This Week in 340B: March 11 – 17, 2025
Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick summary of relevant updates from the prior week in this industry-shaping body of litigation.
Issues at Stake: Rebate Model; Contract Pharmacy; Other
In three appealed cases challenging a proposed Louisiana law governing contract pharmacy arrangements, the appellee filed a motion to consolidate.
In a case challenging the US Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA’s) decision to prevent drug manufacturers from unilaterally implementing rebate models, defendants filed a cross motion for summary judgment and opposition to the plaintiff’s motion for summary judgment.
In a case challenging HRSA’s policy limiting the circumstances in which covered entities can use their group purchasing arrangements to purchase non-340B drugs, the plaintiff filed a motion for summary judgment.
In three cases challenging a proposed state law governing contract pharmacy arrangements in Missouri, defendants and intervenors in each case filed answers to amended complaints.
In four cases against HRSA alleging that HRSA unlawfully refused to approve drug manufacturers’ proposed rebate models:
In three cases, the defendants filed a cross motion for summary judgment and opposition to the plaintiff’s motion for summary judgment.
In one case, the plaintiffs filed a motion to strike portions of an amicus brief, and the amici filed a response.
Nadine Tejadilla contributed to this article.
What to Take Away from CMMI’s Early Termination of Four Demonstration Models
On March 12, 2025, in one of the Trump Administration’s first actions with respect to the Center for Medicare and Medicaid Innovation (CMMI), CMMI announced that it would prematurely terminate four alternative payment model (APM) demonstration models by December 31, 2025. CMMI’s decision was not entirely unexpected. In response to a 2021 report from a Congressional advisory committee recommending that CMMI “streamline” its portfolio of demonstrations, the Biden Administration initiated a 10-year “strategic refresh” of CMMI. Similarly, a critical report from the Congressional Budget Office (CBO) about the net cost initiated a wave of criticism from Republicans. Combined with the Trump Administration’s hyperfocus on reducing government spending (based on CMMI’s estimation, terminating the demonstrations early will save the federal government $750 million), it is not particularly surprising that CMMI was targeted for some cuts.
Less clear is why these specific demonstrations were targeted and whether CMMI’s decision to terminate the demonstrations is merely the continuation of a calculated, years-long push to reform the way CMMI operates, or whether it foreshadows the beginning of a significant pullback in the use of alternative payment model (APM) demonstrations to test out the use of value-based care in federal health care programs.
CMMI’s Plan to Terminate Demonstrations
The four demonstrations that CMMI will terminate at the end of the year are below, including their original performance periods:
Maryland Total Cost of Care (TCOC) (2019 – 2026). Building on prior demonstrations in Maryland, the TCOC implemented a “global budget” funding system through which hospitals in the state receive a population-based payment amount to cover all hospital services provided during the year rather than fee-for-service (FFS) payments. The TCOC also allowed hospitals that achieved savings under the TCOC to make incentive payments to nonhospital health care providers (e.g. physician groups) who partnered and collaborated with the hospital and performed care redesign activities aimed at improving care.
Primary Care First (PCF) (2021 – 2026). The PCF is a voluntary demonstration model offered in 26 states and regions to test whether delivery of advanced primary care can reduce the total cost of care. Through this demonstration, participating primary care practices receive a prospective population-based payment (based on the total number of Medicare FFS beneficiaries attributed to each practice, and adjusted for the acuity of the attributed beneficiaries) to provide primary care services, and flat visit fees for face-to-face encounters. Primary care practices are eligible for additional bonus payments based on performance on various quality metrics.
ESRD Treatment Choices (ETC) (2021 – 2027). The ETC is a mandatory demonstration designed to test payment adjustments for certain end-stage renal disease (“ESRD”) facilities and managing clinicians.
Making Care Primary (MCP) (2024 – 2034). The MCP is a demonstration designed to provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty integration and increase access to care. While the other three models that CMMI will terminate early were already scheduled to terminate in the next year or two, the MCP model only started in July 2024 and was intended to run through 2034.
CMMI also stated that it intends to reduce, or look for opportunities to change the Integrated Care for Kids (2020 – 2026) demonstration and does not plan to move forward with the Medicare $2 Drug List and Accelerating Clinical Evidence demonstrations, which had been announced but had not yet been implemented.
CBO Report from September 2023 Indicated CMMI Increased Spending
CMMI was created by the Affordable Care Act (ACA) in 2010 to test payment models (i.e. demonstrations) in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). That same year, CBO, which is an independent agency that provides Congress with analyses and estimates on federal economic and budgetary decisions, estimated that CMMI would save the federal government $10.3 billion over the following decade, offsetting the estimated $7.5 billion that CMMI was expected spend to operate the models. In September 2023, however, CBO reported that most of the CMMI demonstrations between 2011 and 2020 increased Medicare’s direct spending by $5.4 billion (or 0.1% of net Medicare spending). By April 2024, Republicans on the House Budget Committee were uniformly calling for an investigation into CMMI’s spending and operations.
