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86 Matching News Items

1.  New New York City Local Law Promotes Health Care Price Transparency
Sheppard Mullin Link to more items from this source
July 10, 2023
"This local law amends the New York City Charter and directs the Mayor to establish an Office of Healthcare Accountability -- the first of its kind in the country. Among other things, the NYC Office of Healthcare Accountability will allow New Yorkers to compare costs charged by NYC hospitals for the same services."
2.  FTC Proposed Rule Clarifies Application of Health Breach Notification Rule to Health and Wellness Apps
Sheppard Mullin Link to more items from this source
June 29, 2023
"[T]he FTC has indicated that the Rule applies to developers of mobile health applications and technologies, including those marketed as “wellness” products rather than “health” products The Proposed Rule aims to eliminate confusion by clarifying the Rule’s applicability to Vendors and updating relevant definitions."
3.  Connecticut Governor Signs Legislation to Reduce Health Care Costs and Increase Competition
Sheppard Mullin Link to more items from this source
June 22, 2023
"The Act is extensive and is aimed at increasing competition in the health care market, heightening price transparency, and reducing prescription drug costs.... [1] Payer-provider contracting requirements ... [2] PBM practices and contracts ... [3] Drug discount card program ... [4] Registration for pharmaceutical marketing ... [5] Reducing prescription drug costs ... [6] Facility fees ... [7] Certificate of need laws."
4.  CMS Releases Updates to Hospital Pricing Transparency Rule
Sheppard Mullin Link to more items from this source
June 7, 2023
"CMS will now require a noncompliant hospital to submit a CAP within 45 days of receipt of the CAP request. A hospital must also fully comply with price transparency guidelines within 90 days of CMS issuing the request.... Failure by a hospital to submit a CAP to CMS within the 45-day deadline or failure by a hospital to comply within 90 days with price transparency guidelines will now result in the automatic imposition by CMS of [civil monetary penalties]."
5.  CMS Releases Notice of Benefit and Payment Parameters for 2024 Final Rule
Sheppard Mullin Link to more items from this source
Apr. 24, 2023
"The Notice implements various changes previously proposed by CMS, including [1] requiring provider networks to comply with network adequacy standards and delaying the implementation of appointment wait time standards, [2] standardizing plan options, [3] adding special enrollment periods to increase ease of obtaining coverage, [4] strengthening markets, and [5] bolstering program integrity."
6.  Access to Abortion Pill in Limbo: Navigating the Intricacies of Conflicting Federal Court Rulings in Texas and Washington State
Sheppard Mullin Link to more items from this source
Apr. 16, 2023
"Hours before the restrictions were set to go into effect, Supreme Court Justice Samuel Alito placed a five day administrative stay on the Fifth Circuit's order ... This article provides an in-depth analysis of the dueling decisions, with a deep dive into the implications of the Texas case, including the availability and use of the Mifepristone drug going forward, and the potential impact to the FDA's broader authority, if the Texas plaintiffs ultimately prevail."
7.  PBM Practices Receive Increased Federal Scrutiny
Sheppard Mullin Link to more items from this source
Mar. 15, 2023
"On March 1, 2023, the House Committee on Oversight and Accountability launched an investigation into PBM practices.... Last year, the Federal Trade Commission (FTC) launched an investigation into the PBM industry, seeking information on the competitive impact of the contracting and business practices of the six largest PBMs.... Additionally, the OIG announced its intent to issue a report on whether States provide adequate oversight of Medicaid MCOs to ensure accountability over amounts paid for prescription drug benefits to PBMs."
8.  Telehealth in a Post-PHE World
Sheppard Mullin Link to more items from this source
Mar. 5, 2023
"As the curtains are drawn on the PHE ... it is essential that participants in the telehealth space understand what flexibilities will remain in play. [1] Definition of 'originating site' ... [2] Definition of 'practitioner' ... [3] In-person visit requirement for telehealth mental health services ... [4] Audio-only telehealth ... [5] HDHP/HSA safe harbor for telehealth services."
9.  Certified IDR Entities to Resume Payment Determinations for Services Furnished Before October 25, 2022
Sheppard Mullin Link to more items from this source
Feb. 26, 2023
"Effective February 27, 2023, Certified IDR Entities will resume issuing payment determinations for disputes related to services and items furnished prior to October 25, 2022.... The announcement comes just two weeks after the Departments directed Certified IDR Entities to hold all pending payment determinations ... IDR payment determinations for services and items furnished on or after October 25, 2022 are still on hold, pending additional guidance from the Departments."
10.  CMS Issues Long-Awaited Final Rule on Medicare Advantage Rick Adjustment Data Valuation
Sheppard Mullin Link to more items from this source
Feb. 5, 2023
"CMS will extrapolate RADV audit findings beginning with payment year (PY) 2018 and will not extrapolate RADV audit findings for PYs 2011 through 2017.... CMS will not apply a Fee-For-Service (FFS) Adjuster in RADV audits. MA organizations will be required to remit improper payments identified during RADV audits in a manner specified by CMS.... Despite its promise of transparency and certainty, CMS [1] Did not adopt any specific sampling or extrapolation audit methodology.... [2] Shifted its RADV approach to a more targeted, risk-based approach that incorporates unspecified risk factors."
