Mid-Atlantic Health Law TOPICS

No Surprises Act: Did you know that Aetna Inc. and Cigna Healthcare plans failed to comply with the No Surprises Act requirement to report the qualifying payment amount (QPA) to out-of-network providers when responding to provider invoices? In September 2024, CMS issued reports alleging that the health plans had either disclosed inaccurate QPAs or had failed to include the QPAs at all. The QPA is the median rate the insurer would have paid for the service if provided by an in-network provider, and the No Surprises Act requires the QPA to be considered in the independent dispute resolution process used to settle an out-of-network claim.

Web Tracking Technologies: Did you know that the Department of Health and Human Services (HHS) withdrew its appeal of a judge’s decision to strike down its Health Insurance Portability and Accountability Act (HIPAA) guidance regarding hospital use of third-party web tracking technologies? The guidance, first issued in December 2022, and then amended in March 2024, following a prior legal challenge, stated that when individually identifiable health information (IIHI), such as the individual’s medical record number, home or email address, dates of appointments, IP address or geographic location, is collected through a regulated entity’s website or app, that IIHI will generally be PHI, even if the individual does not have a relationship with the regulated entity and the IIHI does not include any treatment or billing information. Hospitals and the American Hospital Association filed challenges against the amended guidance, and in June 2024, a federal district court judge vacated part of the amended guidance. Now that HHS has decided to cease appealing, it remains to be seen whether HHS will issue additional guidance on this topic. 
 

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