Hospital Health Benefits Archives - HEALTH & LIFE SCIENCES NEWS

Departments Release Update on No Surprises Act Independent Dispute Resolution Process

by Brian Stimson and Emily Curran | Apr 28, 2023 | Hospital Health Benefits, Hospitals & Health Systems

On April 27, 2023, The Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) released a status update on the Federal Independent Dispute Resolution (IDR) Process, which covers the period from April 15, 2022 through March 31, 2023, as well as the initial report on the fourth quarter of 2022. Below are some of the key statistics shared.

Status Update

Between April 15, 2022 and March 31, 2023, 334,828 disputes were initiated through the Federal IDR portal. This caseload is 14 times greater than what the Departments initially anticipated.
- Non-initiating parties challenged the eligibility of 122,781 of the disputes and nearly 40,000 were deemed ineligible and closed.
IDR entities have rendered payment determinations in 42,158 disputes to date.
Initiating parties have been the prevailing party in ~71% of the disputes.

Fourth Quarter Report

During Q4 2022, disputing parties initiated 110,034 disputes through the Federal IDR process. This represented a 53% increase over Q3.
IDR entities made over three times more payment determinations in Q4 compared to Q3. IDR entities also closed fewer disputes as ineligible during Q4. Non-initiating parties challenged 40% of the disputes initiated.
Over two-thirds of the disputes submitted to the Federal IDR portal involved items or services furnished in bifurcated states (i.e., states where some items/services may be subject to a specified state law or All-Payer Model Agreement).
The report includes a summary of the Top 10 Initiating and Non-Initiating Parties.

CDC Issues Guidance for Employer-Operated Vaccination Sites

by Jennifer S. Geetter | Mar 19, 2021 | Hospital Health Benefits, Hospitals & Health Systems

As states across the US expand COVID-19 vaccine eligibility, employers are well-positioned to facilitate vaccine access and improve distribution efficiency. One critical way for employers to achieve these goals is through the operation of workplace vaccination sites, sometimes called closed points of dispensing (CPODs).

On March 16, 2021, the Centers for Disease Control and Prevention (CDC) issued updated guidance on workplace vaccination programs. Among other recommendations, the CDC encourages some employers to implement workplace COVID-19 vaccination sites and outlines best practices for doing so.

According to the CDC, employers with (1) a large number of workers on predictable schedules, (2) the ability to enroll as a vaccination provider or engage an already enrolled vaccination provider, and (3) enough space to operate a vaccination clinic that allows for social distancing should consider operating an on-site vaccination program. Conversely, the CDC recommends an off-site vaccination program for small- or medium-sized employers with a mobile workforce on variable schedules.

The CDC provides several options for employers that choose to operate an on-site vaccination program, including existing occupational health clinics, employer-run temporary vaccination clinics, and mobile vaccination clinics brought to the workplace. Regardless of the model, the CDC advises employers to contact their local health department for guidance. Many jurisdictions have already embraced the CPOD model (e.g. Chicago, IL) and provide extensive information on their websites.

The updated CDC guidance makes clear workplace vaccination clinics should [...]

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Policy Outlook: How The 2020 Election Outcomes Will Impact Your Business – Health Policy

by McDermott Will & Emery | Nov 6, 2020 | Health M&A, Health Private Equity, Hospital Health Benefits

In this session, health law policy authorities discussed changes likely in 2021 in a Biden Administration and how these changes will impact business objectives and strategies for health industry stakeholders.

Below are the top takeaways for Policy Outlook: How The 2020 Election Outcomes Will Impact Your Business session: Health, click here to access the full webinar.

Access the PDF here

COVID-19
If Vice President Biden campaigned on anything, it was a more vigorous response to the pandemic. Look for a Biden Administration to make addressing the spread and restoring the economy top priorities early on. Another relief bill is likely, and maybe even in a lame duck session in 2020, but any relief measure will require Republican and Democratic support. Look at both the House-passed HEROES Act and the Senate Republican HEALS Act as likely starting points for discussion.

Affordable Care Act
Vice President Biden campaigned on sustaining and expanding health insurance coverage by enacting a public option to compete with commercial plans in exchange marketplaces. With Republicans likely to retain control of the Senate, legislative expansions of the ACA are unlikely. Instead, look to a Biden Administration to reverse or revise ACA-related regulations and Executive Orders advanced by the Trump Administration. Still, keep an eye on the Supreme Court’s consideration of California v. Texas, which could call the constitutionality of the ACA into question.

Prescription Drug Pricing
Both parties share the goal of addressing the cost of prescription drugs, and there [...]

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