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Montana Makes Telehealth Expansion Permanent On April 19, 2021, Montana Governor, Greg Gianforte, signed House Bill 43 (“HB43” or the “Bill”) into law. The Bill, which is effective on January 1, 2022, expands access to telehealth services in Montana that was originally extended because of the public health emergency (the “Pandemic”).  HB43 continues in a long line of legislation across the country that have made permanent changes to telehealth exceptions implemented at the height of the Pandemic. The Bill permanently lifts telehealth limitations that were paused during the Pandemic, like requiring an established patient-provider relationship in order to enable a…
Texas Makes Significant Strides to Expand Telehealth On April 14, 2021, the Texas House passed House Bill 4 (the “Bill” or “HB4”), a telehealth bill seeking to make permanent the temporary waivers issued during the public health emergency (the “Pandemic”) to expand telemedicine. The Bill, sponsored by State Rep. Walter Thomas Price, IV, is intended to provide expansive coverage to Texas citizens and address the technology gaps that exist in more rural communities by incorporating audio-only services into the scope of the telehealth exceptions in the state. The Bill follows the trend of recent legislation across the country by expanding…
The Biden Administration used the annual rulemaking that governs health plans sold on the Affordable Care Act’s exchanges to lower health care costs for consumers and improve access to health care. Part 2 of the Notice of Benefit and Payment Parameters for 2022 Final Rule (the Payment Notice), issued April 30, 2021, is the second in a series of rulemakings addressing exchange plans.[1]  The Department of Health and Human Services (HHS) anticipates additional rulemakings on the 2022 Payment Notice later this year.[2] The rulemaking announced changes to out-of-pocket costs, special enrollment periods, risk adjustment, and HHS’s audit…
In 2019, the Chair of the U.S. House Committee on Ways and Means (the “Committee”) asked the Medicare Payment Advisory Commission (“MedPAC”), an independent congressional agency established in 1997 to advise Congress on issues affecting the Medicare program, to examine the role that private equity (“PE”) plays in the Medicare program.  More specifically, MedPAC was asked to examine the following four issues related to PE investment: Gaps in Medicare data that make it difficult to track PE investments in Medicare-participating providers; Business models that PE firms use when they invest in the health care sector; The effects of PE ownership…
Late last month, the Biden Administration announced the second installment of its recovery plan, dubbed the “American Jobs Plan” (the “Plan”).  The Plan’s $2.3 trillion price tag includes $400 billion to revamp and reinvest in Medicaid’s home and community-based services (“HCBS”) over the next eight (8) years – representing over 17% of the Plan’s budget. Biden’s HCBS strategy aims to provide more solutions to help the overburdened healthcare system serve America’s aging and other special-needs populations through increased funding for Medicaid HCBS. The Plan Aims to Support Independent Living and Foster the “Care Infrastructure.” Medicaid is the federal-state…
On April 15, 2021, the FCC announced that on Thursday, April 29, 2021 at 12:00 PM ET it will begin accepting applications for the second round of its COVID-19 Telehealth Program (the “Program”).  The filing window will last for seven days and will close on Thursday, May 6, 2021 at 12:00 PM ET.  All applications filed during this period will be reviewed after the application filing window has closed. Under this application processing round, the FCC will distribute nearly $250 million to eligible health care providers to provide telehealth and connected care services to patients in response to the COVID-19…
State and federal regulators, Congress, and the plaintiffs’ bar are increasingly focused on compliance with the Mental Health Parity and Addiction Equity Act (MHPEA), particularly given the opioid epidemic and COVID-19’s impact on mental health. MHPAEA compliance and enforcement is a top priority for the United States Department of Labor (DOL) and the National Association of Insurance Commissioners (NAIC) with market conduct exams, state attorneys general investigations, and DOL investigations and subpoenas focused specifically on MHPAEA. A recent amendment to MHPAEA requires DOL, the Department of Health and Human Services, and the Treasury (collectively, the Departments) to audit MHPAEA compliance…
As many of us are starting to see the small light at the end of the tunnel, many hospitals are still reeling from the stress of the last year. Following the recent release of “Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020” (the “Report”), a report issued by the Department of Health and Human Services Office of Inspector General (“OIG”) that examines the impact of the public health emergency on United States hospitals, we review federal and state efforts to keep hospitals afloat during this time, and expectations as we…
