What We’re Reading: Abortion Ban Lawsuit; Emergency Care Payment Disputes Settled; Work Requirement for Medicaid

Idaho Abortion Lawsuit Sees 16 States Wanting to Weigh In

There are 16 states, including Indiana, Alabama, Kentucky, Tennessee, and West Virginia among others, that are requesting to weigh in on a lawsuit against Idaho’s strict abortion laws. The lawsuit was filed by the Justice Department, saying that the abortion ban set to take effect this week in Idaho violates federal law that requires Medicaid-funded hospitals to provide “stabilizing treatment” for patients with medical emergencies. The 16 states claim that the federal guidelines are grant conditions of the Emergency Medical Treatment and Labor Act and do not have the power to overrule state law. The Idaho abortion ban would make abortions a felony to perform but would allow physicians to defend themselves in court to prove that the abortion was medically necessary to save a patient’s life.

Biden Administration Outlines Rules on Contested Medical Bills

Median contract rates must be the starting point for taking care of payment disputes, according to a new rule issued by the Biden administration. The rule, issued by the Labor Department, HHS, and Internal Revenue Service, is meant to clarify what must be considered to resolve out-of-network emergency care billing disputes. Arbitrators must also consider the qualifying payment amount, based on the median contract rate, before considering all information submitted by each party to give an accurate payment amount for the services provided. Hospitals and doctors had requested that severity of the patient’s condition, training and experience of the provider, and market share held by providers and health insurers be considered, but these were not included in the rule.

Georgia Medicaid Work Requirement Reinstated by Federal Judge

A federal judge in Georgia reinstated the work requirement needed to qualify for Medicaid in the state. The federal judge claimed that the revocation of the approval of the work requirement was “unlawful” and that a Georgia proposal to charge some Medicaid recipients monthly premiums was “arbitrary and capricious on numerous, independent grounds.” The Trump administration had approved the work requirement during his presidency, but CMS last year revoked that part of the plan and a requirement for the premium. CMS argued that the work requirement could be harder to meet for low-income Georgia residents during the pandemic, which would make it difficult for the vulnerable group to have health coverage.