"The good news for the telemedicine industry is that the majority of the several hundred pages of statutes and regulations are inapplicable to many telehealth providers."   MORE >>

"These Guidelines detail the preventative services that group health plans, health insurance issuers and individual health plans must cover without cost-sharing.... HRSA revised five preventive services: [1] Breastfeeding services and supplies; [2] Contraception; [3] Screening for HIV infection; [4] Counseling for sexually transmitted infections: and [5] Well-woman preventative visits."   MORE >>

"The court's decision has been lauded by providers as 'a major victory for patients and physicians,' but criticized by health insurance plans as 'wrong and misguided.' " [ Texas Medical Assoc. v. HHS , No. 21-0425 (E.D. Tex. Feb. 23, 2022)]   MORE >>

"[The Texas Medical Association] asserted that the agencies, when issuing their interim final rule, revised the statutory language and created a 'rebuttable presumption' that requires IDR entities to give greater weight to a single statutory factor -- the 'qualifying payment amount' (QPA). The QPA is generally the median of the health plan's contracted rates for the relevant item or service, as calculated by the health plan. This, the TMA argued, will skew IDR results in favor of health plans and undermine providers' ability to obtain adequate compensation for their services. The court agreed with the TMA, finding that 'nothing in the [NSA] instructs arbitrators to weigh any one factor or circumstance more heavily than the others.' " [ Texas Medical Assoc. v. HHS , No. 21-0425 (E.D. Tex. Feb. 23, 2022)]   MORE >>

"The Consolidated Appropriations Act, 2021 adopted a series of transparency requirements that apply to employer-sponsored group health plans.... A subset of these transparency requirements, while not likely well suited to class action claims, will nonetheless prove vexing.... [P]rovisions relating to mental health parity seem perfectly designed to attract class actions claims.... The motherlode for the plaintiffs' bar however is in the broker/consultant compensation disclosure rules."   MORE >>

"During the first year of the pandemic, 37.4 percent of nonelderly adults and 46.2 percent of elderly adults had at least one telehealth.... Publicly insured nonelderly adults were more likely to have had a phone visit, as opposed to a video visit, than those with private insurance, which may reflect differences in patient access to video technology or the telehealth modalities insurers cover."   MORE >>

"When states pass meaningful PBM reform, the increase in their average health insurance premium costs have been lower than the nationwide average. In fact, some states have actually seen a decrease in their premium costs ... PBMs and their conflicts of interest are responsible for rising prescription drug benefit costs. Limiting those conflicts of interest helps patients by empowering them to make healthcare decisions for themselves ... without raising their health insurance premiums."   MORE >>

"Two recent cases illustrate how an organization can end up in serious and costly litigation based on statements that did not have to be made in SPDs that did not have to be issued."   MORE >>