A closer examination of the September 2023 CBO report creates a more complicated and nuanced picture of CMMI’s operations. For one, the September 2023 report did not include the Medicare Shared Savings Program (MSSP), which was also created by the ACA in its calculation of costs. While the MSSP is a permanent model operated by CMS rather than CMMI, CBO acknowledged the fact that its design has been informed by the CMMI’s ACO demonstrations. CBO estimated that this program generated small net savings for the government. The September 2023 report also only assessed demonstrations where provider participation was voluntary. While this decision was logical – most of the demonstrations that CMMI launched during the period were voluntary – mandatory versions of these models could have resulted in more significant net savings. Finally, CBO acknowledged in the report that six of the 49 demonstrations it analyzed produced net savings, including four of which have been certified by the CMS Office of the Actuary for expansion.
Nonetheless, it is not surprising that the new Administration, particularly given its purported focus on substantially cutting government spending, saw terminating CMMI demonstrations as a way to accomplish these goals. The March 12 announcement estimates that eliminating the demonstrations early will save the federal government $750 million (although no detail is provided on how CMMI calculated these potential savings).
MedPAC Report and Biden’s Strategy Refresh
Criticism of and initiatives to reform CMMI precede the September 2023 CBO report, however. In response to a 2021 report by the non-partisan Medicare Payment Advisory Committee (MedPAC), which advises Congress on Medicare payment reforms, CMMI had begun the process of “streamlining” its portfolio of demonstrations. While the 2021 MedPAC report identified a variety of concerns with CMMI, the biggest issue MedPAC focused on was the sheer number of simultaneous demonstrations being tested by CMMI, and the operational complexity they created. As noted, during that first decade, CMMI tested 49 APMs. While acknowledging the “valuable information” generated by the demonstrations, MedPAC ultimately concluded that CMMI’s large portfolio created significant overlap between various simultaneous demonstrations. As a result, many providers and beneficiaries were participating in multiple demonstrations at the same time, which MedPAC argued diluted the incentives imposed by each demonstration and complicated the ability of CMMI to properly analyze the impact of specific demonstrations. MedPAC ultimately recommended that CMMI streamline its portfolio. Among other things, MedPAC also noted that some of the demonstrations needed a longer performance period (which is typically five years) for the benefits to truly materialize, and further stated that CMMI’s heavy reliance on bonus payments to entice provider participation, which is a feature of the voluntary demonstrations, created some selection bias and often reduced the net savings of the demonstrations.
In response to the MedPAC report, the Biden Administration announced a “Strategy Refresh” in 2021 to incorporate lessons from the prior decade. Notably, this Strategy Refresh included a statement that CMMI was “undertaking an internal review of its portfolio of models,” and incorporated MedPAC’s recommendation to streamline its portfolio of demonstrations. As such, it is unclear whether the decision to prematurely terminate the demonstrations above represents a change by the new Administration, or whether they are indicative of pre-existing reforms that CMMI was undertaking.
The Case on Maryland
At first glance, the state most affected by the terminations is clearly Maryland, which has integrated its entire hospital system into the TCOC demonstration. Maryland has a rich history of utilizing APMs, having operated under federal waivers since 1977 that have allowed it to set hospital payments for all Medicare, Medicaid, and commercial payers. Until 2014, the state used prospective diagnosis-based payments for each hospital admission, similar to the Medicare hospital payment system, which successfully reduced the rate of spending per hospital admission. Corresponding increases in the volume of hospital admissions, however, limited the impact of this all-payer rate setting on controlling overall hospital spending. The TCOC model sought to address this issue by changing the payment methodology from prospective diagnosis-based reimbursement to a hospital global budget. By all indications, the TCOC has largely succeeded in generating a reduction in hospital spending.
For Maryland and its hospitals, the ultimate impact of the TCOC demonstration termination will likely not be significant because of forthcoming changes. Even though the TCOC was previously set to end at the end of 2026, the state was reportedly planning on winding the program down at the beginning of 2026 year anyway. Beginning in 2025, Maryland plans to implement a new CMMI demonstration waiver called the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model, which is heavily inspired by the TCOC demonstration. While Maryland will be the only state participating in the AHEAD model in 2026, Connecticut, Hawaii, New York, and Vermont plan to implement the AHEAD model in 2027.
The impact of the early termination of the PCF demonstration on primary care providers in Maryland is more complicated, however. The AHEAD model also includes bonuses for participating primary care providers, although, unlike the TCOC, providers must agree to participate in the state’s Medicaid “transformation efforts.” It is unclear what percentage of Maryland primary care providers already participate in Medicaid, although historically, the share of Maryland physicians that participate in Medicaid has been lower than the percentage that participate in Medicare due to lower payment rates by the former program. As such, terminating the PCF model early may incentivize some Maryland primary care providers to begin participating in the AHEAD model, and thus accepting Medicaid patients, early. While this would benefit Medicaid beneficiaries by increasing their access to providers, the significant cuts to Medicaid that congressional Republicans are currently contemplating complicate the picture.
Looking Forward and AHEAD
For right now, the impact of the demonstration terminations appears to be limited, both for Maryland and more broadly for other stakeholders involved in other demonstrations. Recent Republican complaints notwithstanding, payment and delivery demonstrations have long enjoyed some level of bipartisan support. Notably, CMMI stated in the March 12 announcement that it had “determined its other active models can meet the Center’s statutory mandate—either as is or with future modification—and therefore will continue moving forward.” An unnamed source told the publication Axios that CMMI still planned on going forward with the AHEAD model.
