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Tim Ribelin

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Tim focuses his practice on commercial litigation, with an emphasis on healthcare and financial services. Tim represents healthcare clients in front of administrative agencies. He handles licensing issues for medical professionals, regularly defending physicians before the Texas Medical Board and nurses before the Texas Board of Nursing.

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Executive Order GA-40

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.

After a month of spirited efforts to accommodate the disparate interests of the Freedom Caucus and the Tuesday Group, Amendments offered by Representatives Tom MacArthur (R-NJ) and Fred Upton (R-MI) facilitated the hurried House passage of H.R. 1628 – – the American Health Care Act of 2017. Passed as a “reconciliation bill” (more on that later), the House voted 217-213 on May 4, 2017, to dismantle the Affordable Care Act (ACA) and make sweeping changes to the nation’s health care system.

The decision by the House Leadership to choose not to bring the American Health Care Act (AHCA) to a vote left industry analysts speculating both about the fate of “Obamacare,” and the prospects for narrower reforms. With bipartisan support to reduce prescription drug prices, it appears as though Democrats and Republicans are working on plans to fix drug prices. This tenth article in our series on the effect of a “slow repeal” of the ACA updates our January 12, 2017, article on the pharmaceutical industry and addresses current efforts aimed at reducing drug prices in the U.S.

On March 20th, House Republicans rolled out a number of changes to their bill, the American HealthCare Act (AHCA), seeking to repeal and replace the Affordable Care Act, the healthcare law better known as Obamacare. Although the House Leadership ultimately chose not to bring the AHCA to a vote, this ninth article in our series on the effect of a “slow repeal” of the ACA unpacks the Manager’s Amendment, and offers insights on what may still form the basis for health care legislation.

On Monday, March 6, 2017, House Republicans released the long awaited proposed legislation to replace the Affordable Care Act (ACA).

The GOP bill, the “American Health Care Act” (AHCA), repeals or significantly changes major portions of the ACA involving the individual and employer mandates, subsidies, and Medicaid expansion, among others. The AHCA, which is already facing political headwinds and healthcare industry objections, has not yet been scored by the Congressional Budget Office (CBO), so the economic effect and the potential change to the number of people covered by health insurance have not been officially quantified. However, the AHCA’s overall philosophy and goals are clear, and it signals areas of concern for healthcare providers and Medicaid expansion States. In this article in our series on the effect of a “slow repeal” of the ACA, this week’s discussion focuses on the significant aspects of the proposed AHCA, potential concerns for healthcare providers, and likely next steps.

This is the seventh article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact on healthcare technology.

Industry experts are predicting that a slow repeal of the ACA will have very little, if any, negative impact on healthcare technology. Healthcare technology grew at an unprecedented pace under the ACA, in part because the ACA contains provisions which provide healthcare technology with incentives to develop and implement new systems aimed at increasing efficiency. Despite the significant amount of uncertainty with a slow repeal of the ACA for many players in the healthcare industry, healthcare technology appears to be poised for continued growth through value-based care, telemedicine, and the increased need for interoperability.

This is the sixth article in our series on the effect of a “slow repeal” of the ACA. This week’s discussion focuses on the potential impact on post-acute care providers.

The term “post-acute care provider” encompasses a large and diverse group of healthcare providers that includes nursing facilities, home health agencies, hospice agencies and assisted living communities. While each group has its own very unique industry characteristics, they all have at least one thing in common: none of them rely, to any great extent, on private insurance as a form of payment. This is because the vast majority of the patients served by post-acute care providers are older than 65 and, accordingly, are covered by Medicare. So, any repeal efforts relating to the private insurance exchanges that expanded healthcare coverage for more than 30 million Americans will have minimal impact on post-acute care providers. Instead, the key issue facing post-acute care providers relating to the slow repeal of the ACA is the threatened conversion of Medicaid into a block grant program.

This is the fifth article in our series on the effect of the “slow repeal” of the Affordable Care Act (ACA). This week’s article focuses on the potential impact of the slow repeal of the ACA on rural communities and healthcare.

Continued Fragile System Leads to Uncertainty or Closure Causing Economic Ripple Effect Throughout Rural America

There are nearly 5,000 short-term, acute care hospitals in the United States, half of which are in rural areas. About four in 10 rural hospitals are located in the South. More than half of rural hospitals are Critical Access Hospitals (CAHs) (53.5%); a smaller share of rural hospitals are designated as Sole Community Hospitals (SCHs) (13%), Medicare Dependent Hospitals (MDHs) (8%), and Rural Referral Centers (RRCs) (11%). All of these designations provide enhanced or supplemental reimbursement under Medicare, using different formulas. Rural hospitals that do not qualify for these Medicare programs are reimbursed as standard Medicare Prospective Payment System (PPS) hospitals.

This is the fourth article in our series on the effect of the “slow repeal” of the ACA. This week’s article starts a three-part discussion on the potential impact of the slow repeal of the ACA on the health insurance industry, with this week’s focus on the individual health insurance market.

On February 2, 2017, an important House Subcommittee – the Energy and Commerce Health Subcommittee – began addressing four bills that address portions of the ACA. Although three of the four bills were introduced in previous years, all four measures come at a time when lawmakers are grappling with the impact of “repeal and replace” – or just “repeal” – on the increasingly fragile individual health insurance markets.

President Trump’s nominee for Secretary of the Department of Health & Human Services (HHS), Congressman Tom Price (R-Ga.), has now completed two confirmation hearings in the Senate. If confirmed, Rep. Price will direct more than $1 trillion of annual spending, as well as assist in developing and implementing a replacement for the Affordable Care Act (ACA). First, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a courtesy hearing January 18, and then the Senate Finance Committee, which has jurisdiction over the nomination, held its hearing January 24. The following is a summary of what we learned – or did not learn – over the course of those hearings.