The Time is Now for Reference-Based Pricing Plans

As if the standard issues facing businesses related to healthcare were not enough, businesses now have to deal with the COVID-19 pandemic. As it was, annual premiums were on the rise – increasing 5% in 2019 and predicted to increase 6% in 2020.[1] The health care costs related to COVID-19 are immense. Kaiser Family Foundation … Continued

Section 1332 Waivers-Reinsurance

Section 1332 of the Affordable Care Act (ACA) allows states to apply for a State Innovation Waiver to pursue innovative strategies for achieving high quality, affordable health insurance and to to alter key ACA requirements in the individual and small group insurance markets in furtherance thereof. A January 7, 2020 Kaiser Family Foundation article reported … Continued

Looking for an Exit?

Before the onset of COVID-19, there existed a seller’s market for businesses. Clean, profitable businesses were in short supply. An abundance of private equity and historically low interest rates drove multiples to levels this author had not previously seen in his 40-year legal career. Good businesses in even mundane sectors might sell for 10 times … Continued

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