As such, there is currently no indication that CMMI has imminent plans to announce the termination of other demonstrations, or terminate the AHEAD model, both of which would have a larger effect on stakeholders. Nonetheless, the wild card is the current Administration’s propensity for rapidly changing its approach to various issues without notice, and the potential for cuts to CMMI’s budget to pay for other priorities. With this in mind, nothing, including the future of CMMI demonstrations, should be considered certain.
The Top 3 Mistakes Health Club Operators Make in New Jersey
It might be a surprise, but many health club operators in New Jersey are not in compliance with the law. This can include the gym not being properly registered with the State’s Division of Consumer Affairs or the gym itself is missing key safety devices and staff training. This can leave a gym open to fines up to $5,000.00 from the Division of Consumer Affairs, as well as potential liability should a member experience a health hazard while at the gym.
As a new gym operator, these are the Top 3 concerns which must be addressed before opening day.
Registration with the Division of Consumer Affairs
Many gyms currently in operation either never registered with the Division of Consumer Affairs or failed to renew their registrations. This can potentially cost a gym in fines and negative publicity.
The Division of Consumer Affairs has in the past launched investigations against unregistered gyms. A 2014 investigation (https://nj.gov/oag/newsreleases14/pr20140410b.html) resulted in 53 Notice of Violations, including for unregistered fitness centers. Businesses who received notices included not only small family businesses, but franchised locations of well known fitness chains such as Curves, Snap Fitness, Retro Fitness and Crunch Fitness. This caused the franchisee to receive large fines and the franchisor to receive bad press. In 2016, a similar investigation (https://www.nj.gov/oag/newsreleases16/pr20160331a.html ) issued fines against 20 health club operators.
You can verify whether a health club has an active license at https://rgbportal.dca.njoag.gov/public-view/.
CPR/AED training of staff, and required automated external defibrillator
N.J.S.A. 2A:62A-31 requires that the owner or operator of a registered health club must have at least one automated external defibrillator (AED) located in an accessible location, that the AED is tested and well maintained, and that at least one on site employee is trained with a current certification with the AED.
This is a continual necessity for a health club operator which must be planned beyond opening day. An AED can expire, with the pads lasting approximately 2 years, a battery lasting approximately up to five years, and the AED itself possibly requiring replacement after a decade. Additionally, certifications typically last up to two years, meaning the same staff member will require regular training multiple times to keep their certifications active.
A surety bond on file with the Division of Consumer Affairs
N.J.S.A. 56:8-41 requires any health club operator to maintain a surety bond with the Division of Consumer Affairs of between $25,000.00 and $50,000.00 based on 10% of the gross income of that health club. Additionally, if a health club operator sells memberships during any period before the facility actually opens, the surety bond must be for $50,000.00 during the preopen. There are exceptions to the surety requirements – a gym operator can supply an irrevocable letter of credit from a bank or obtain acceptance to maintain their own funds. Whichever option, the purpose is to ensure an avenue for refunds should a health club never open or shut down unexpectedly after accepting money. A health club operator which requires a surety bond can be fined as much as $5,000.00 in addition to any other fines, meaning an unregistered and unbonded health club operator can receive multiple fines of $5,000.00 each.
Trending in Telehealth: February 2025
Trending in Telehealth highlights monthly state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.
Trending in February:
Interstate compacts
Telepharmacy services
Veterinary services
Telehealth practice standards
A CLOSER LOOK
Proposed Legislation & Rulemaking:
North Dakota proposed amendments to the North Dakota Century Code related to optometrist licensure and standards for providing tele-optometry. The amendments delineate the circumstances under which a licensed optometrist may use telemedicine to provide care. Proposed practice standards include requirements to establish a proper provider-patient relationship and requirements related to informed consent.
In Indiana, Senate Bill 473 proposed amendments that would allow providers to prescribe certain agonist opioids through telemedicine technologies for the treatment or management of opioid dependence. Current law only allows partial agonist opioids to be prescribed virtually.
Finalized Legislation & Rulemaking Activity:
Ohio enacted Senate Bill 95, authorizing the operation of remote dispensing pharmacies, defined as pharmacies where the dispensing of drugs, patient counseling, and other pharmacist care is provided and monitored through telepharmacy systems.
The Texas Health and Human Services Commission adopted an amendment to the Texas Government Code, requiring that providers be reimbursed for teledentistry services. The amendment allows flexibility for a dentist to use synchronous audiovisual technologies to conduct an oral evaluation of an established client. This change makes oral evaluations more accessible and prevents unnecessary travel for clients in the Texas Health Steps Program.
The Arkansas governor signed Senate Bill 61 into law, authorizing the practice of veterinary telemedicine in the state. The bill includes practice standards for veterinary telemedicine and provision of emergency veterinary care.
Also in Arkansas, House Bill 1427 enacted the Healthy Moms, Healthy Babies Act. The act amends Arkansas law to improve maternal health and establish reimbursement procedures for remote ultrasounds.
Compact Activity:
Several states have advanced licensure compacts. These compacts enable certain categories of physicians to practice across state lines, whether in person or via telemedicine. The following states have introduced bills to enact these compacts:
Dietitian Licensure Compact: Mississippi, Kansas, and North Dakota.
