|
Welcome
Welcome to our fourth issue of 2025 of The Health Record -- our healthcare law insights e-newsletter.
In this edition, we look at prior authorization transparency and physician decision-making; the impact of Medicaid cuts in West Virginia and Virginia; the latest with hospital price lists; the status of proposed changes to the HIPAA Security Rule; the extension of telehealth services; the confirmation of Dr. Oz as CMS Administrator; cybersecurity and credit downgrades; rural hospitals' efforts to enhance cybersecurity; and the latest regarding the Corporate Transparency Act. And finally, Eric Kinder explains the latest regarding DEI efforts and best practices for employers moving forward.
We want to take a moment and congratulate Spilman attorney David Amsbary on his recent election as President of the West Virginia State Bar. David is a Member in our Huntington office. He will bring his deep legal knowledge, leadership acumen, and commitment to professional excellence to this esteemed role. He is well-versed in healthcare law, as that is his primary area of practice, along with labor and employment law, commercial transactions, and litigation. Please join us in congratulating David on this great honor!
In addition, Joseph A. “Jay” Ford, a Member in our Charleston office, was named the 2024 “Young Lawyer of the Year” by the West Virginia State Bar. This prestigious honor recognizes Jay’s exceptional contributions to the legal profession and his leadership in the legal community. This is a much-deserved honor!
We hope you enjoy this issue and will let us know if you have any questions or suggestions.
Brienne T. Marco
Member, Chair of the Corporate Department, Co-Chair of the Health Care Practice Group, and Editor of The Health Record
| | |
“It is a reintroduction of similar bills brought by the lawmaker in 2023 and 2022.”
Why this is important: In an effort to help streamline necessary care and reduce administrative burdens among healthcare providers, Rep. Mark Green, M.D., R-Tennessee, introduced The Reducing Medically Unnecessary Delays in Care Act of 2025 in the House. The bill has backing from Reps. Greg Murphy, M.D., R-North Carolina, and Kim Schrier, M.D., D-Washington. Rep. Green’s bill is an effort to streamline the prior authorization process, which can cause significant delays to patient access to critical life-saving care. The proposed legislation would require all Medicare Administrative Contractor (MAC), Medicare Advantage plan and Part D prescription drug plan pre-authorizations and adverse determinations to be made by a licensed, board-certified physician of the relevant specialty. The bill also requires that these plans create published clinical criteria in line with current standards of care on their pre-authorization standards, which would be assessed and/or updated annually.
This legislation seeks to have prior authorization determinations be made by qualified and experienced specialty physicians, which should lend to a more efficient and effective process, especially when a physician provider has already evaluated their patient and deemed a service necessary. Therefore, the bill aims to provide a more seamless and timely process to the patient with respect to a prior authorization determination, but also cut back on unnecessary administrative costs and burdens.
This legislation is supported by the Medical Group Management Association (MGMA), which represents medical group practices that see the legislation as a necessary step toward ensuring that seniors receive appropriate and timely access to critical care and treatment. --- Jennifer A. Baker
| | |
“If federal officials cut the amount West Virginia is reimbursed for the healthcare expenses of its Medicaid expansion population below the current 90% level, delegates are preparing a refusal in state law to assure the state would not fill the gap.”
Why this is important: The West Virginia House of Delegates sent a message to the federal government as well as local healthcare providers when it originated House Bill 3518, a bill designed to disenroll and eliminate state coverage in the Medicaid waiver expansion program if the federal medical assistance for the expansion program were reduced. As drafted, any reduction whatsoever by the federal government to the current 90-10 match rate would trigger the full disenrollment of approximately 165,00 beneficiaries. Opposition to this bill among healthcare providers and citizen groups mobilized quickly as the bill was dubbed the “Killing Rural Hospitals Act of 2025.” The impact to the healthcare system was summarized by Cindy Beane, the Commissioner of the Bureau of Medical Services, the state agency in charge of the Medicaid program, as follows: “if the federal funding were cut then the department would be directed to immediately begin to disenroll people who qualify under Medicaid expansion…those funds don’t go to the enrollees. They go to our doctors, our hospitals, our providers.” Beane noted that, if implemented as written, the trigger law results in a combined loss of over $1 billion in Medicaid spending, thus imperiling healthcare finances across the state.
