Where we’re going

On July 1, 2021, the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued the first set of regulations under the No Surprises Act – “Part I of the Requirements Related to Surprise Billing.”[1] Part I provides regulations for only a portion of the No Surprises … Continued

Over the past two years, we’ve followed and discussed the twists and turns in the Patient Protection and Affordable Care Act (the “PPACA”) legal battle.[1] In December 2020, we concluded that the Supreme Court would not overturn the PPACA. We anticipated that the Supreme Court may use the nullified penalty in the individual mandate as … Continued

In November 2017, ACS Primary Care Physicians Southwest PA and Emergency Services of Texas (affiliates of physician led TeamHealth), filed a lawsuit in Houston, Texas alleging that Molina Healthcare, Inc. and Molina Healthcare of Texas, Inc. failed to pay the usual and customary rates for out-of-network services.[1] ACS and Emergency Services of Texas sought more … Continued

Covid-19 has had sweeping effects across the world, as worldwide, 3.5 million people have died.[1] An estimated 591,000 of these deaths occurred in the U.S.[2] Future impacts on health insurers and insureds are uncertain and difficult to project. While economists are aiming at a moving target, the pandemic will have an estimated 4.5 percent GDP loss, … Continued

In April, Nuance Communications, Inc. announced that it was being acquired by Microsoft for 19.7 billion dollars. This deal is expected to be ongoing throughout the rest of 2021. [1] Microsoft, in this transaction, made sure to emphasize that it wants to provide software that works alongside doctors. [2] Let’s take a look at what … Continued

If you did not watch the Academy Awards, you may have missed a new national campaign. It wasn’t about COVID. It wasn’t about the opioid crisis, anti-bullying, or suicide prevention. (https://rpdrlatino.com) It was about medical price transparency – Power to the Patients – “Our Health. Our Money.” The campaign strives to raise awareness that knowing … Continued

Prescription drug prices and spending are hot topics and for good reason. U.S. pharmaceutical prices are 2.56 times higher than prices seen in 32 other nations, according to a report released by the Rand Corporation.[1] For brand-named drugs that number multiple jumps to 3.44.[2] Retail prescription drug spending accounted for 10% of the total health … Continued

On December 12, 1980, the Bayh-Dole Act was enacted to provide incentives to innovate and promote the commercialization of federally funded inventions and amended the existing patent laws. In December 2002, The Economist published an opinion piece calling the Bayh-Dole Act “innovation’s golden goose” and stating that it was “[p]ossibly the most inspired piece of … Continued

On December 27, 2020, the former President signed into law the Consolidated Appropriations Act – a 5,593-page piece of legislation with 32 divisions addressing a myriad of disparate subjects, including the COVID-19 stimulus. Tucked into it and beginning on page 4,095 is the No Surprises Act. The approximately 750 page No Surprises Act purports to … Continued

After Singing “Happy Birthday”, Sing Another Song, Then Take Action Don’t Let Time Pass[i] Many plan sponsors use “life events” as a trigger to prompt participants to reconsider their benefit elections – marriage, birth, relocation, etc.  Why not birthdays?  Why not a reminder to workers, regardless of their actual age, on their birthday in 2021?  … Continued