On June 24, 2022, the United States Supreme Court released Dobbs v. Jackson Women’s Health Organization, overturning Roe v. Wade. The Dobbs decision has employers scrambling to understand the impact on group health plan coverage. Many employers are considering implementing travel reimbursement options to assist employees who wish to seek abortions that might be restricted …
White House issues recommendations on telehealth and SUD services – Part II
On June 22, 2022, via the Legislative Analysis and Public Policy Association, the White House Office of National Drug Control Policy (ONDCP) released its “Telehealth and Substance Use Disorder Services in the Era of COVID-19: Review and Recommendations” (Guidance). While this publication does not have the force of law, it is clear direction to legislators …
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White House Issues Recommendations on Telehealth and SUD services
In June 2022, the White House Office of National Drug Control Policy (ONDCP), via the Legislative Analysis and Public Policy Association, released its “Telehealth and Substance Use Disorder Services in the Era of COVID-19: Review and Recommendations” (the “SUD Recommendations”). Although this publication does not have the force of law, it provides clear directions to …
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Employers, Employees, & HIPAA, Oh My!
Oftentimes, healthcare entities’ employees are also patients of the healthcare entity, creating a dual role as employer and employee as well as doctor and patient. But what can an employer do when they need to access an employee’s medical records? Are these medical records treated differently than non-employee patients? Throughout the last few years, we …
HOW APPLICATION PROGRAMMING INTERFACES APPLY TO HEALTHCARE ENTITIES
ONC Final Rule Information blocking On May 1, 2020, the Federal Department of Health and Human Services (“HHS”), Office of the National Coordinator for Health Information Technology (“ONC”) released a Final Rule (the “ONC Final Rule”), which implements the information blocking provision of the 21st Century Cures Act, enacted in 2016. The information blocking provision …
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Updates to Wit v. United Behavioral Health
The United States Court of Appeals for the Ninth Circuit recently released an unpublished memorandum decision in the landmark mental parity case of Wit v. United Behavioral Health. In this decision, the Ninth Circuit reversed the district court’s order requiring UBH to reprocess more than 60,000 claims that had initially been denied for not meeting …
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Risk-Based Contracting: How does taking on risk contribute to value-based care?
As healthcare laws are ever-evolving, the latest shift in the industry centers around value-based care. In fact, value-based care has recently become exceedingly popular, because it seeks to streamline healthcare while also cutting costs. It is both patient- and practice-centric. To achieve lawful value-based care, at least two value-based enterprises must enter into a value-based …
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State Funded Benefits for ASD in Arizona: The Basics
Who are the relevant state entities? The Division of Developmental Disabilities (“DDD”) operates under the Arizona Department of Economic Security (“ADES”).[1] The DDD provides services to qualifying Arizona children with developmental disabilities. The Arizona Long Term Care System (“ALTCS”) is Arizona’s Medicaid program that provides long-term care services to DDD members. ALTCS operates under the …
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Autism and Steven’s Law in Arizona
What is Autism Spectrum Disorder (“ASD”)? Autism spectrum disorder (“ASD”) is a developmental disability.[1] Children with ASD may experience social, communication, learning, and behavioral challenges. The severity of ASD varies and some children require more assistance than others. There is no cure for ASD, but early intervention treatment for children between birth and 36 months …
Update to the ALJ Backlog for Medicare Appeals
For the majority of the 2010s, the Medicare appeals process had become extremely backlogged. The Office of Medicare Hearings and Appeals (“OMHA”) is in charge of administering the Administrative Law Judge (“ALJ”) hearing program for appeals arising from Medicare claims and disputes. Pursuant to 42 U.S.C. § 1395ff(d)(1)(A), an ALJ is statutorily required to provide …
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