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, Sen. Escamilla noted that “mental health is becoming a big crisis and in our state we’re seeing an increase in needs, and access has become very limited.”
Continue Reading The “State” of Telehealth: Utah

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 the actions of the U.S. Department of Health and Human Services (“HHS”) drove up premiums, made enrollment more difficult, and caused more people to go without affordable, high-quality health insurance.
Continue Reading Federal Court Decides ACA “Sabotage” Case

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. 
Continue Reading OIG Warns Telehealth Industry: “With Great Power Comes Great Responsibility”

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.
Continue Reading Senior Living Communities, Liability for COVID-19 Countermeasures, and the PREP Act: Is the Tide Turning for Providers?

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.”
Continue Reading What Virginia’s New Privacy Law Means for Organizations in the Healthcare Industry

West Virginia Bill Seeks to Regulate Parity and Out-of-State Providers

On February 10, 2021, members of the West Virginia Legislature introduced Senate Bill 1 (“SB1”) which seeks to regulate the use of telemedicine in the state. If passed, the proposed bill would require the Public Employees Insurance Agency, Medicaid and specified insurance plans to cover telehealth services at the same rate as in-person healthcare, starting July 1, 2021. The bill would also permit healthcare providers who are licensed in other states to provide telehealth services in West Virginia.
Continue Reading The “State” of Telehealth: West Virginia

Washington State Seeks to Make Audio-Only Telehealth Permanent

On February 5, 2021, Washington State Rep. Marcus Riccelli introduced House Bill 1196 (“HB-1196”) which seeks to set specific guidelines for use and coverage of audio-only telehealth platforms, such as the phone. HB-1196 would mandate coverage for audio-only telehealth beyond the public health emergency (the “Pandemic”) as long as the service met certain requirements. The bill was passed almost unanimously by the House on February 24, 2021 and is now before the state Senate.
Continue Reading The “State” of Telehealth: Washington

Oregon Telehealth Bill Proposes Parity for Telehealth Services

On January 11, 2021, Oregon Senator Lee Beyer and Rep. Rachel Prusak, introduced Senate Bill 11 (“SB11”)[1], which would permanently extend parity for telehealth services with in-clinic care services. Parity for telehealth services was originally proposed in response to Governor Kate Brown’s March 23, 2020 Executive Order 20-22 which ordered a temporary halt on nonurgent procedures to preserve personal protective gear for frontline workers. Telehealth services provided clinical providers with an opportunity to maintain revenue by allowing individuals to seek care from the safety of their own homes. In line with the move to telehealth services, emergency payment policies enacted by the Oregon Department of Consumer and Business Services and payers’ voluntary agreement allowed providers to receive the same rates for telemedicine services as they would for in-clinic services.
Continue Reading The “State” of Telehealth: Oregon

On February 26, 2021, the Departments of Labor, Health and Human Services (HHS), and the Treasury issued Frequently Asked Questions (FAQs) on the implementation of the Families First Coronavirus Response Act (“FFCRA”), the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), and other health coverage issuesrelated to COVID-19.

Continue Reading New Guidance on Health Plans’ COVID-19 Coverage Obligations

As it continues to grapple with the COVID-19 pandemic, the healthcare sector will face increased antitrust scrutiny from the Biden administration, with the Federal Trade Commission (the “FTC”) and Department of Justice, Antitrust Division (the “DOJ”) (together the “Agencies”) as the Agencies ramp up their reviews not just of “horizontal” transactions (i.e., deals between competitors), but also of “vertical” transactions (i.e., deals that combine market participants at different levels of the healthcare industry, such as payors, hospitals, and physician practices).
Continue Reading Vertical Deals in Healthcare: Key Antitrust Takeaways for Private Equity Firms