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57 Matching News Items |
| 1. |
Duane Morris LLP
Nov. 4, 2025
"[On] October 21, 2025, CMS ... [directed] MACs to lift the claims hold for Medicare physician fee schedule, ground ambulance transport and federally qualified health center claims, including telehealth claims that 'CMS can confirm are definitively for behavioral and mental health services.' ... CMS directed MACs to continue to temporarily hold claims for nonbehavioral and mental health services telehealth claims and for acute hospital care at home claims."
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| 2. |
Duane Morris LLP
Oct. 22, 2025
"[K]ey provisions ... include: [1] an 'any willing provider' requirement; [2] a prohibition on spread pricing; [3] a requirement to use a passthrough business model; and [4] a general prohibition on retroactive payment reductions and payment reductions through a reconciliation process. Effective dates vary, with many of the provisions applying to any contracts from January 1, 2019, or later and other provisions applying to contracts beginning January 1, 2026, or 2027."
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| 3. |
Duane Morris LLP
Oct. 9, 2025
"The latest ESSTA amendments seek to mandate the front-loading of an additional 32 hours of unpaid safe and sick leave for employees upon hire and each calendar year thereafter ... [T]he bill seeks to expand the list of eligible safe and sick time uses for leave under the ESSTA.... The collapsing of the [NYC Temporary Schedule Change Act (TSCA)] into the ESSTA provides some consistency for employers who have struggled to synthesize these competing statutory schemes."
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| 4. |
Duane Morris LLP
Sept. 17, 2025
"Effective January 1, 2026, New Hampshire employers with at least 20 employees must provide unpaid leave rights for employees to attend medical appointments related to childbirth, postpartum care and infant pediatric care.... The law entitles covered employees up to 25 hours of unpaid leave from work to attend the employee's own medical appointments for childbirth or postpartum care, or the employee's child's pediatric medical appointments within the first year of the child's birth or adoption."
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| 5. |
Duane Morris LLP
Aug. 28, 2025
"[T]he state of West Virginia ... filed a federal court action against pharmacy benefit manager (PBM) Express Scripts Inc. (ESI) based on its alleged role in manipulating and exacerbating the opioid overdose epidemic. The West Virginia attorney general asserts that ESI, as a PBM, held a 'uniquely powerful position' within the 'prescription drug ecosystem.' " [West Virginia v. Evernorth Health, Inc., No. 25-0182 (N.D.W.V. complaint filed Aug. 15, 2025)]
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| 6. |
Duane Morris LLP
Aug. 26, 2025
"This case arose from Caremark's failure to comply with a change in Medicare's policies intended to curtail opaque pricing practices.... This case and Judge Goldberg's judgment further demonstrate to PBMs the consequences of failing to keep up with changes in the law and the increased scrutiny PBMs are now facing from federal agencies." [U.S. ex rel Behnke v. CVS Caremark Corp, No. 14-0824 (E.D. Penn. Aug. 19, 2025)]
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| 7. |
Duane Morris LLP
Aug. 5, 2025
"Although this order likely postpones Act 624’s effective date, a preliminary injunction is just that: preliminary. The court’s reasoning for the commerce clause and supremacy clause challenges rests entirely on a preliminary assessment of existing law. But since those challenges are now moving to litigation, both parties must now present evidence for their claims, along with additional legal arguments, which will inform the final decision on Act 624 at trial." [Express Scripts, Inc. v. Arkansas State Board of Pharmacy, No. 25-0520, 25-0524 (E.D. Ark. Jul. 28, 2025)]
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| 8. |
Duane Morris LLP
July 14, 2025
"[S]ince January 1, 2025, the New York State Paid Sick Leave Law (PSLL) has required all private-sector employers, regardless of size, to provide paid prenatal leave banks to all full-time and part-time employees.... Effective July 2, 2025, as described in the ESSTA's updated FAQs, the ESSTA amendments require that New York City employers take affirmative steps to comply with the updated rules, which includes new pay stub requirements, updates to policies and the provision of a new notice."
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| 9. |
Duane Morris LLP
June 26, 2025
"This ruling is particularly significant as it sheds light on the all-too-opaque process of drug pricing.... When PBMs are accused of having violated the False Claims Act by overbilling Medicare -- when Caremark is supposed to be reporting the actual prices remitted in reimbursement to pharmacies for Medicare Part D drugs -- it follows that the reimbursement paid to pharmacies is significantly less than what it otherwise should be." [U.S. ex rel Behnke v. CVS Caremark Corp., No. 14-0824 (E.D. Penn. Jun. 25, 2025)]
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| 10. |
Duane Morris LLP
June 20, 2025
"The Supreme Judicial Court’s (SJC) decision reversed a lower court’s ruling that had disrupted the long-held understanding that the MNAA categorically excludes nonsolicitation agreements, and it further clarified the scope of the MNAA’s reach.... [T]he Miele case remains a cautionary tale for employers when seeking to reaffirm restrictive covenants, a common practice when an employee resigns." [Miele v. Foundation Medicine, Inc., SJC?13697 (Mass. S.J.C. June 13, 2025)]
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