The Texas Legislature in April passed H.B. 1445, which adopted amendments to the Texas sales tax law regarding medical and dental billing. Governor Greg Abbott on April 30, 2021, signed the bill, which aims to clarify the state law that has been in force since 1987. Continue Reading 2021 Texas Legislature Amends Texas Tax Code to Define Medical and Dental Billing Service and Address Texas Comptroller Policy
Since last year, the Husch Blackwell privacy attorneys have been working with various healthcare providers—from hospitals to hospices, to independent physician groups—to comply with the Information Blocking rule (the Rule) implemented by the Office of the National Coordinator for Health Information Technology (ONC) as part of the 21st Century Cures Act. Recently, Education clients have been asking, “We’re a university – does the Information Blocking rule apply to our student health center?” We discuss the answer to that question, along with practice tips, in this blog post. Continue Reading Information Blocking: College & University Student Health Centers – Does the Rule Apply to Us?
As of April 27, 2021, 29.1% of the U.S. population has been fully vaccinated for COVID-19. With COVID-19 vaccine eligibility expanding to the general public, and states and cities relaxing COVID-19 restrictions, employers face the new challenge of navigating a partially vaccinated workforce. We previously addressed questions related to return-to-work and vaccination issues for employers here. Below are some additional, and recent, questions we’ve received from clients related to this topic. Continue Reading Funny You Should Ask: Employer Considerations for a Partially Vaccinated Workforce
On April 27, 2021, the United States Tax Court held that legal fees incurred by generic drug manufacturers in connection with “Section 271(e)(2)” patent infringement suits are deductible as ordinary business expenses and need not be capitalized. The opinion contradicts longstanding IRS field advice, and has potential applicability to generic drug manufacturers and others who have capitalized legal fees in recent years. Continue Reading Tax Court Rules in Favor of Generic Drug Manufacturer on Deductibility of Patent Litigation Expenses in Connection with ANDAs
On April 2, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury (collectively the “Departments”) jointly released nine (9) questions and answers (“FAQs Part 45”) related to recent changes made to the Mental Health Parity and Addiction Equity Act (“MHPAEA”) by the Consolidated Appropriations Act of 2021 (the “Appropriations Act”).
FAQs Part 45 answers questions raised by Health Plans and Issuers (collectively “Health Plans”) concerning the timing of parity comparative analyses disclosures, as well as the information that must be captured in these comparative analyses, and disclosed to the Departments upon request. While Health Plans have conducted parity comparative analyses for years as a best practice, the Appropriations Act codifies this best practice into law. As of February 10, 2021, Health Plans must be prepared to make these analyses available to the Departments, or the appropriate State authority upon request. Furthermore, Health Plan participants, beneficiaries, or their authorized representatives may also request these documents free of charge.
The Departments make clear that a statement of compliance, or cursory analysis, will not do. Rather, Health Plans must disclose comparative analyses between Mental Health/Substance Use Disorder (“MH/SUD”) and Medical/Surgical (“M/S”) benefits that contain a “robust discussion” over the following areas:
1. Identification of the specific Non-Quantative Treatment Limitation (“NQTL”), Health Plan terms, and policies at issue.
2. The specific MH/SUD and M/S benefits affected by the NQTL.
3. The factors, evidentiary standards or sources, strategies or processes considered in the design or application of the NQTL, and in determining which benefits are subject to that NQTL. The analyses should include an explanation of the weighting of the factors applied and an evaluation of any specific data used when the Health Plan determines the use of a NQTL.
4. The precise definitions used, and the supporting sources for, any defined factors, evidentiary standards, strategies, or processes used by the Health Plan.
5. An explanation of variations in the application of a guideline or standard by the Health Plan, and the processes and factors used by the Health Plan for establishing variations in the use of that guideline or standard between MH/SUD and M/S benefits.
6. For specific decisions involving the administration of the benefits, the Health Plan should identify the nature of those decisions, any decision maker(s), the timing of the decisions, and the qualifications of those decision maker(s).
7. For analyses that relies on experts, the Health Plan should include an assessment of each expert’s qualifications and the extent to which the Health Plan relied on that expert’s recommendations.
8. A reasoned discussion, with citations, by the Health Plan, of its findings and conclusions regarding the comparability of the processes, strategies, evidentiary standards, factors, and sources as to whether plan coverage is or is not in compliance with MHPAEA.
9. The date of the analyses and the name, title, and position of the person or persons who performed or participated in the comparative analyses.
FAQs Part 45 also provides detail regarding specific practices and procedures that Health Plans should avoid when responding to the Departments, as well as highlights supplemental information and records that Health Plans should have available for review. FAQs Part 45 can be found at https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-45.pdf
Health Plans should review their parity comparative analyses to ensure that they contain sufficient information to satisfy the Departments’ expectations. Additionally, Health Plans should work with closely with their third-party administrators, and other vendors, to be sure that parity compliance meets both the “as written” and “as applied” standards.
If you have any questions, please contact Noreen Vergara or your Husch Blackwell attorney.
In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the new wave of CMS Center for Program Integrity (CPI) audits that have been issued during the past couple weeks. These CPI audits remain focused on long length of stay patients and typically involve hundreds of claims valued at over $1 million. As Meg and Bryan explain, these audits may signal a new approach to auditing by CMS, and it is important for hospices to refine their response and appeal strategy accordingly. Tune in here: https://bit.ly/3viR6Re
As vaccine distribution becomes widespread, and employees begin to return to work, we continue to field questions related to return-to-office plans in a post pandemic world. We previously compiled a list of FAQs, addressing COVID-19 safety protocols (here, here and here) that should be considered as the workplace opens for business. Below are some additional, and recent, considerations related to this topic. Continue Reading Opening for Business? Your Return-to-Work Policies Answered
In today’s episode of Hospice Insights: The Law and Beyond, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Erin Burns to discuss the recent denial of physician visits. Over the last several months, a number of auditors have begun questioning the medical necessity of billed physician visits, claiming the physician services were solely administrative in nature. They break down the criteria auditors appear to be using, what this means for hospices and how hospices can avoid such denials. We hope you enjoy the conversation: https://bit.ly/3wUGeus
Missouri’s Senate advanced Senate Bill 63 this week in a move to become the last state in the Nation to create a Prescription Drug Monitoring Program (“PDMP”). The bill would establish a Joint Oversight Task Force for Prescription Drug Monitoring, if adopted by the House of Representatives and signed by Governor Parson. Continue Reading Missouri Last in the Nation to Roll Out Prescription Drug Monitoring Program
The increase in physician practice mergers and acquisitions across most specialties is projected to continue for the foreseeable future. Healthcare attorneys Joe Geraci and Kate Bechen present alongside Brian Teefey, CPA and Corey Palasota of Weaver on a webinar addressing a multitude of transaction considerations including strategic, legal and financial. Register today: https://lnkd.in/emMy_xp