Social Work Licensure Compact: Mississippi, Maryland, and North Dakota.
Occupational Therapy Licensure Compact: North Dakota and New Mexico.
Audiology and Speech Language Pathology Compact: New Mexico.
Why it matters:
States continue to expand practitioners’ ability to provide telehealth services across state lines. While telemedicine is often seen as an alternative method for care delivery, it can sometimes be the most effective and efficient option. Expanding interstate licensure compacts improves access to qualified practitioners, particularly in underserved and rural areas. These compacts also enhance career opportunities and reduce the burdens associated with obtaining multiple state licenses.
States continue to apply telehealth practice standards to various professions. Legislative and regulatory trends reflect recognition that telehealth can be used in a variety of specialty practices, including veterinary medicine, dentistry, and optometry.
Telehealth is an important development in care delivery, but the regulatory patchwork is complicated.
The DOL’s New Guidance on the Interplay of the Federal FMLA and State-Paid Family Medical Leave Programs
On Jan. 14, 2025, the U.S. Department of Labor (DOL) issued Opinion Letter FMLA2025-01-A, clarifying the complex interaction between (1) the federal Family and Medical Leave Act (FMLA), (2) state-paid family and medical leave program (PFML) benefits and (3) employer-provided accrued vacation, paid time off, and/or paid sick time (employer-paid leave).
The takeaway for employers under the DOL opinion letter is that when an employee is on FMLA leave and is receiving state-paid PFML benefits, the employer cannot unilaterally require the employee to simultaneously use employer-paid leave.
PFML Background
Generally speaking, PFML benefits – funded through employee payroll withholdings employers remit to the state government – provide state-paid partial wage replacement to qualifying employees while on a covered leave of absence, such as personal medical leave, family medical leave, and child bonding leave.
In the absence of the federal government providing for or requiring paid leave under its own leave laws, a growing number of states have implemented PFML benefits in recent years, including California, Colorado, Connecticut, Delaware (effective Jan. 1, 2025), the District of Columbia, Maine (effective Jan. 1, 2025), Maryland, Massachusetts, Minnesota (effective Jan. 1, 2026), New Jersey, New York, Oregon, Rhode Island, and Washington. Other states have proposed similar legislation to implement PFML programs.
PFML benefits can be a valuable source of income for employees during an otherwise unpaid leave of absence but are often not the only source. Many employers choose or are required under state or local law to provide employer-paid leave for certain absences, some of which may include the same leaves that qualify for PFML benefits.
FMLA Background
The FMLA provides eligible employees with a leave of absence up to 12 weeks for certain purposes, including personal medical leave, family medical leave, and child bonding leave.
While FMLA leave itself is unpaid, employers can – with one important exception noted below – require employees to simultaneously use employer-paid leave during FMLA leave. Employers often prefer required simultaneous use, both to ensure that employees have a source of pay during an otherwise unpaid leave, and to minimize the total amount of time that an employee is anticipated to be away from work in the foreseeable future.
An exception to this rule is when an employee receives workers’ compensation benefits or disability plan benefits during FMLA leave, in which case the employer cannot unilaterally require the employee to simultaneously use employer-paid leave. Instead, in this scenario, simultaneous use of employer-paid leave is only permitted if the employer and employee consent to it.
New DOL Guidance on Integration with PFML Benefits
Borrowing from the logic of the simultaneous use exception described above, the DOL’s opinion letter clarifies that when an employee receives PFML benefits during FMLA leave, the employer cannot unilaterally require the employee’s simultaneous use of employer-paid leave, though employers and employees may consent to it.
While the DOL’s opinion letter is not binding law, courts generally grant deference to agency guidance like it.
Employer Considerations
Employers should review their (and/or their third-party leave administrators’) policies and practices and consider appropriate steps, if any, if employees are required to use employer-paid leave (e.g., vacation, paid time off, or paid sick time) during a period of FMLA leave when the employee also receives PFML benefits.
Given that the DOL opinion letter was issued in the final days of the Biden administration, the Trump administration may withdraw it, just like other recently withdrawn agency guidance across various sectors. However, even if the Trump administration does so, employers must still review FMLA-analogous state leave of absence laws to determine whether the same rule still applies, which is the case, for instance, in California and New York.
Bufkin v. Collins (No. 23-713)
When a veteran seeks disability benefits, federal law provides that ties go to the applicant. But if the Veterans Administration decides it’s not a tie—that is, the preponderance of the evidence comes out against the veteran—then it has no occasion to apply this tiebreaking rule. That leads to a question only an appellate lawyer would ask: What standard of review applies to the VA’s determination that the evidence isn’t even: The de novo standard generally used for legal questions or the clear error one used for findings of fact? In Bufkin v. Collins (No. 23-713), a seven-Justice majority held that this is a best seen as a mixed question of law and fact where the fact piece dominates, meriting clear error review. That prompted a dissent from the two Justices perhaps most likely to favor the little guy against the big-bad government—Justices Jackson and Gorsuch—who thought the whole point of this tie-breaking rule was to thwart the VA’s historical reluctance to award veterans the disability benefits they should receive.
