Where we’re going

Part I of the Requirements Related to Surprise Billing require cost-sharing amounts for emergency services provided at nonparticipating emergency facilities or by nonparticipating providers or non-emergency services provided by nonparticipating providers at participating facilities to be based on the lesser of the billed charge or the Qualifying Payment Amount (QPA) where an All-Payer Model Agreement … Continued

With the New Year approaching, you may be wondering will the No Surprises Act really go into effect on January 1st (at least the parts that have not already been delayed)? The answer for now is YES. But, with four lawsuits pending in three courts, this could change at a moment’s notice. Here is a … Continued

And the lawsuits have started… The Texas Medical Association (TMA) was the first to challenge the No Surprises Act. On October 28, 2021, TMA filed a Complaint in the United States District Court for the Eastern District of Texas seeking to vacate certain provisions of Part I of the Requirements Related to Surprise Billing (Part … Continued

On October 7, 2021, the Department of the Treasury, Department of Labor, and Department of Health and Human Services drafted and published Part II of the Requirements Related to Surprise Billing, which establish the Independent Dispute Resolution process. The most interesting development arising out of Part II relates to the discretion (or lack thereof) provided … Continued

A study entitled, “Trends in the Concentration and Distribution of Health Care Expenditures in the US, 2001-2018” published in the JAMA Network Open[1] examined healthcare spending by between 30,461 and 39,165 individuals over that period. The authors[2] “sought to answer the following questions: How is the concentration of health care spending changing in the US … Continued

Having easy access to understandable information is critical to a quality healthcare system. It is so critical that since 1999, October has been designated as Health Literacy Month, a time to bring awareness to the importance of making complex health information easy for all to navigate. During Health Literacy Month, organizations and individuals raise awareness … Continued

On September 7, 2021, a massive group of Plaintiffs (all sponsors/administrators of, or self-insured group plans purchasing administrative services only (“ASO”) from the Defendants),[i] including Alaska Air, Albertsons Companies, American Electric Power, Boeing, Bridgestone, Burlington Northern, Conagra, Dollar General, FedEx, Kellogg, Kroger, Meijer, Publix, Walgreen, churches, benefit plans, and labor organizations filed an antitrust action … Continued

Under applicable federal law, all private insurance plans are required to cover the entire cost associated with approved COVID-19 testing provided the test is deemed medically appropriate. The U.S. government has also paid for COVID-19 vaccines with no out-of-pocket costs regardless of whether the vaccine recipient is insured or not. But there has been no … Continued

On January 1, 2021, the Federal Hospital Price Transparency Rule went into effect requiring hospitals to disclose certain pricing information. Specifically, the Rule requires hospitals to provide pricing information: in a “single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified … Continued

On August 20, 2021, the Health and Human Services, Labor and Treasury Departments released FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 49, which delays the enforcement of certain provisions contained in the No Surprises Act and the Transparency in Coverage (“TiC”) Final Rules. The reasons for the various delays include … Continued