Last Friday, the Defendants in the lawsuit filed by the Texas Medical Association (TMA) against the U.S. Department of Health and Human Services (HHS) and other Federal Departments, entered a notice that the federal departments collectively intend to … [Read more...] about Federal Departments File Notice to Appeal TMA Decision
Surprise Bill
California Law Confirmed by DMHC as Specified State Law Under NSA
The California Department of Managed Healthcare (DMHC) on March 21, 2022 issued an All Plan Letter with guidance to All Full-Service Commercial Health Care Service Plans clarifying the enforcement rules that apply between relevant, specified state … [Read more...] about California Law Confirmed by DMHC as Specified State Law Under NSA
Qualifying Payment Amount Presumption Invalidated | IDR Rule Rewrite Expected
Recently the U.S. Department of Labor issued a memorandum notifying the public and interested parties that the Qualifying Payment Amount (“QPA”) “presumption” has been invalidated as the result of a Federal Texas Court’s decision in a complaint filed … [Read more...] about Qualifying Payment Amount Presumption Invalidated | IDR Rule Rewrite Expected
Plaintiffs Challenging the No Surprises Act Implementation Rules Find Support from the Industry and Most Notably Members of Congress
As we welcome in 2022, the much-anticipated federal legislation, the No Surprises Act, has officially gone into effect to protect patients from surprise bills when receiving certain medical services mainly emergency care and non-emergency care … [Read more...] about Plaintiffs Challenging the No Surprises Act Implementation Rules Find Support from the Industry and Most Notably Members of Congress
NY Moves to Amend State Surprise Bill Law, Will Other States Follow Suit?
The NY Department of Financial Services (DFS) recently announced it is amending the NY surprise billing law to “apply federal requirements to the NY IDR process.” As previously reported, in 2020, Congress adopted the No Surprises Act (NSA) which … [Read more...] about NY Moves to Amend State Surprise Bill Law, Will Other States Follow Suit?
Why so much controversy surrounding the No Surprises Act, Qualifying Payment Amount?
What is the Qualified Payment Amount (QPA) and why is there so much controversy surrounding the interim rules announced by the departments with regard to its application in the Independent Dispute Resolution (IDR) process under the No Surprises … [Read more...] about Why so much controversy surrounding the No Surprises Act, Qualifying Payment Amount?
Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
As previously indicated, several lawsuits have been filed challenging the rules under the No Surprises Act regarding the presumption for Independent Dispute Resolution (arbitration) that the Qualified Payment Amount (QPA), the median in-network … [Read more...] about Healthcare Heavyweights File Lawsuit Over No Surprises Act IDR/QPA Rules
Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
Concerns About the Federal No Surprises Act: Interim Final Rules According to an article published by KHN, the federal agencies responsible for issuing the regulations for the implementation of “the No Surprises Act” (NSA) have publicly … [Read more...] about Challenges to the No Surprises Act’s Interim Final Rules, Part II, Fall on Deaf Ears
Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
The No Surprises Act (NSA) becomes effective on January 1, 2022 and will apply to virtually all commercial medical claims covered by ERISA, Non-ERISA, self-insured and fully insured plans for (1) emergency care performed by an out-of-network … [Read more...] about Does State Law Now Preempt ERISA Under The No Surprises Act (NSA)
Will the No Surprises Act be Implemented as Lawmakers Intended?
Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he … [Read more...] about Will the No Surprises Act be Implemented as Lawmakers Intended?