Photo of Jessamyn Vedro

Jessamyn Vedro

Subscribe to Jessamyn Vedro's Posts

Jessamyn is a partner in the firm’s Consumer Financial Services practice, based in Los Angeles. She focuses her practice on the health insurance and managed health care sectors. Jessamyn represents major health plans and insurers in complex litigation in both state and federal courts, including actions for breach of contract, bad faith denial of benefits, ERISA benefits, and unfair competition, among others, with particular emphasis on out-of-network provider reimbursement disputes.

Contact:Read more about Jessamyn Vedro

On January 7, the U.S. Court of Appeals for the First Circuit denied the federal government’s request for a stay of the nationwide preliminary injunction barring implementation of the Health Resources and Services Administration’s (HRSA) 340B Rebate Model Pilot Program. Five days later, on January 12, the Department of Justice advised the court that the parties are discussing returning the challenged approvals to HRSA for reconsideration and that they “plan to dismiss the appeal in short order,” signaling that the current version of the pilot is unlikely to move forward on appeal.

On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight, leaving in place the Fifth Circuit’s June 2025 decision that we covered in our prior post (available here). As a result, within the Fifth Circuit, providers cannot rely on the No Surprises Act (NSA) itself to enforce Independent Dispute Resolution (IDR) awards in court and face a heightened standing bar for ERISA-based claims where patients are insulated from financial harm. And the persuasive effect of the Fifth Circuit’s holding is bolstered nationwide.

On December 29, 2025, Chief Judge Lance Walker of the U.S. District Court for the District of Maine granted the plaintiffs’ motion for a preliminary injunction in American Hospital Association v. Kennedy. The court enjoined implementation of HRSA’s 340B Rebate Model Pilot Program “pending further order,” blocking the program from going into effect on January 1, 2026 (and April 1, 2026 for one manufacturer).

On November 24, the Ninth Circuit issued an unpublished memorandum disposition in Dedicato Treatment Center, Inc. v. Aetna Life Insurance Co., affirming dismissal of an out-of-network provider’s state-law claims as preempted by ERISA’s remedial scheme. The panel’s brief decision underscores that the Court’s 2024 decision in Bristol Holdings (discussed here) applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member. Although not precedential under Ninth Circuit Rule 36-3, the disposition is a clear, persuasive affirmation of Bristol’s reach.

On October 31, CMS finalized the CY 2026 Medicare Physician Fee Schedule (PFS) rule (CMS-1832-F), effective January 1, 2026. While primarily directed at Medicare providers, the rule’s changes have clear downstream effects for payors and private insurers that benchmark to Medicare or align commercial policies with federal payment logic. Key themes are higher baseline rates, a stronger push toward value-based care via dual conversion factors, permanent telehealth flexibilities (including virtual supervision), expanded behavioral health integration, and a cost-containment overhaul for skin substitutes.

On October 15, the California Hospital Association (CHA) filed a petition against the California Office of Health Care Affordability (OHCA) and related entities. The petition challenges the imposition of stringent cost targets on hospitals across California, arguing that these targets are arbitrary, capricious, and not based on comprehensive data analysis. CHA contends that the cost targets violate both state and federal laws, including the Takings and Due Process Clauses of the U.S. Constitution, by being confiscatory and lacking a clear methodology for compliance. Furthermore, the petition asserts that OHCA’s actions were prematurely implemented without adequate stakeholder engagement, potentially leading to significant operational disruptions and threatening the quality and accessibility of health care services.

On September 17, California Governor Gavin Newsom signed Assembly Bill 144 (AB 144) into law, a move in response to recent changes in immunization recommendations by the U.S. Food and Drug Administration (FDA). The bill, which took effect immediately, mandates that health plans cover a wide range of preventive care services, including immunizations, without cost-sharing or utilization management. This legislation is particularly noteworthy for its implications on vaccine coverage requirements.

Today, the U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s judgment, which affirmed the right of Medicaid beneficiaries to sue state officials for excluding Planned Parenthood from South Carolina’s Medicaid program.

Background…

On May 31, the Ninth Circuit Court of Appeals published an opinion in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, which has significant implications for the healthcare industry, most notably by clarifying the broad scope of the Employee Retirement Income Security Act’s (ERISA) preemption of state law causes of action arising from pre-service coverage communications between medical providers and health plan administrators.