and in some instances driven by politics and opportunity, certainly not by medical necessity. On March 19, 2020, the Cybersecurity & … Continued

COVID-19: Insurance Policy Considerations

As of March 31, the Coronavirus Resource Center of Johns Hopkins University reports that, in the United States, there have been approximately 177,452 people diagnosed with COVID-19 with 3,606 deaths being recorded.  It is an understatement that this new strain of Coronavirus will radically alter life in the United States – and the world – … Continued

ERISA Plan Disclosures Not “Actual Knowledge” Unless Read

ERISA requires plaintiffs with “actual knowledge” of an alleged fiduciary breach to file suit within three years of gaining that knowledge under 29 U. S. C. §1113(2). For plaintiffs without “actual knowledge, a 6-year period applies. The United States Supreme Court addressed the requirements for having “actual knowledge” in a case decided on February 26, … Continued

Balance Billing Defense, an “Op Ed” by James F. Koehler

The authors of this newsletter have followed, and occasionally written about, various state and federal legislative efforts to reign in and address the problem of balance bills, or as the legislators incorrectly name them, “surprise medical bills.” Incorrectly named because in many cases the bills are anticipated by the patient, albeit unknown in amount. “A … Continued

2019 Federal Health Care Legislation – Action or No Action

Funding for the ACA continues to be reduced. “As part of a 1.4 trillion dollar spending package the Senate passed [December 19, 2019] and which President Donald Trump has said he’ll sign, three taxes that were created to fund the Affordable Care Act are set to be repealed. The outgoing fees include the “Cadillac tax,” … Continued

Constitutionality of the ACA – A Brief Timeline and Update

State of Texas, et al. v. United States (N.D. Tex. Case No. 4:18-cv-167-O; 5th Cir. Case No. 19-10011) will follow the traditional litigation path and not be fast-tracked. Here is a look back over the case’s history: December 2017: Congress set the shared responsibility payment at $0 as of January 1, 2019 after enacting the … Continued