Insights on Health Care

Gender-affirming care (GAC) is a model of care encompassing medical, surgical, mental health, and non-medical services to support transgender and nonbinary individuals in affirming their gender identity. Advocates argue that GAC can be lifesaving for transgender youth experiencing gender dysphoria, a condition characterized by clinically significant distress resulting from incongruence between one’s gender identity and sex assigned at birth. However, recent legislative, executive, and judicial developments at both the federal and state levels have cast uncertainty over the future of GAC for minors.

Headlines that Matter for Companies and Executives in Regulated Industries

In the final days of the Biden Administration, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a notice of proposed rulemaking (NPRM) to modify the Security Rule under the Health Insurance Portability and Accountability Act (HIPAA). The NPRM proposes sweeping changes that impact how health care providers, health plans, and health care clearinghouses (covered entities) and their business associates (collectively, regulated entities) implement, document, and maintain safeguards for electronic protected health information (ePHI). OCR is accepting public comments on the NPRM through March 7.

Headlines that Matter for Companies and Executives in Regulated Industries

Headlines that Matter for Companies and Executives in Regulated Industries

California is leading the way in ensuring that determinations of medically necessary health care services are made by licensed physicians and not artificial intelligence (AI) algorithms.

Health Care Practice Leader Douglas A. Grimm was quoted by Law360, urging hospital leaders and lawyers across the country to start implementing new strategies after the Trump Administration pulled back a Biden Administration 2021 directive to avoid immigration enforcement at certain locations, including hospitals.

Headlines that Matter for Companies and Executives in Regulated Industries

Headlines that Matter for Companies and Executives in Regulated Industries

Now is the time for health care providers to consider participating in the recent Blue Cross Blue Shield (BCBS) antitrust class action settlement and the newly filed antitrust cases alleging widespread price fixing for out-of-network claims by MultiPlan and health insurers.

Headlines that Matter for Companies and Executives in Regulated Industries

On December 30, 2024, the Massachusetts state legislature passed House Bill 4653 (the Act), which significantly enhances regulatory oversight in the Massachusetts health care market. As signed into law by Governor Maura Healy on January 8, the Act will have profound effects for private equity (PE) investors and real estate investment trusts (REITs) engaging with the Massachusetts health care market. Passage of the Act comes on the heels of prominent PE-backed hospital failures in Massachusetts.

On November 20, 2024, the US Department of Health and Human Services, Office of Inspector General (OIG) issued its Industry Segment-Specific Compliance Program Guidance for Nursing Facilities (Nursing Facility ICPG).

In November, we wrote about Massachusetts legislative and regulatory updates that impact both nursing homes and assisted living residences.

Headlines that Matter for Companies and Executives in Regulated Industries

As of December 23, health care providers, health plans, and health care clearinghouses (covered entities) and their business associates (collectively, regulated entities) must comply with new reproductive health care privacy protections under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Enforcement will begin against the backdrop of a pending lawsuit challenging the validity of the new protections and an incoming Trump Administration with an uncertain enforcement posture.

Headlines that Matter for Companies and Executives in Regulated Industries

Welcome to the Fall 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and compliance tips. We bring you the most recent and significant insights in an accessible format, concluding with our main takeaways — aka “And the Fox Says…” — on what you need to know.

Headlines that Matter for Companies and Executives in Regulated Industries

Headlines that Matter for Companies and Executives in Regulated Industries

This past July, we reported on the Centers for Medicare & Medicaid Services (CMS) release of the 2025 proposed Hospital Outpatient Prospective Payment System (HOPPS) and Physician Fee Schedule (PFS) rules. CMS has now released the 2025 final rules, though they will not be published in the Federal Register for several more weeks.

Headlines that Matter for Companies and Executives in Regulated Industries

Health Care Counsel Gayland Hethcoat will lead a session on California’s Data Exchange Framework (DxF) at the California Society for Healthcare Attorneys’ (CSHA) 2024 Fall Seminar in Sacramento, California, on November 15, 2024.

Headlines that Matter for Companies and Executives in Regulated Industries

The United States awoke on November 6 to a changed and improbable political landscape. The nation has re-elected Donald J. Trump as President and has given him a US Senate Republican majority and potentially a US House of Representatives Republican majority as well. As fatigued and steadfast local and state election workers continue to sort through ballots, we continue to look to the finalization of tallies for some remaining Senate and House races to determine the nature and size of Congressional majorities.