Joshua Bufkin and Norman Thornton are two veterans who applied for disability benefits for PTSD caused by their time in the military. Their claims began in local VA regional offices (the first port of call for veterans seeking disability benefits), where Bufkin’s claim was denied entirely, while Thornton received lower benefits than he sought. Both then appealed to the Board of Veterans’ Appeals, an Article I court that reviews the benefits decisions of VA regional offices. The Board affirmed both regional offices’ decisions. In doing so, it acknowledged that whenever “there is an approximate balance of positive and negative evidence” on any issue material to a veteran’s claim, the VA must “give the benefit of the doubt to the claimant.” 38 U.S.C. § 5107(b). But the Board concluded that the evidence was not approximately balanced, so Bufkin and Thornton weren’t entitled to that deferential standard.
Bufkin and Thornton then appealed their respective cases to the U.S. Court of Appeals for Veterans Claims (the “Veterans Court”), another Article I tribunal, which reviews decisions from the Board. There, they argued that the evidence supporting their claims was about equal to the evidence against them, and that they were therefore entitled to get the benefit of the doubt. Federal law provides that in reviewing Board decisions, the Veterans Court must “take due account” of this benefit-of-the-doubt rule. But the Veterans Court concluded that the account that was “due” wasn’t much: Seeing no clear error in the Board’s decision that evidence weighed more strongly against the veterans, it affirmed the Board.
Bufkin and Thornton then appealed the Veterans Court’s decisions to the U.S. Court of Appeals for the Federal Circuit, a genuine Article III court that (among a great many other things) reviews decisions from the Veterans Court. It agreed with the Veterans Court that clear error applies to the Board’s decision that the evidence wasn’t roughly 50-50, so it too affirmed the denial of benefits. These three rounds of appeals weren’t enough for Bufkin and Thornton, though, as they successfully convinced the Supreme Court to grant cert to address the appropriate standard of review.
Unfortunately for our persistent appellants, the Court affirmed all the courts below it in a 7-2 opinion authored by Justice Thomas. It began with the language of the statute which, as discussed above, requires the Veterans Court to take “due account” of the “benefit-of-the-doubt” rule in reviewing the Board’s decisions. But the phrase “due account” doesn’t have a lot of content on its own, so Thomas concluded the general standards of review called for by the veterans statutes are all the “account” that is “due.” Those statutes prescribe the ordinary standards of review appellate lawyers know well, calling for the Veterans Court to review conclusions of law de novo and findings of fact for clear error. So in which bucket fell the Board’s conclusion that the evidence wasn’t about equal, meaning there’s no “doubt” for the veteran to benefit from? For Thomas and majority, weighing up the evidence involves both legal and factual work, making it a mixed question of fact and law. And because this particular mixed question “is about as factual sounding as any question gets,” Thomas thought it was appropriately reviewed only for clear error.
Justice Thomas then brushed aside two objections to this reasoning. First, Bufkin and Thornton argued this interpretation of the legislative command that the Veterans Court take “due account” of the benefit-of-the-doubt rule made the “due account” provision surplusage. Thomas acknowledged that this objection was “a serious one,” but the problem was that it’s just as true if you apply the de novo standard Bufkin and Thornton asked for: Either way, you’re simply following the statute’s default standards of review. Thomas thus concluded that this wasn’t a context where the rule against surplusage could do any work. Second, the veterans observed that some mixed questions of law and fact—like probable cause determinations—are reviewed de novo. But for Thomas, probable cause determinations dwelt in the “constitutional realm,” giving rise to heightened scrutiny. The “benefit-of-the-doubt” standard, by contrast, was a create of statute. And further, probable cause asks the legal-sounding question of what the hypothetical reasonable man might think of a particular set of facts. The question here—whether the evidence is about equal—was just too fact-like for an appellate court to conduct de novo review.
In dissent, Justice Jackson, joined by Justice Gorsuch, disagreed on both points. In her view, the statutory mandate that the Veterans Court “take due account” of the benefit-of-the-doubt rule should be understood as superseding the general standard of review found in the statute, thereby mandating de novo review. And even if one were to apply the baseline standards of review, Jackson thought that the Board’s determination about whether the benefit-of-the-doubt rule applied looked more like a probable cause determination, meriting de novo review. Although couched in the language of textualism, Jackson’s dissent relied heavily on legislative history, pointing to past drafts of the statute and testimony from veterans groups to Congress, all of which suggested that the whole point of the “due account” provision was to override the Veterans Court’s perceived record of being too deferential to the Board. Finally, Jackson bolstered her ultimate conclusion with the so-called veterans canon, which provides that statutory provisions for the benefit of veterans should be construed in the beneficiary’s favor. It is notable that Justice Gorsuch signed on to a dissent that made such heavy use of legislative history. Perhaps he simply thought veterans should get the benefit of the doubt.
Why Having a Special Needs Child Sign a Power of Attorney Is Not a Good Idea
In a previous blog, I discussed the process of a parent obtaining a guardianship for their special needs child. This blog discusses why it is not a good idea to try to shortcut this process and to simply have your child sign a power of attorney. Unfortunately, I have heard practitioners suggest this approach, and frankly, it made me cringe as it would be committing legal malpractice to have most special needs children sign a power of attorney.
