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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.

There has been a flurry of recent activity in a case originally filed by six air ambulance companies claiming $20 million in unpaid emergency services invoices. On June 11, Aetna filed a counterclaim against REACH Air Medical Services LLC, CALSTAR Air Medical Services LLC, Guardian Flight LLC, Med-Trans Corporation, Air Evac EMS Inc., and AirMed International LLC based on alleged manipulation of the Independent Dispute Resolution (IDR) process established under the No Surprises Act (NSA). On July 2, the plaintiffs moved to dismiss the counterclaim.

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…

Earlier this week, the Consumer Financial Protection Bureau (CFPB or Bureau) released its second report detailing changes in the credit reporting of medical debts made by the three national consumer reporting agencies (CRAs) to reduce the number of medical bills on credit reports. Overall, the CFPB found the changes in the reporting of medical collections have led to a significant reduction in the number of consumers with tradelines relating to medical debts on their consumer reports. However, the total balances of medical collections on consumer reports only fell by 38% nationwide.