While the bill was reported out of the House Finance Committee to the full House of Delegates, it was immediately placed on the inactive calendar and failed to advance as required by April 2, thus ensuring that it would not be enacted this legislative session. --- Alexander Macia
| | |
“Trump's new order, signed in February, said that hospitals and health plans ‘were not adequately held to account when their price transparency data was incomplete or not even posted at all.’"
Why this is important: Transparency with medical billing has always been an opaque exercise that has been slow to change. This article discusses the government’s push for clarity in billing for the consumer, how that process has played out to date, and what could happen in the future. Of interest for medical professionals and facilities is the renewed push by the Trump administration for transparency in billing and enforcement of that transparency through various means, including Medicaid/Medicare. How this will play out exactly is not entirely clear, but rest assured, some level of enforcement is coming, and the medical field should prepare accordingly.
--- Matthew W. Georgitis
| | |
"'At this point we've received about 4,745 comments,’ Noonan said.”
Why this is important: In our first issue of The Health Record of 2025, we discussed the U.S. Department of Health and Human Services’ (HHS) plan to overhaul the HIPAA Security Rule. The proposed new rules include:
- All policies, procedures, plans, and analyses must be in writing;
- Facilities must create and maintain an up-to-date technology asset inventory along with a network map to track the movement of PHI through the network;
- More specifics regarding how to conduct a security risk analysis; and
- The implementation of multi-factor authentication.
The comment period on the updates to the HIPAA Security Rule has closed, and HHS’s Office of Civil Rights (OCR) is now reviewing the 4,745 comments that it received. These thousands of comments include criticisms of the new rules, including the fact that the cost of implementation is too high. Industry groups have also reached out to the Trump administration in an attempt to have the proposed rules rescinded due to the unreasonable timelines and cost expectations. Timothy Noonan, deputy director of health information privacy at OCR, stated that OCR will review all of the received comments in order to judge public sentiment regarding the proposed new rules before making a final decision. Spilman’s Healthcare and Technology practice groups will monitor the publication of the proposed rules and provide an update when they are published. --- Alexander L. Turner
| | |
“The funding patch contains limited healthcare extenders and funding.”
Why this is important: Recent legislation has extended telehealth flexibilities through September 30, 2025. At the time this article was written, the extension had just passed the U.S. House of Representatives, but it subsequently passed the Senate as part of a continuing resolution that funds the government until September 30, 2025. The telehealth flexibilities were set to expire on March 31, 2025, absent action by Congress. With the passage of the government funding package, Medicare patients can continue to receive telehealth services for non-behavioral/mental healthcare in their home for the next six months, and there will be no geographic restrictions on originating sites for these services. --- Brienne T. Marco
| | |
“The 64-year-old will manage health insurance programs for roughly half the country, with oversight of Medicare, Medicaid or Affordable Care Act coverage.”
Why this is important: Dr. Oz will now oversee health insurance programs covering roughly half of all Americans through Medicare, Medicaid, and the Affordable Care Act. His confirmation has sparked significant concerns among healthcare advocates who fear his leadership could accelerate privatization of Medicare and lead to cuts in essential services for millions of vulnerable Americans, including seniors, children, and people with disabilities.
Despite Dr. Oz’s longstanding criticism of socialized healthcare and advocation of healthcare privatization, he has not yet indicated whether he would oppose proposed cuts to the government-funded program. Instead, Dr. Oz has outlined a vision centered on promoting healthier lifestyles, integrating artificial intelligence and telehealth into the system, and rethinking rural healthcare delivery.
During his confirmation hearing last month, Dr. Oz expressed support for work requirements for Medicaid recipients while cautioning against excessive paperwork that could block enrollment. He acknowledged longstanding issues with the program, noting that "doctors dislike Medicaid for its relatively low payments and some don't want to take those patients." Dr. Oz highlighted particular concerns about Medicaid expansion, stating that when "eligibility was expanded without improving resources for doctors, that made care options even thinner for the program's core patients, which include children, pregnant women and people with disabilities." Despite taking this stance in the face of his confirmation, during this hearing, Dr. Oz reportedly signaled support for further privatization of Medicare through Medicare Advantage plans, which critics note already cost taxpayers nearly $100 billion annually in excess costs compared to traditional Medicare.