In order for a power of attorney to be considered legally valid, the person granting the power of attorney would have to fully comprehend the power of attorney, including the powers that it grants to others to act on their behalf. The reality is that the majority of special needs children would be unable to fully comprehend a power of attorney to the extent they are legally required to do so in order to be able grant such authority. While some special needs children may possess the necessary intellect and understanding to grant a power of attorney, most special needs children could not meet this burden. Despite this reality, I have seen practitioners have special needs children sign powers of attorneys when they were simply not competent to do so. Unfortunately, this can lead to future problems for both the parent and child as discussed below.
One potential problem could arise if an individual, who is a family member or any other party with a potential interest, seeks to challenge the power of attorney in court. Should such a challenge be levied, an evaluation would be performed as to legal capacity of the child to grant a power of attorney. Should the challenge prove successful it would result in the invalidation of the power of attorney, and further, can lead to the invalidation of other transactions wherein the power of attorney was utilized, as well as the assessment of counsel fees and sanctions against the parent who improperly obtained the power of attorney. This could lead to a disastrous result for both the child and his/her family. Another problem that could arise is that the power of attorney does not legally establish that the child is legally incapacitated. As such, in the absence of this finding by a court, which is always made during a guardianship proceeding, the child may be able to legally bind himself/herself to transactions that they undertook, or they may undertake other transactions contrary to their interest which may be difficult to unwind. On the contrary, once a legal guardianship is granted by a court and there is a finding of legally incapacity, the guardian would be able to quickly void any such transactions which may not be in the best interests of the child.
As such, for the reasons discussed above it is bad idea to attempt to utilize a power of attorney when a guardianship is more appropriate. Frankly, this blog simply touches the tip of the iceberg as to potential issues, however, it should be clear that a guardianship is vastly preferred for most special needs children. Obviously, parents who are interested in this process should consult with competent legal counsel to guide them through it.
Proposed Rules for Minnesota’s Earned Sick and Safe Time Law: Key Insights for Employers
Over a year after Minnesota’s Earned Sick and Safe Time (ESST) law went into effect in January 2024, Minnesota’s Department of Labor and Industry (DLI) recently published proposed permanent rules (the Proposed Rules) that, if adopted, will regulate the ESST law. Although the rules are not yet final, they offer insights for employers on DLI’s interpretation of the ESST law.
Certain Employees Accrue ESST When Working Outside of Minnesota
As a reminder, under the Minnesota ESST law, employees accrue one hour of ESST for every 30 hours worked, up to 48 hours annually. The Proposed Rules explain that an employee’s hours worked outside of Minnesota count towards accrual as long as the employer anticipates the employee will work more than 50% of their hours for the employer inside of Minnesota per accrual year. If the employer anticipates that the employee will work 50% or less of their hours in Minnesota during the accrual year, then only the employee’s hours worked in Minnesota will count toward accrual of ESST. If the employee begins the accrual year without the expectation of working in Minnesota for more than 50% of their work time, but the expectation of working in Minnesota increases during the year to more than 50% of worked time, then the employer must allow the employee to accrue hours beginning on the date of the change in circumstances. Under the Proposed Rules, an employee who is teleworking is considered to be working in the state from which they telework.
Guidance on Calculating ESST Deductions for Indeterminate Shifts
When an employee takes ESST for a shift scheduled for an indeterminate time, the ESST law does not expressly state how an employer should calculate the hours to deduct from an employee’s ESST bank. The Proposed Rules clarify that an employer can only deduct from an employee’s “accrued” ESST the hours worked by the employee who picked up the ESST-taking employee’s shift. If there is not a replacement worker for that shift, but there are similarly situated employees, then the employer can deduct: either the average hours worked by the similarly situated employees who worked the same shift or the greatest hours worked by a similarly situated employee who worked the same shift. If there is no replacement worker or any similarly situated employees, then the employer may use the hours worked by the ESST-taking employee in their most recent similar shift of an indeterminate length.
Employers Can Demand Documentation from Employees Suspected of ESST Misuse
The Proposed Rules provide guidance on an employer’s ability to address a suspected “pattern of misuse” of ESST. The Proposed Rules define a pattern of misuse for claimed unforeseeable use of ESST as an employee routinely taking ESST (1) before a weekend, vacation, or holiday; or (2) before the start of a scheduled shift for under 30 minutes. The Proposed Rules do not indicate what number of such suspected misuses qualify as “routine.” When an employer observes a pattern of misuse, the Proposed Rules allow the employer to demand reasonable documentation from the employee suspected of ESST misuse. The reasonable documentation is limited to the definition in the ESST statute.
The ESST Law Covers Other Paid Time Off Used for Qualified ESST Purposes
If a covered employer provides paid time off beyond the hours required by the ESST law to an employee for absences from work due to personal illness or injury, then under the Proposed Rules, the excess paid time off is also subject to certain requirements imposed by the ESST law when the employee uses the time off for a reason covered by the ESST law. Such requirements include but are not limited to those related to the ESST requirements on notice, documentation, and anti-retaliation.
Next Steps
The DLI has opened a second comment period on these Proposed Rules. Comments are due by April 7, 2025. We will continue to monitor these developments.
Minnesota Department of Labor and Industry Proposes Rules on Statewide Earned Sick and Safe Time Law
The Minnesota Department of Labor and Industry (MNDOLI) recently issued proposed rules for governing Minnesota’s Earned Sick and Safe Time Law (ESST). The proposed rules are open for public comment through April 2, 2025.
