Mid-Atlantic Health Law TOPICS

High Deductible Health Plan Telehealth Flexibility:

Did you know that the Consolidated Appropriations Act 2023 (CAA 2023) extended the High Deductible Health Plan (HDHP) telehealth flexibility for another two years? During the pandemic, Congress passed a law permitting an HDHP to cover telehealth service pre-deductible and still allow the insured to contribute to a Health Savings Account. This flexibility was set to expire on December 31, 2022, but has been extended to create a safe harbor for plan years beginning after December 31, 2022, and before January 1, 2025.

FDA Diagnostic Test Oversight:

Did you know that absent from the CAA 2023 was the contemplated removal of the Food and Drug Administration’s oversight of certain diagnostic tests?

False Claims Defense:

Did you know that the U.S. Supreme Court is considering whether False Claims Act cases should consider a provider’s subjective intent when deciding if the provider “knowingly” submitted false claims to the federal government? The question arose on appeal of two cases where subjective intent was held not to be relevant if the entity’s regulatory interpretation was objectively reasonable. Other courts have considered the provider’s subjective state of mind in determining whether the provider “knowingly” submitted false claims.

DEA Training:

Did you know that the Drug Enforcement Administration issued a Training Letter explaining which providers need to complete the one-time eight-hour training requirement included in the Consolidated Appropriations Act of 2023 and which entities are offering the training? The Letter states that all DEA-registered practitioners need to be prepared to attest to completing training on any initial or renewal applications initiated on or after June 27, 2023. While all DEA-registered practitioners are required to have received specific training, the DEA will accept training that practitioners previously received, if it meets certain criteria, and the DEA is not requiring all practitioners to attend new training programs.

Vaccinations for Minors:

Did you know that a court in the District of Columbia blocked enforcement of a D.C. law that allowed “mature” minors 11 and older to receive vaccinations without the minor’s parent’s knowledge or consent? The district judge concluded that the D.C. law conflicted with a federal law requirement that a minor’s legal representative receive a vaccine information sheet describing the vaccine’s risks and benefits.

No Surprises Act:

Did you know that a court in Texas vacated portions of the No Surprises Act Final Rule? The Final Rule defines the median rate an insurer would have paid for a service if the service were provided by an in-network provider as the “qualified payment amount” (QPA). The Final Rule also requires independent dispute resolution reviewers to first consider the QPA when determining the appropriate reimbursement rate to pay an out-of-network provider unless credible evidence demonstrates that the QPA is not the appropriate reimbursement. The court excised that deferential language from the Final Rule because it conflicted with the unambiguous language of the Act. Although the Centers for Medicare and Medicaid Services (CMS) has appealed that decision, CMS has also issued guidance that the court’s decision should be followed in the meantime.

Darci M. Smith
410-576-4153 • dsmith@gfrlaw.com