11.  OCR Releases Guidance on Use of Tracking Technologies
Sheppard Mullin Link to more items from this source
Dec. 6, 2022
"Regulated entities must ensure that all tracking technology vendors have signed a BAA and that there is an applicable permission prior to a disclosure of PHI. If there is not an applicable permission or if the vendor is not a business associate of the regulated entity, a HIPAA-compliant authorization is required. OCR notes that website cookie banners do not constitute a valid HIPAA authorization."
12.  Final Rule Changes No Surprises Act Requirements
Sheppard Mullin Link to more items from this source
Sept. 22, 2022
"The Final Rule addresses specific disclosure requirements for group health plans and health insurance issuers related to the Qualified Payment Amount (QPA) for out-of-network (OON) services and sets forth the factors and information which certified Federal Independent Dispute Resolution (IDR) entities must consider in arbitrating disputes for OON services or items. The Final Rule is effective October 25, 2022, for services/items rendered during plan years beginning or after January, 1, 2022."
13.  What Employers Need to Know in a Post-Dobbs Landscape
Sheppard Mullin Link to more items from this source
Aug. 4, 2022
"This article analyzes several employment law issues employers may face following the Dobbs decision.... Travel benefits for employees seeking reproductive care ... [1] Is the employer's benefit plan subject to ERISA? ... [2] What procedures does the plan cover? ... [3] Specific or 'general' travel stipends? ... [4] What about privacy concerns?"
14.  2023 Payment Rule's Nondiscrimination Provisions and Anticipation of New Section 1557 Rules
Sheppard Mullin Link to more items from this source
May 17, 2022
"The 2023 NBPP final rule aims to protect consumers from discriminatory practices in the coverage of essential health benefits (EHB). Specifically, a benefit design that limits coverage for an EHB on a discriminatory basis under this rule must be clinically-based to be considered nondiscriminatory.... HHS's Office of Civil Rights (OCR) is developing a rule that also will address prohibited discrimination based on sex in health coverage under ACA Section 1557. HHS also removed its proposed example of presumptively discriminatory benefit design related to gender-affirming care."
15.  Less Is More: Ninth Circuit's Brevity Is the Soul of Wit?
Sheppard Mullin Link to more items from this source
Apr. 14, 2022
"The Ninth Circuit's breezy eleven-page opinion (including cover page and concurrence) overturned a massive lower court ruling -- both in impact on behavioral health law and volume ... The Wit litigation influenced behavioral health care nationwide inspiring similar litigation, spurring additional state regulatory actions, and even legislation.... It is unclear how much the Ninth Circuit's ruling will affect Wit's influence. It may serve as the rallying cry for additional action or signal a shift in how courts and regulators should evaluate coverage guidelines." [Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]
16.  Fifth Circuit Upholds ACA Risk Adjustment Program
Sheppard Mullin Link to more items from this source
Mar. 27, 2022
"[T]he Fifth Circuit upheld the lower court's ruling that HHS's interpretation of 42 US Code Section 18063 is entitled to Chevron deference because Congress delegated development of the methodology to HHS, which prompts courts to adopt 'a deferential standard of review' giving 'considerable weight to HHS's judgment.' " [Vista Health Plan, Inc. v. HHS, No. 20-50963(5th Cir. Mar. 17, 2022)]
17.  Agencies Report MHPAEA Compliance Lacking, But Don't Name and Shame Plans and Issuers... Yet
Sheppard Mullin Link to more items from this source
Jan. 27, 2022
"[T]he DOL's MHPAEA Self-Compliance Tool and multiple FAQs have provided guidance on certain questions to ask and general orientation, but stopped short of identifying exactly how and what must be done to satisfy regulators. This concern is exacerbated by the fact that states may have additional and variable expectations, particularly during market conduct exams. Nonetheless, the Report's summaries of common missteps ... provides more grist for iterating an effective comparative analysis model."
18.  2023 Proposed Notice of Benefit and Payment Parameters Would Revert Nondiscrimination and Guaranteed Availability Provisions, Return Standardized Plan Options
Sheppard Mullin Link to more items from this source
Jan. 5, 2022
"The 2023 NBPP proposed rule would ... explicitly prohibit discrimination on the basis of sexual orientation and gender identity, as had been the case prior to 2020.... The proposed rule also would clarify the nondiscrimination policy for benefit design ... The rulemaking also would address prescription drug benefit tiering as a potentially discriminatory benefit design.... The proposed rule would 'reinterpret' guaranteed availability to require insurers to provide coverage to individuals even if they owe past-due premiums to the issuer (or an issuer in the same control group)."
19.  State, Federal, and Private Enforcement of Mental Health Parity Compliance
Sheppard Mullin Link to more items from this source
Nov. 4, 2021
"The DOL, state insurance regulators, state attorneys general, and private parties have an array of tools to probe a plan's compliance with MHPAEA. ERISA's disclosure obligations require health plans to provide their comparative analysis demonstrating MHPAEA compliance ... The CAA further broadened disclosure and access requirements for plan beneficiaries ... And the price transparency rules will give yet another tool for providers, beneficiaries, and regulators to evaluate reimbursement rates for potential parity compliance."
20.  CMS Proposes Expansion of Telehealth Coverage
Sheppard Mullin Link to more items from this source
July 27, 2021
"This temporary extension of Medicare covered telehealth services will also see additional services added to the coverage list, allowing more data to be collected on the efficacy of these services. CMS has noted however, that it does not intend to permanently add these proposals as they do not meet the criteria for Medicare coverage that are currently on the books."
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