Critics, including Robert Weissman, co-president of Public Citizen, have raised the alarm about Dr. Oz's qualifications and potential conflicts of interest. Weissman warned that Dr. Oz is currently poised to enact the new Presidential administration’s agenda of stripping crucial healthcare services through Medicare, Medicaid, and the Affordable Care Act, which could result in hundreds of millions of Americans losing their eligibility. Another critic of Dr. Oz, Lee Saunders, president of the American Federation of State, County, and Municipal Employees (AFSCME), stated that "Dr. Mehmet Oz has been shilling pseudoscience to line his own pockets. He can't be trusted to defend Medicare and Medicaid from billionaires who want to dismantle and privatize the foundation of affordable healthcare in this country."
While Dr. Oz has faced criticism for promoting certain supplements and alternative treatments, he has consistently encouraged Americans to get vaccinated. He has also committed to continuing the Medicare drug price negotiation program established under the Biden administration's Inflation Reduction Act, telling senators, "It's the law. I'm going to defend it and use it."
As it stands, CMS is expected to lose approximately 300 staffers under the current administration and its push to reduce federal overspending. Such losses would include those who worked on minority health initiatives and cost reduction strategies. While CMS has been spared from the deeper cuts implemented at other health agencies like the FDA, CDC, and NIH, healthcare advocates warn that these personnel reductions, combined with Dr. Oz's leadership, could mark the beginning of a fundamental restructuring of America's healthcare safety net. With rising consumer prices and newly announced tariffs threatening to spark a global trade war, the timing of potential healthcare cuts could not be more precarious for millions of Americans already struggling with economic uncertainty and increased costs of living. --- Hikmat N. Al-Chami
| | |
“But cyberattacks can be especially problematic for smaller providers that don’t have the resources of some larger health systems.”
Why this is important: The healthcare industry is one of the leading targets for cyberattacks. Such attacks can lead to the disruption of services, the loss of critical data, loss of reputation in the community, and loss of revenue. Those are all the risks that people commonly associate with a cyberattack. However, there is a new one that is not often considered - damage to the facility’s credit rating. Recently, two smaller facilities that were already experiencing financial pressure had their credit ratings lowered following a cyberattack. Specifically, it was the slower rebound from a recent cyberattack that caused the lowering of their credit ratings due to an already weak financial situation. This new consequence of a cyberattack will disproportionally impact rural hospitals that lack the resources to sufficiently protect their systems. This is why it is so important for even small healthcare facilities to prioritize cybersecurity as much as possible. --- Alexander L. Turner
| | |
“Leading Virginia Democrats at the State Capitol and in Washington say the Republican House majority's recent budget resolution, which would cut $880 billion from healthcare and energy over 10 years, would be a disaster for low-income Virginians. Rep. Rob Wittman (VA-01) says not so fast.”
Why this is important: With DOGE slashing workforces and budgets, many Virginians are concerned about what will happen to Medicaid. Virginia Medicaid, health insurance for low-income families and the disabled, relies heavily on federal funding, which covers just over half of traditional Medicaid and 90 percent of the expansion passed in 2018 as part of the Affordable Care Act. The Virginia Republican House majority’s recent budget resolution, which includes cuts of $880 billion from healthcare and energy over 10 years, does not reference cuts to Medicaid; however, leading Virginia Democrats say the proposed budget’s impact on Medicaid is obvious. Democratic Rep. Jennifer McClellan (VA-04) said cuts of $880 billion cannot occur without cuts to Medicaid. Any reduction in how much the federal government reimburses states for Medicaid will have a devastating impact on over 600,000 Virginians covered by Medicaid, argues state Sen. Ghazala Hashmi (D-Chesterfield). Rep. Rob Wittman (VA-01) says that they are still looking at where the cuts in healthcare will come. --- Jennifer A. Baker
| | |
“More than 550 rural hospitals have joined the Cybersecurity for Rural Hospitals Program, a partnership created last year by the American Hospital Association and Microsoft to provide free and heavily discounted cybersecurity services.”
