Senate Bill 1264, which recently passed during the 86th Texas legislative session, places restrictions on certain out-of-network providers regarding the practice known as “balance billing” and establishes a process through which health plans and providers may resolve payment disputes. The bill is effective September 1, 2019 and applies to services and supplies provided on or after January 1, 2020.
I. Balance Billing and SB 1264
The term “balance billing” refers to when a healthcare provider bills a patient for the difference between the reimbursement provided by the patient’s health insurance and the amount charged by the provider. SB 1264 places restrictions on balance billing by out-of-network (OON) providers of emergency services, facility-based services provided at an in-network healthcare facility, and lab and diagnostic imaging services that are related to an in-network service. The law disallows these providers from billing a patient for an amount greater than the applicable copayment, coinsurance, and deductible under the health plan based on the initial amount determined to be payable by the plan, or if applicable, a modified amount determined under the plan’s appeal process. Continue Reading SB 1264 Restricts Certain Providers from Balance Billing in Texas
On June 1, 2019, the United States Pharmacopeia (“USP”) published the final revisions to its pharmaceutical sterile compounding standards (“chapter <797>”). Chapter <797> sets forth standards for the preparation of compounded sterile medications to help ensure products are safe and effective and reduce risks such as contamination or incorrect dosing. The most recent revisions implement new standards and revise existing ones based on recent scientific and technological developments. The chapter <797> revisions also incorporate stakeholder input raised during the July 2018 to November 2018 public comment period, much of which concerned allergens, beyond-use dating, and the general ambiguity throughout the chapter.
In 1988, the Kansas legislature enacted K.S.A. 60-19a02 to limit personal injury plaintiffs’ recovery for non-economic losses such as pain and suffering, mental anguish, loss of enjoyment of life, etc. Thirty years later, in a 4-2 decision handed down on Friday, June 14th, Hilburn v. Enerpipe Ltd. put an end to non-economic damage caps in Kansas personal injury cases. This change does not apply to wrongful death cases or punitive damages, but it will affect non-economic damages in future medical malpractice cases as well as those currently pending in Kansas state courts. 
To increase the likelihood of ultimately closing a transaction with a private equity investor or buyer, the key is preparation. Preparation is divided up into several steps.
Bipartisan legislation to address surprise medical billing was introduced June 19 in the Senate Health, Education, Labor and Pensions (HELP) Committee. Most notable for health insurers and providers is the way the bill tackles the biggest sticking point in the issue—mandating a benchmark rate to avoid pay disputes between health insurers and non-network providers.
Unfortunately, workplace violence is in the news every day. OSHA is paying increasing attention to the workplace violence issue, particularly in the healthcare industry. While there is no specific OSHA regulation addressing workplace violence, a recent decision supports OSHA’s use of the General Duty Clause in workplace violence cases in the healthcare industry.
On Tuesday, June 18, 2019, our team of legal professionals and industry experts hosted a Compliance Considerations for Pharmacy Sale or Acquisition Webinar that took a look at the regulatory pitfalls and problems that can arise in a pharmacy transaction.
In January of 2019, the Centers for Medicare and Medicaid Services (“CMS”) implemented a helpful change to the signature exception to the 
On April 24-26, 