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.

The USP’s most recent revisions to chapter <797> are extensive and those who prepare compounded sterile products (“CSPs”) are advised to familiarize themselves with the new standards. Significant changes include: Continue Reading USP Finalizes Revisions to Sterile Compounding Standards

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. Continue Reading The disposal of non-economic damage caps in the State of Kansas

Part I: Preparing for a Transaction
First in the series.

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.

First, before seeking a potential investor or buyer, the owners of the business should go through a semi-formal process to confirm the owners and key members of the business have shared, or at least compatible, motivations and priorities in a pursuing a potential transaction (e.g., capital for improving or growing the business, building a brand, creating value for a future exit, or cashing out). This will allow the business to focus on those investors/buyers with aligned expectations, and ultimately gain the required approval to close a transaction from the owners and key members of the business. Continue Reading Ultimate Guide to Closing a Private Equity Transaction

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.

Surprise medical billing is commonly the result of care received in an in-network facility, such as a hospital, but that included the services of a non-network provider, such as an anesthesiologist who is based at the in-network facility. Continue Reading Bipartisan Senators Choose Benchmark Approach to Prevent Surprise Medical Billing

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.

In Secretary of Labor v. Integra Health Management, No 13-1124 (March 4, 2019), the Occupational Safety and Health Review Commission (OSHRC) upheld a violation of the General Duty Clause when it found an employer did not adequately address workplace violence hazards.  In that case, the company employed “service coordinators” to help its clients obtain medical care.  Health insurers send the clients to Integra after reviewing claim histories to identify individuals who are not receiving appropriate care.  In this case, a service coordinator was assigned to visit a client at his home and that service coordinator made notes in her report that the client made her “uncomfortable” and detailed his strange behavior.  On a following visit to the client, the service coordinator was stabbed by the client nine times and died. Continue Reading OSHA, Workplace Violence, and 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.

The free on-demand recording will provide real-life examples of what to do – and not do –to avoid last-minute “deal killers.” Learn how to address compliance and operational risks to put yourself in the best posture to acquire, or sell, a pharmacy.

Presenters

Wakaba Y. Tessier, Partner, Husch Blackwell
Renee E. Zerbonia, Attorney, Husch Blackwell
Bruce Ball, CEO, Britton Gallagher
Greg Rockers, Managing Director, Williamson Rockers Group
Brian Williamson, Managing Director, Williamson Rockers Group

In January of 2019, the Centers for Medicare and Medicaid Services (“CMS”) implemented a helpful change to the signature exception to the Stark Law. In particular, the exception may now be used more than once during a 3-year period for compensation arrangements with the same referring physician.

History of Signature Exception

The signature exception to the Stark Law has undergone several revisions within the past few years. The original version of the exception was implemented by CMS effective October 1, 2008 in response to concerns regarding the potential for significant Stark Law penalties for mere “technical” violations of the statute. The original language in the signature exception provided for a grace period for noncompliance with the signature requirement of many of the compensation arrangement exceptions to the Stark Law, such as the personal service arrangements exception and fair market value exception. In particular, a 90-day grace period was permitted for late signatures that were inadvertent, and a 30-day grace period was permitted for late signatures that were “not inadvertent.” In addition, the exception could only be used once for the same referring physician during a 3-year period. In other words, after the exception was used once by a DHS entity for a late signature on a compensation agreement with a referring physician, any late signatures on other agreements entered into by the DHS entity and the same referring physician during the following 3-year period would trigger a violation of the Stark Law. Continue Reading CMS Finalizes Helpful Change to Stark Law Signature Exception

On April 24-26, The National Association of Accountable Care Organizations held its semi-annual conference for members. NAACOS invites its business partner members, including Husch Blackwell, to attend their semi-annual meetings. Scott Loftin, a Healthcare Regulatory Associate in Husch Blackwell’s Denver office, and I were fortunate enough to attend the conference on behalf of the firm. This conference provided an opportunity for us to listen to the issues, challenges, concerns, and ideas ACO leadership are exploring and facing in today’s regulatory landscape. The presentations and conversations among the members provided us with a deeper understanding of our ACO clients’ business and legal needs. Continue Reading Husch Blackwell at the NAACOS Conference

On Wednesday, April 17, a three-judge panel of the Eighth Circuit heard oral arguments in an appeal from the United States District Court for the Eastern District of Missouri in Horton v. Midwest Geriatric Management LLC. Although the forthcoming Eighth Circuit decision would add to the split among the federal circuits as to whether the prohibition against sex discrimination in Title VII applies to discrimination based on sexual orientation, today’s order list indicates that SCOTUS will settle the issue.

Learn more about the implications of this development in our legal alert.