Legal Insights and Perspectives for the Healthcare Industry

The recently passed FY 2020 Appropriations Act increases funding for US healthcare agencies and programs over FY 2019 levels. The new law limits reauthorization of expiring healthcare extenders to five months, delays a scheduled reduction in Medicaid Disproportionate Share Hospital payments, enhances federal funding for healthcare research, and permanently repeals certain Affordable Care Act (ACA) taxes.

In this LawFlash, Morgan Lewis healthcare industry partner Susan Feigin Harris analyzes the December 18, 2019, decision by the US Court of Appeals for the Fifth Circuit in Texas v. Azar and concludes that it “portends potential chaos in health insurance coverage and puts the future of the entire Patient Protection and Affordable Care Act (ACA) in limbo.” Harris retraces the individual mandate’s road to the Fifth Circuit, unpacks the court’s “confusing” decision, and discusses the severability analysis “that the entire viability of the ACA now resides.” Noting that “[f]or now, the decision appears to have little day-to-day impact,” Harris expects that it “may be many months or even years before the issues remanded to the district court are resolved."

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In what has become the new “normal” in Washington, DC, these days, hospitals and their associations filed a lawsuit today against the US Secretary of Health and Human Services (Secretary) challenging the recent Final Rule issued by the Centers for Medicare and Medicaid Services (CMS) on November 27, 2019, addressing hospital pricing disclosures.

In its complaint, the American Hospital Association, joined by the Association of American Medical Colleges, the Federation of American Hospitals, the National Association of Children’s Hospitals, Inc. (d/b/a Children’s Hospital Association), and three representative hospitals in Missouri, California, and Nebraska (collectively, Plaintiffs), argue that the Secretary issued a Final Rule that (1) is unlawful and in excess of his statutory authority; (2) is a violation of the First Amendment by unlawfully compelling speech; and (3) is arbitrary and capricious, an abuse of discretion, and contrary to law, citing the Administrative Procedures Act (APA).

Price transparency rules impacting hospitals, health plans and third-party payers released by the Trump administration promise to substantially change how health plans, consumers, and providers will interact over the coming years. In this LawFlash, our healthcare industry team unpacks the final rule requiring hospitals to make standard charges public and the proposed transparency in coverage rule requiring group health plans and health insurance issuers to disclose negotiated rates with providers and out-of-network estimates for consumers. Across the industry as a whole, plans and providers alike will have to undertake additional costs to update their current programs, technology, and web pages to comply with the price transparency rules and take on or train personnel to maintain that programming and technology.

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“Medicare for All” has appeared in the nation’s political dialogue as we head into the next election cycle, with a number of plans being proposed by Democratic lawmakers. Recent public opinion polls show a growing surge in popularity for expanding the federal program that currently insures older Americans. Yet the polls also show a decline in favorability for Medicare for All when respondents are asked about the details of the plans. While there appears to be general agreement that Americans should have access to affordable coverage, the Democratic plans differ over options for reforming the health insurance system. To that end, the Medicare for All plans can be divided into one of two categories: a single payor or a public option plan. From there, the proposals diverge over a mix of fault lines, tradeoffs, and potential for disruption.

In a tersely worded letter to the US Court of Appeals for the Fifth Circuit, the US Department of Justice (DOJ) announced on Monday that it “has determined that the district court’s judgment in Texas v. U.S. should be affirmed” and “is not urging that any portion of the district court’s judgment be reversed.” In December 2018, Judge Reed O’Connor of the US District Court for the Northern District of Texas reignited the simmering debate over the Affordable Care Act’s (ACA’s) ultimate survival when he ruled the entire law unconstitutional in Texas v. U.S. In a surprising reversal of its previously stated position that only certain provisions of the ACA (such as the ban on preexisting condition protections) should be severed from the statute, the DOJ is now asking the Fifth Circuit to invalidate the entire law. Even before yesterday’s abrupt change of course by the DOJ, the US Department of Health and Human Services has said that it will continue to administer and enforce the ACA during the appeals period.

The 116th Congress convened on January 3 with Democrats controlling the House for the first time since 2011 and Republicans maintaining their majority in the Senate. Divided government typically constrains Congress’s ability to pass broad, new legislative initiatives, while also limiting the scope of the legislation that does pass. Healthcare policy, especially, has been a point of partisan contention in the past. However, there are several areas where some degree of cooperation is possible in the 116th Congress and will likely impact the healthcare industry and health policy in 2019.

In an opinion released on a Friday evening in mid-December, Judge Reed O’Connor of the US District Court for the Northern District of Texas reignited the simmering debate over the Affordable Care Act’s (ACA’s) ultimate survival when he ruled the entire law unconstitutional in Texas v. U.S. The case, filed by 20 Republican-led states in February 2018, alleges that Congress invalidated the ACA when it zeroed out the individual mandate penalty under the tax reform legislation in 2017. Law360 published an article on December 18, 2018, by Morgan Lewis partners Susan Feigin Harris and Howard Young and senior health policy analyst Kathleen Rubinstein that discusses the decision, its impact, and what to expect next.

In an article published by Managed Healthcare Executive, Morgan Lewis partners Joyce Cowan and Susan Feigin Harris, and associate Jacob Harper discuss three CMS regulatory actions that managed care organizations will want to watch. These include the final rule on short-term, limited duration health plans; expanded telehealth coverage under the Medicare program; and the CMS announcement that certain quality and patient safety indicators will no longer be reported by CMS to the Hospital Inpatient Quality Reporting Program. As the administration proceeds with its incremental dismantling of the Affordable Care Act, it is important that managed care organizations maintain a watchful eye on emerging CMS policy changes and their potential implications for the industry.

Read the Managed Healthcare Executive Article