Quick Hits
The Minnesota Department of Labor and Industry issued proposed rules stating that employees anticipated to work over 50 percent in Minnesota in an accrual year would accrue earned sick and safe time leave (ESST) for all hours worked despite location.
The proposed rules would allow employers to “advance” ESST hours.
The proposed rules also clarify that employees have a choice to use paid ESST or take unpaid and “unprotected” leave, and that employers may not require employees to use ESST.
The proposed rules are open for public comment through April 2, 2025.
Definitions
The proposed rules define “Accrual Year,” “Qualifying Purpose,” and “Work Day.” Namely, a “work day” means a consecutive period of time not greater than twenty-four hours.
Accrual Year
The Minnesota ESST law requires employers to designate and notify employees of the accrual year. Under the proposed rules, “[i]f an employer fails to designate and clearly communicate the accrual year to each employee … the accrual year is a calendar year.” The proposed rules would require employers to “provide a revised written notice” to affected employees if the accrual year changes before the change takes effect and “[i]f an employee has not received timely revised written notice … then the employee’s designated accrual year remains unchanged, unless the employee agrees otherwise.”
Hours Worked
Location of hours worked: The proposed rules would allow employees to accrue ESST as follows:
If the employer anticipates that an employee will work more than 50 percent of his or her hours for that employer in Minnesota in an accrual year, then all hours worked would count toward accrual of ESST regardless of the employee’s location.
If the employer anticipates the employee will work 50 percent or less of his or her hours for that employer in Minnesota in an accrual year, then only the hours worked in Minnesota would count toward the employee’s ESST accrual.
If there is a change in circumstances during the accrual year (e.g., change in location or duties) and the employee is working more than 50 percent in Minnesota in the accrual year or 50 percent or less in Minnesota in the accrual year, then the employer would be required to apply the applicable accrual when the change occurs.
For this section only, a teleworking employee would be considered working in the state where the employees teleworks.
Indeterminate shifts: Under the proposed rules, an employer would be required to deduct an employee’s ESST for an indeterminate length accordingly:
If a replacement worker is used to cover the employee’s shift, the hours worked by the replacement worker;
If no replacement worker, but similarly situated employees, then either:
the average hours worked of the other similarly situated employees who worked the same shift for which the employee used ESST; or
the greatest hours worked by a similarly situated employee who worked the shift for which the employee used ESST.
If no replacement worker and no similarly situated employees, then the hours worked in the most recent similar shift of an indeterminate length worked by the employee.
Time Credited and Increments of Accrual
Processing and crediting accrual: Under the proposed rules, employers would be required to credit accrued ESST by the end of the pay period. ESST would be “accrued” when the employer processes and credits the time to the employee at the end of each pay period.
Increment of time accrued: The proposed rules clarify that employers would not be “required to credit employees with less than hour-unit increments of [ESST].”
Rehire: The proposed rules also clarify that “[a]n employee rehired by the same employer within 180 days of separation is entitled to a maximum reinstatement of 80 hours of previously accrued but unused” ESST, unless law, policy, contract, or other authority requires a greater amount.
Accrual and Advancing Methods
Advancing hours: The proposed rules would allow employees to “advance” ESST hours. In other words, “[w]hen an employee begins employment, an employer is permitted to advance [ESST] to an employee based on the number of hours the employee is anticipated to work for the remaining portion of the accrual year and calculated at no less than the rate required in” Minn. Stat. § 181.9446(a), provided an employer need not advance over forty-eight ESST hours (unless law, policy, contract, or other authority requires a greater amount). However, if the advanced amount were less than the amount the employee would have accrued based on the actual hours worked for the rest of the accrual year, the employer would be required to provide more ESST to make up the difference within fifteen days of the actual accrued amount surpassing the advanced amount.
Changing methods: The proposed rules clarify that employers can “change methods” (i.e., switch from accrual to frontloading and vice versa) so long as the employer communicates the change to employees in writing and the change does not take effect until the first day of the next accrual year. If an employer fails to provide adequate notice, the prior accrual method remains in effect unless the employee agrees otherwise.
No additional accrual necessary: The proposed rules clarify that if an employer is frontloading ESST, the employee would not also accrue ESST under the accrual method.
Employee Use
The proposed rules would give employees the right to use ESST and prohibit employers from requiring employees to use ESST. However, if an employee chooses not to use ESST, the absence would not be protected by the ESST law.
Employee Misuse of ESST
The proposed rules address ESST misuse by clarifying that an employee’s use of ESST for a non-ESST covered reason would not be protected by the ESST law. The proposed rules would allow employers to “demand reasonable documentation from an employee when there is a pattern of misuse … for a claimed unforeseeable use,” notwithstanding the timeline in Minn. Stat. § 181.9447(3)(a). Misuse is defined to include an employee routinely using ESST the day immediately before or after a weekend, vacation, or holiday; or using increments of ESST in less than thirty minutes at the start of a scheduled shift. The proposed rules further specify that employers would be barred from denying an employee ESST based on earlier misuse or the employer’s suspicion that the employee may misuse ESST.
