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U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

Fifth Circuit Clarifies Enforcement of IDR Awards Under the No Surprises Act

On June 12, the U.S. Court of Appeals for the Fifth Circuit issued a significant opinion in the case involving Guardian Flight, LLC and Med-Trans Corporation, two air ambulance providers, against the defendant insurance...more

California Governor Signs Legislation Impacting Health Care Claim Reimbursement and DMHC Requests for Records

On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state....more

California Court of Appeal Affirms Grant of Summary Judgment Against Health Care Provider in Win for Managed Care Payors and...

The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare (United), finding that United did not...more

After Multiple Strikes, Final Rules Issued for the No Surprises Act

On August 19, the U.S. Departments of Health and Human Services, Labor, and the Treasury (the Departments) issued final rules implementing the No Surprises Act, known as the “Requirements Related to Surprise Billing: Final...more

Massachusetts Health Care Laws Are Bellwethers of National Trends Two Years into the Pandemic

As states begin to pivot away from the emergency health measures implemented at the beginning of the COVID-19 pandemic, state governments are now grappling with addressing traditional health care concerns, while...more

Providers Prevail in Challenge to No Surprises Act Interim Final Rule

On February 23, a Texas federal court vacated several key portions of an interim final rule (Rule) governing the No Surprises Act's (Act) independent dispute resolution (IDR) process. The court's decision has been lauded by...more

Unsurprisingly, The No Surprises Act Has Surprises: Part II

On December 9, the American Medical Association (AMA) and the American Hospital Association (AHA) (the Associations) filed a lawsuit in the U.S. District Court for the District of Columbia challenging the proposed regulations...more

The No Surprises Act Gets Litigated

On October 28, the Texas Medical Association (TMA), a trade association that represents more than 55,000 physicians and medical students, filed a lawsuit in the Eastern District of Texas challenging key portions of CMS’s...more

HHS Issues Second Set of Regulations Implementing the No Surprises Act

On September 30, U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, as well as the Office of Personnel Management, issued another interim final rule — “Requirements Related to Surprise Billing: Part II”...more

HHS Issues Interim Final Rule for the No Surprises Act

On July 1, U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, as well as the Office of Personnel Management, issued an interim final rule implementing the No Surprises Act (Act) and requesting...more

SURPRISE! Along with COVID Relief, Congress Delivers Long-Anticipated Changes to Medical Billing with the “No Surprises Act”

On December 21, Congress passed the $900 billion spending and COVID-19 relief package — the Consolidated Appropriations Act, 2021 (CAA) — which President Trump signed on December 27. Although the CAA’s monetary relief...more

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