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Key Questions on Telehealth and Substance Abuse Disorder: Lessons from the Pandemic

"In a recent webinar, the American Medical Association (AMA) and Manatt examined changes in telehealth policies, how those changes are impacting SUD treatment, and which new policies should be extended long term to maximize continued access to SUD services. The program also analyzed key lessons providers learned during the pandemic about using telehealth to serve those with SUDs - -and how to carry those important learnings forward."

California Court Rules Provider's Prior Authorization Calls with Payor Are Not a Binding Contract

"[A] California Court of Appeal ... agreed with a lower court decision granting summary judgment in favor of a payor by finding that the payor did not enter into a binding agreement with an out-of-network substance use treatment provider during a prior authorization and verification of benefits communication. The court's ruling has implications for out-of-network providers that rely on quasi-contractual theories to recover money from payors for services they rendered to members/insureds based on verification of benefits and prior authorization calls." [AToN Center, Inc. v. United Healthcare Ins. Co., No. D080122(Calif. Ct. App. Jul. 27, 2023)]

Ninth Circuit Again Supersedes Its Prior Opinion in Landmark Mental Health Case

"The August 2023 opinion states that the court had never remanded an ERISA case for reprocessing unless the claimant had shown both that the plan had applied an incorrect standard and that the claimant could be entitled to benefits under the correct standard. However, the Wit plaintiffs' claim was purely about the 'process' and not about the result.... As to plaintiffs' contention that reprocessing was a permissible remedy under the 'catchall' equitable provision of Section 1132(a)(3), the court held again that plaintiffs failed to show that reprocessing was the type of equitable remedy traditionally available before the merger of law and equity." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]

Tracking Telehealth Changes State-by-State in Response to COVID-19

Updated Aug. 25, 2023. Descriptive list of current and proposed state and federal guidance, regulations, and legislation.

Tracking Telehealth Changes State-by-State in Response to COVID-19

Updated May 5, 2023. Descriptive list of current and proposed state and federal guidance, regulations, and legislation.

409A Issues in Executive Compensation Contracts and Employment Agreements (PDF)

"[T]he difficulty with 409A is its overly broad definition of what constitutes a nonqualified deferred compensation plan.... The article provides a summary of the more common 409A issues that arise when drafting and negotiating executive compensation contracts and employment agreements."

Pricing Private Company Stock Options to Avoid the Pitfalls of IRC 409A (PDF)

"This article summarizes the valuation requirements under the 409A Treasury regulations as they relate to pricing private company employee stock options. The general valuation parameters provided in the 409A Regulations are summarized ... as well as three specific valuation methods that, if utilized, create a presumption of reasonableness. General guidance is also provided for companies at various stages concerning the appropriate course of action when establishing the fair market value of their common stock for purposes of pricing stock options."

Budget Proposal Includes Substantial Amounts for Implementation and Enforcement of No Surprises Act and Mental Health Parity Requirements

"President Biden's proposed 2024 budget includes substantial additional amounts for continued funding of the implementation and enforcement of the No Surprises Act (NSA) and the transparency laws passed along with the NSA, including prohibitions on gag clauses regarding price and quality information, the required disclosure of indirect compensation for brokers and consultants with respect to employer-sponsored health plans, required reporting on pharmacy benefits and drug costs, and enforcement of the mental health parity comparison requirements."

State Policy Levers to Improve Access to Telebehavioral Health

"States are utilizing a variety of policy levers to maintain access to telebehavioral health services. Commonly used levers include: [1] Creating allowances for out-of-state behavioral health [roviders.... [2] Enabling coverage for audio-only telebehavioral health services.... [3] Expanding telehealth-eligible provider types to include a broad range of behavioral health providers.... [4] Requiring payment parity for telebehavioral health visits."

Treasury Releases Proposal to Address 'Family Glitch'

"Without the option of a premium tax credit, some family members are enrolled in coverage today that under the proposed rule would be considered unaffordable. The proposal's economic analysis indicates that some of those family members will shift to the Marketplace, which could lead to an overall reduction in employer spending on health coverage, but that the number of people taking up the new option could be modest."