Why this is important: The healthcare industry continues to be one of the leading sectors of our economy targeted for cyberattacks. Protecting this vital part of our economy can be expensive, and often, the most vulnerable targets lack sufficient resources to protect patient data. This includes rural hospitals. In order to assist these rural hospitals, the American Hospital Association and Microsoft are teaming up to provide rural hospitals with free or highly discounted cybersecurity resources. This assistance will plug a hole in the healthcare cybersecurity dam that has been vulnerable for too long. --- Alexander L. Turner
| |
Treasury Department Issues Interim Final Rule Limiting the Corporate Transparency Act to Foreign Reporting Companies | | |
By Brienne T. Marco and Joseph C. Unger
On March 26, 2025, the Financial Crimes Enforcement Network of the U.S. Department of Treasury (FinCEN) published an interim final rule to narrow the existing beneficial ownership information (BOI) reporting requirements under the Corporate Transparency Act (CTA) to require only entities previously defined as “foreign reporting companies” to report BOI. Under this interim final rule, entities previously defined as “domestic reporting companies” are exempted from the reporting requirements and do not have to report BOI to FinCEN, or update or correct BOI previously reported to FinCEN.
Click here to read the entire article.
| | Featured Attorney Question & Answer | | This is our Featured Attorney Q&A to introduce you to our large healthcare law team. To help you get to know our team a little better, we are highlighting attorneys in each issue by asking them a healthcare-related question. We hope their responses will be insightful for you. | | |
Eric E. Kinder
Member
Charleston, WV
304.340.3893
ekinder@spilmanlaw.com
Q: With the recent shift in policies regarding diversity, equity and inclusion (DEI) programs, many companies and institutions are left wondering how best to create and maintain a diverse workforce while honoring long-standing obligations to provide equal employment opportunities. As someone whose primary areas of practice are labor and employment law, what guidance are you giving your clients on how best to move forward in these uncertain times?
A: This is a confusing area for many employers. The Equal Employment Opportunity Commission (EEOC) recently published guidance to employees and employers regarding “What [Everyone] Should Know About DEI-Discrimination At Work.” In it, the EEOC reaffirms the long-established doctrines under Title VII and states that it will apply the same standard of proof to all race discrimination claims, regardless of the victim’s race. Employers have long known that the use of quotas when hiring was not permitted and that would include diversity-related quotas because the EEOC is clear that the prohibition against disparate treatment because of race includes DEI-related disparate treatment. The guidance also announced that “an employer initiative, policy, program or practice may be unlawful if it involves an employer… taking an employment action motivated - in whole or in part - by an employee’s or applicant's race, sex, or another protected characteristic.” This prohibition applies to employer-sponsored employee activities, such as employee clubs or groups that are limited to certain protected groups.
One item we are paying very close attention to is where the EEOC indicates that DEI training can potentially create a hostile work environment. This has put many employers on notice, and so to mitigate potential litigation, you will want to review your anti-discrimination and/or pro-diversity trainings. Do your trainings align with your business objectives? Are you promoting inclusivity without granting preferential treatment based on protected characteristics?
Do you know the latest legal developments? Do you have counsel who are on top of legislation and judicial rulings? And if so, are they relaying that information to the appropriate managers, supervisors, and HR staff? Are your departments talking amongst themselves about changing policies and programs? Communication is absolutely vital and will only be helpful moving forward.
I cannot stress enough how important it is to have legal counsel that knows the ins and outs of this area of law. Your attorneys should be a true part of your team. They should know your business, your goals, and the best way for you to have a reliable and effective workforce. If you have questions about this issue or any labor and employment topic, please reach out. Our team is extremely well-versed in these areas and can help guide you through what are unprecedented times.
| | |
This is an attorney advertisement. Your receipt and/or use of this material does not constitute or create an attorney-client relationship between you and Spilman Thomas & Battle, PLLC or any attorney associated with the firm. This e-mail publication is distributed with the understanding that the author, publisher and distributor are not rendering legal or other professional advice on specific facts or matters and, accordingly, assume no liability whatsoever in connection with its use.
Responsible Attorney: Michael J. Basile, 800-967-8251
| | | | |
