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NSA’s Model Notice: Doing Your Own Thing

On November 14, 2022
It’s November, and most TPAs are neck-deep in No Surprises Act compliance. This is a busy time of year as it is – but with new, daunting requirements piled onto a TPA’s usual renewal-time craziness, this is a special year. Some have opined that the last time they had a year like this was when the ACA was first passed, and that’s saying something!

The Fair Labor Standards Act (FLSA): Who Benefits and Who Doesn’t

On November 4, 2022
It’s hard to fathom today, but less than a century ago, America was a country in which elementary-school-aged children were accustomed to laboring in coalmines, glass factories, and shipyards; an untold number of employees earned less than $1 per day; a typical workweek consisted of six 12-hour shifts. Such was life for tens of millions of Americans barely scraping by during the depths of the Great Depression before FDR implemented his landmark New Deal, which, among other initiatives, provided workers greater protection with the passage of the Fair Labor Standards Act (FLSA).

RxDC Reports Are Almost Due – Make Sure You Are on Track for Compliance

On October 27, 2022
Our consultants have been receiving tons of questions in the last month about the upcoming Prescription Drug and Health Care Spending reporting (RxDC) requirements. The first two reports are due on December 27, 2022, for the 2020 and 2021 calendar years.

Mental Health Matters Act: Why the MHPAEA Needs Reinforcement

On October 6, 2022
It was fourteen years ago this month that the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law. The landmark piece of legislation had a profound impact on the healthcare industry, requiring group health plans and insurance companies to provide coverage for mental health/substance use disorder treatments in parity with medical services.

Fourth Circuit Extends ADA Protection to Americans Suffering from Gender Dysphoria

On October 4, 2022
This August, the Fourth Circuit Court of Appeals in Williams v. Kincaid extended ADA protections to those suffering from gender dysphoria. The case related to the treatment of plaintiff Kesha Williams, a transgendered woman, while housed in a Virginia prison, but the holding has important implications in the workplace context.

More Twists to the IDR Process in the No Surprises Act?

On August 25, 2022
The latest final rule on the No Surprises Act has finally been released by the U.S. Departments of Health and Human Services, Labor, and Treasury. There are some important clarifications made in this latest rule, including confirmation that the Qualifying Payment Amount (QPA) is no longer the presumptive out-of-network rate.

Marietta Memorial Hospital Employee Health Benefit Plan v DaVita Inc. - Dialysis Carve-Out

On August 2, 2022
In one of last month’s momentous Supreme Court cases, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., the justices confronted the legal question of whether the health plan covering employees of a small Ohio hospital contained a dialysis carve-out discriminating against participants with end-stage renal dialysis (ESRD). The Court, in a 7-2 decision, ruled that there was no such discrimination because the dialysis carve-out neutrally applied to all outpatient dialysis claims, not just those involving ESRD, and thus did not violate the Medicare Secondary Payer Act (MSP). While the Court’s ruling in favor of Marietta Memorial Hospital was surely a major victory for health plans implementing dialysis carve-outs, as well as plan sponsors, the contextual background to this case speaks to some critical underlying issues in the healthcare industry.

The Forum Redux

On July 21, 2022
After a three-year hiatus, The Phia Forum resumed on July 11th, exclusively geared toward Independent Consultation and Evaluation (“ICE”) clients, many of whom have been using Phia’s health care cost containment services for over two decades. During the two days of events, the first of which occurred at The Phia Group’s new office in Canton, Massachusetts, “ICE” clients enjoyed seminars highlighting enhancements to current services while learning how new developments in healthcare—and American legal landscape— will impact their businesses.

Transparency in Coverage Compliance? | The Phia Group

On June 16, 2022
It’s Almost July 1st – Are You Ready for Transparency in Coverage Compliance?

A Love Letter to Plaintiffs’ Attorneys Everywhere

On June 7, 2022
You know, in the modern information and technological age it is rather easy to forget that we are not in Kansas, anymore, i.e. the 1990s; anything you say or do on the internet can be accessed by the masses, can and will be used against you, and it will never go away. On the same token, it is important to understand the intended audience and perspective of the speaker and even perhaps get to know the person before you judge them based on what I, personally, would consider a (negligent, at worst) throw away phrase.

The Baby Formula Shortage and Preventive Care

On May 31, 2022
The baby formula shortage in the United States has been worsening for months. Our country’s supply was already squeezed by a perfect storm of pandemic-related supply chain issues and inflation costs. Then, with the detection of dangerous bacteria leading to the sickening and death of several infants, Abbott Nutrition shut down its Michigan plant in February – a plant that formerly supplied nearly one-fifth of all the baby formula in the country.

Limits of Arbitration Provisions on Participant ERISA Claims

On May 9, 2022
A recent sixth circuit decision shows limits of arbitration provisions on participant ERISA claims. Read our blog to find out the latest actions taken.

Medical Tourism Increases From Abortion Law | The Phia Group

On May 3, 2022
Trying to find out why medical tourism has increased? Read our blog to learn about medical tourism and the reason why it may be increasing.

State Law Development: Abortion Restriction | The Phia Group

On April 27, 2022
Looking for more information on abortion restrictions? You can read about different case studies involving the supreme court and their precedence.

The Mess in the American Healthcare System | The Phia Group

On April 25, 2022
Do you have someone to relate to when it comes with the health care system? This blog discusses some of the hardships people go though with healthcare.