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COVID and a Cloud of Dust

The COVID-19 pandemic forced lawmakers to respond with an array of legislation to help Americans, such as the No Surprises Act, the Families First Coronavirus Responses Act and the Coronavirus Aid, Relief and Economic Security Act. Now, however, pandemic-related litigation involving the Employee Retirement Income Security Act of 1974 (ERISA) is becoming more common. In this Best Lawyers article, McDermott Partner Ted Becker highlights the major types of pandemic-related litigation, including out-of-network provider litigation, the Racketeer Influenced and Corrupt Organizations Act (RICO) and antitrust claims, and COVID-19-related litigation against ERISA health plans.

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CDC Updates Its COVID-19 Guidelines: What Does It Mean for Your Business?

On August 11, 2022, the Centers for Disease Control and Prevention (CDC) unveiled its updated COVID-19 guidelines, revising both quarantine and isolation guidelines in the process. The updates reflect the growing number of vaccinated individuals (meaning, those individuals who have received initial doses and all recommended boosters) and past exposures, leading to a greater level of herd immunity than in previous eras of the virus. These adjustments to the CDC’s guidance also serve, in large part, to clarify existing recommendations or to loosen restrictions. This article provides a closer look at what exactly the updated guidance requires and how to best approach these updates in the workplace.

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How Telehealth Adoption May Drive Increase in Value-Based Care

The COVID-19 pandemic has ushered in significant changes to the healthcare industry, specifically the transition from a fee-for-service model to a value-based care model, and digital health has proved to be a driver of value-based care models. In this Westlaw Today article, McDermott Partners Marshall E. Jackson, Jr. and Jeremy Earl suggest that increased use of telehealth during the pandemic may lead to an increase in the adoption of value-based care models that reward providers for efficiency and effectiveness.

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California Updates COVID-19 Cal/OSHA ETS

On April 21, 2022, the California Division of Occupational Safety and Health’s (Cal/OSHA) Standards Board approved the Third Readoption of the state’s COVID-19 Prevention Emergency Temporary Standard (ETS). Per Governor Gavin Newsom’s Executive Order N-23-21, the Third Readoption will remain in effect for no longer than December 31, 2022. The Third Readoption makes some additional material changes and clarifications, including acceptable return-to-work criteria, elimination of certain cleaning and social distancing requirements, and creation of a “returned case” category of workers recovered from COVID-19. Employers in California should update their COVID-19 ETS policies to ensure continued compliance with Cal/OSHA’s changes in the Third Readoption.

Read about the Third Readopted ETS here.




Proposed Rule on MA and Part D Would Reinstate Historical Requirements, Make Changes to Prescription Drug Payment Structure

On January 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, marking the Biden administration’s first proposed rule on these topics. The proposed rule includes proposed changes to the manner in which pharmacy price concessions are accounted for in the Part D benefit, the timing of network adequacy reviews for Medicare Advantage Organization (MAO) applicants, and new rules regarding oversight of third-party marketing organizations. The proposed rule also reverses course on some policy changes that were initiated under the prior administration, including changes related to medical loss ratio (MLR) reporting and past performance evaluations. The proposed rule includes proposed policy updates for Dual Eligible Special Needs Plans (D-SNPs) and a few provisions related to the ongoing COVID-19 public health emergency (PHE).

Read more here.




Agencies Clarify How Employers Can Charge COVID-19 Vaccine Premium Incentives

US employers have grown increasingly interested in identifying incentives that increase COVID-19 vaccination among employees. The US Departments of Labor, Treasury and Human and Human Services recently issued guidance regarding the application of the Health Insurance Portability and Accountability Act (HIPPA) wellness rules to vaccine-related premium surcharges and discounts, clarifying that employers may charge vaccine premium incentives if they adhere to the requirements of activity-only health-contingent programs. In this Employee Benefit Plan Review article, McDermott Partner Judith Wethall and McDermott Associate Sarah G. Raaii outline what this HIPPA guidance means for employers.

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VIDEO: Telehealth Laws in Flux as Pandemic Precautions End

The uncertainty around the termination of state public health emergencies is leading to the growth of healthcare companies with physical and virtual presences. In this recent Reuters video, McDermott Partner Lisa Mazur explained how these providers are more valuable from a valuation perspective.

“And part of that is because they’re able to enroll in Medicaid and get services covered, and they’re more likely to become a participating provider with a commercial plan,” Mazur noted.

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Massachusetts AG to Appeal Toss of Landmark COVID-19 Neglect Case

The Massachusetts Attorney General will appeal a state court decision to dismiss a landmark criminal case against the operators of a state nursing home. In November 2021, the Hampden County Superior Court dismissed charges against the Massachusetts nursing home’s former superintendent and former medical director. According to this Law360 article, McDermott Partner Mark Pearlstein, who conducted a report into the facility’s deaths, called the leadership decisions at the home “baffling.”

Read more here.




After High Court Loss, OSHA Looks to Other COVID-Curbing Means

The US Supreme Court’s January ruling that stayed enforcement of the US Occupational Safety and Health Administration’s (OSHA) shot-or-test mandate may limit some employers from introducing their own vaccination, testing or mask requirements. However, in this Bloomberg Law article, McDermott Partner Michelle Strowhiro said employers might still want to consider implementing portions of the standard—so long as state and local limits let them.

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Broadband Internet a Hurdle as Telehealth Services Rise in Popularity

Doctors and lawmakers say reliable broadband internet is lagging for populations that could benefit the most from telehealth services. In this MetroWest Daily News article, McDermott Partner Stephen Bernstein and McDermott+Consulting Vice President Mara McDermott offer insight into the challenges—and opportunities—for virtual care as it gains popularity.

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