On Thursday, April 8, 2021, the Center for Medicare and Medicaid Innovation (the “Innovation Center”) announced its final list of 53 organizations set to participate in the Global and Professional Direct Contracting (“GPDC”) Model (previously named the Direct Contracting Model for Global and Professional Options).  The 53 Direct Contracting Entities (“DCEs”) are participating in the first Performance Year (“PY2021”) of the GPDC Model, which runs from April 1, 2021 through December 31, 2021. The DCEs will serve Medicare fee-for-service (“FFS”) beneficiaries in 38 states as well as in the District of Columbia and Puerto Rico.…
On March 10, 2021, President Biden signed into law the American Rescue Plan Act of 2021 (the “Act”). This $1.9 trillion COVID-19 relief package not only includes a whole host of healthcare-related provisions, but, along with actions taken (or not taken) by the Biden Administration, accounts for a marked departure from healthcare policy carried out by the Trump Administration. No difference is more striking than the Administration’s treatment of the Affordable Care Act (“ACA”). While President Trump spent much of his four years in office targeting and undermining the ACA, in these early days of his administration, President Biden not…
With the uptick in the pace of vaccinations and lifting of restrictions in many states over the past few weeks, a clearer picture of the road ahead is coming into focus.  In a timely discussion, Los Angeles’ Association for Corporate Growth (ACG) hosted healthcare industry leaders to share lessons learned over the past year, what’s here to stay, and what’s on the horizon.  ACG dubbed the panel “Coming up for Air: Healthcare Investing and Growth in 2021 and Beyond,” which featured leaders from various healthcare sectors, including Shane Armstrong, President and General Counsel at American Vision Partners (AVP); John …
Utah Bill Uses Telehealth to Address Mental Health On March 2, 2021, Utah Governor, Spencer Cox, signed Senate Bill 41 (“SB41”) into law. The bill, sponsored by State Senator Luz Escamilla, allows coverage for mental health services delivered by telehealth – often referred to as “telemental health” services.  While we have seen many states move to create greater access to telehealth services in efforts to address the current public health crisis (the “Pandemic”), Utah is one of the first states to expand telehealth coverage to address the mental well-being of its citizens.  In a statement to State of Reform,…
On March 4th, the U.S. District Court for the District of Maryland struck down four provisions of the Trump Administration’s Notice of Benefit and Payment Parameters for 2019, 83 Fed. Reg. 16930 (April 17, 2018) (the “Rule”), which governs many aspects of Affordable Care Act (“ACA”) insurance markets beginning in the 2019 plan year.  The decision in City of Columbus, et al. v. Norris Cochran comes two and a half years after the cities of Columbus, Baltimore, Cincinnati, Chicago, and Philadelphia, as well as two individuals who rely on health insurance offered on ACA exchanges, filed suit alleging that…
On February 4, 2021, the Department of Justice (“DOJ”), Office of Public Affairs, issued a Press Release (the “DOJ Press Release”) announcing that Kelly Wolfe, President of Regency, Inc., a medical billing company located in Florida, pleaded guilty to conspiracy to commit healthcare fraud through a “pernicious telefraud scheme”[1] involving fraudulent Medicare and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) claims for medically unnecessary durable medical equipment (“DME”) supplies.  As a result of Wolfe’s criminal plea, Wolfe could face up to 13 years in federal prison. …
In a February 10, 2021 ruling (the “Garcia Ruling”) out of the District Court for the Central District of California (the “CDCA Court”) in the case of Gilbert Garcia et al v. Welltower OpCo Group LLC, et. al., 20-02250JVS (C.D. Ca. Feb. 10, 2021), the CDCA Court held that the Public Readiness and Emergency Preparedness Act (42 U.S.C. § 247d–6d) (the “PREP Act”) provides senior living facilities with an exemption from civil liability for actions taken by such facilities to protect facility residents from COVID-19.…
Virginia is now the second state, after California, to pass a comprehensive privacy law. The Consumer Data Protection Act (“CDPA”) will come into effect January 1, 2023 (the same time as the modification to California’s Consumer Privacy Act (“CCPA”), i.e., the California Privacy Rights Act (“CPRA”)). While CDPA has fairly broad exemptions for entities regulated by other laws, such as HIPAA, there is also a new “opt-in” requirement for collecting “sensitive data.”…

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