On July 26, 2022, Judge Jeremy Kernodle of the Eastern District of Texas affirmed that certain parts of the Interim Final Rule Part II implementing the No Surprises Act (the Act) were invalid. This ruling is nearly identical to Judge Kernodle’s February decision in Texas Medical Association & Corley v. US Dept. of Health and Human Services. This decision vacated a portion of the Interim Final Rule that required arbitrators to give more weight to the out-of-network rate, including what is called the Qualified Payment Amount (QPA), over other permissible factors. The rule’s requirement ultimately contradicted the Act’s direction that arbitrators consider various factors, and not weight any one more heavily than another.
Ellee Cochran
Ellee focuses her practice on healthcare regulatory law. Ellee has had experience representing hospitals, physicians and managed care companies with day-to-day compliance with various state and federal regulations.
Texas District Court Vacates Portions of No Surprises Act Rule Related to Arbitration
On February 23, 2022, Judge Jeremy Kernodle of the Eastern District of Texas ruled that certain parts of the Interim Final Rule Part II (the Rule) implementing the No Surprises Act are invalid. Specifically, the provisions of the Rule governing the methodology for how arbitrators determine the amount of payments insurers and self-funded health plans…
Texas Governor Mandates “No Mandates” for COVID-19 Vaccination
Governor Abbott’s Executive Order
On October 11, 2021, Texas Governor Greg Abbott issued Executive Order GA-40 (the Texas Order) banning COVID-19 vaccine mandates by any entity, including private employers, in Texas. Because the Texas Order was issued while Texas remains in a state of emergency related to the pandemic, the Texas Disaster Act grants it the force and effect of law. The Texas Order states that “no entity in Texas” can compel vaccination for anyone in the state who objects “for any reason of personal conscience, based on a religious belief, or for medical reasons, including prior recovery from COVID-19.” “Personal conscience” is undefined, and this ambiguity in the Texas Order makes it unclear whether an individual can object to the COVID-19 vaccine due to reasons other than religion or those medically related.
Healthcare Providers to Receive $25.5 Billion in Relief Funds
On September 10, the Biden-Harris Administration, in conjunction with the Department of Health and Human Services (HHS), announced that $25.5 billion in relief funds will be distributed to healthcare providers through the Health Resources and Services Administration (HRSA). The American Rescue Plan (ARP) will provide $8.5 billion in funding and an additional $17 billion will be distributed as Phase 4 Provider Relief Funds (PRF).
Update: Texas HHSC Issues Provider Relief Fund Reporting Requirements – October 1, 2021 Deadline
As reported in a previous blog post, the Texas 87th Legislature passed S.B. 809, an Act adding Chapter 81A entitled “Coronavirus Disease Public Health Emergency Reporting” to the Texas Health and Safety Code. This Act requires “health care institutions” who received federal relief funds under the CARES Act, Consolidated Appropriations Act, 2021, or the American Rescue Plan Act of 2021 to report the amounts received to the Texas Health and Human Services Commission. As directed in the Act, HHSC has issued proposed rules regarding the reporting requirements, comments were due September 3, 2021.
The Act defines “health care institution” as an entity listed in Texas Health and Safety Code 74.001(11).
Texas Legislature Passes S.B. 809 – Federal Provider Relief Fund Reporting Requirement
This Spring, the Texas 87th Legislature passed S.B. 809, an Act adding Chapter 81A entitled “Coronavirus Disease Public Health Emergency Reporting” to the Texas Health and Safety Code. This Act requires “health care institutions” who received federal relief funds under the CARES Act, Consolidated Appropriations Act, 2021, or the American Rescue Plan Act of…
Provider Relief Fund Update: HHS Changes Reporting and Use of Funds Deadlines
On June 11, 2021, the U.S. Department of Health and Human Services issued new guidance on Provider Relief Fund (PRF) reporting and the deadline for providers to use their funds. Provider recipients can now begin submitting information in the PRF Reporting Portal on July 1, 2021. Summary of use and reporting timeline can be found…
Multi-Agency FAQ Issued Regarding COVID-19 Testing and Vaccine Coverage by Health Plans
On Friday February 26, 2021, several agencies including The Departments of Labor, health, and Humans Services (HHS) published FAQs regarding health insurance issuers’ obligations under the FFCRA and CARES Act for governing diagnosing testing for COVID-19 and related items and serves during the public health emergency. This new guidance is helpful for plans, providers, and individuals alike and provides clarity on the nuances of coverage for COVID-19 tests and vaccines.
CMS Issues Interim Final Rule Requiring Hospital COVID-19 Reporting
CMS has issued a new rule clarifying that its daily Covid-19 reporting via the HHS Teletracking portal is mandatory as a condition of participation in the Medicare program. 42 C.F.R. § 482.42. HHS’s FAQ detailing the hospital reporting requirements can be found here – https://www.hhs.gov/sites/default/files/covid-19-faqs-hospitals-hospital-laboratory-acute-care-facility-data-reporting.pdf. Failure to consistently report throughout the Public Health Emergency…
CMS Announces a Temporary Policy for Premium Reductions
In light of the public health emergency and the urgent need to help individuals and small employers experiencing economic hardship, CMS announced on August 4, 2020 that it has adopted a temporary policy to allow health plan issuers to offer premium credits for 2020 coverage. In its guidance, CMS encouraged states to adopt a similar…