More Generous Sick and Safe Time Policies
The Minnesota ESST law requires paid time off and other paid leave provided to employees over the minimum amount required under the ESST law for absences from work due to personal illness or injury (but not including short-term or long-term disability or other salary continuation benefits) to meet or exceed the minimum standards and requirements under the ESST law other than Minn. Stat. § 181.9446 (i.e., ESST accrual). The proposed rules clarify this would only apply “when the leave is being used for a qualifying purpose.”
Defense Verdict in First Ethylene Oxide Case to Go To Verdict in Colorado
Background
Ethylene Oxide (EtO) is an industrial solvent widely used as a sterilizing agent for medical and other equipment that cannot otherwise be sterilized by heat/steam. EtO may also be used as a component for producing other chemicals, including glycol and polyglycol ethers, emulsifiers, detergents, and solvents. Allegations that exposure to EtO increases the risk of certain cancers has led to governmental regulation as well as private tort actions against companies that operate sterilization facilities that utilize EtO.
The first ethylene oxide case to go to trial was the Kamuda matter, in which an Illinois jury awarded $263 million in September of 2022 against Sterigenics for ethylene oxide exposure from that company’s Willowbrook facility. A subsequent trial in the same jurisdiction against the same defendant resulted in a defense verdict. Ultimately, Sterigenics resolved its pending claims involving the Willowbrook plant in the amount of $408 million.
Colorado Verdict
In only the third ethylene oxide case to go to verdict in the country (and the first one outside of Illinois), on March 14, 2025 a Colorado jury rendered a verdict in favor of defendant Terumo BCT Inc. Not only was this the first ethylene oxide trial to go to verdict outside of Illinois, it was the first one not involving defendant Sterigenics. The Colorado case is Isaacks et al. v. Terumo BCT Sterilization Services Inc. et al. in the First Judicial District of Colorado (docket number 2022CV031124). This was a bellwether trial that lasted six weeks, and involved four female plaintiffs. The jury determined that the defendant was not negligent in its handling of emissions from its Lakewood plant. The plaintiffs had sought $217 million in damages for their alleged physical impairment and also $7.5 million for past and future medical expenses as well as punitive damages. In light of the fact that the six person jury found the defendant Terumo not negligent, it did not need to consider damages or causation. Notably, there remain hundreds more pending claims against Terumo in Colorado. In fact, plaintiffs’ counsel filed almost 25 more cases while the trial was in progress.
All of the plaintiffs alleged that they had developed cancer as a result of ethylene oxide emissions from the Terumo facility. One plaintiff alleged breast cancer as a result of 23 years of exposure from the plant, while another alleged breast cancer after almost 35 years of exposure (these two plaintiffs were neighbors). Another plaintiff alleged multiple myeloma while the fourth plaintiff alleged Hodgkin’s lymphoma.
Analysis
While it is difficult to draw conclusions from a sample size of three verdicts given the differences in plaintiffs, jurisdictions, and alleged disease processes, we continue to believe that plaintiff firms will recruit new clients who allege some type of cancer as a result of residing in the vicinity of an ethylene oxide plant. In fact, there is ongoing ethylene oxide litigation in California and a few other states. How long will it be until we see television advertisements run by plaintiff firms seeking new plaintiffs? We’ve seen this in asbestos, talc, contaminated water, firefighting foam, defective earplugs, and other types of litigation. It is not out of the realm of possibility to think that we will see this with ethylene oxide litigation at some point in the near future.
Unclaimed Property Laws and the Health Industry: Square Peg, Round Hole
Likely due to the tremendous number of healthcare mergers, acquisitions, and private equity deals that have been taking place, the industry has recently been the target of multistate unclaimed property audits. This increased scrutiny has highlighted many of the complexities and tensions that exist in this space. At almost every stage of the process, healthcare industry holders are pressured by state unclaimed property auditors and administrators to fit a square peg in a round hole – something both they and their advocates should continue to vigorously push back against.
Determining whether any “property” exists to report in the first instance can be a daunting task in an industry where multiple parties are involved in a single patient transaction that is documented by complex business arrangements between sophisticated parties, which are updated and accounted for on a rolling basis. Unclaimed property audits are conducted in a vacuum of one single holder and use standard document requests that were developed to apply to all businesses, creating unrealistic record retention and management expectations that almost never neatly align with healthcare industry laws or practices.
Making matters worse, unclaimed property auditors and voluntary disclosure agreement (VDA) administrators frequently do not have a detailed understanding of the complex healthcare privacy, billing, and payment practices, yet these practices materially impact how providers manage unclaimed property and when they report it. Getting them up to speed on these laws, practices, and procedures can be very time-consuming. For example, providers or their advisors may need to explain to auditors what HIPAA is or what prompt pay laws are. Many of the payments in this space are managed or funded by the US government, resulting in federal preemption of a state’s ability to demand at least some portion of the funds a review is likely to identify. And while some of the larger healthcare providers and payors have detailed records for more recent periods, the degree of detail requested by the auditors is frequently unreasonable (in both time and scope) and can result in sampling, extrapolation, and grossly overstated audit results.
This article explores some of the unclaimed property law tensions and legal risks that exist for healthcare providers of all sizes.
COMMON PROPERTY TYPES
Some common property types at risk of exposure in the healthcare industry include patient credit balances, accounts payable checks, payroll checks, refund checks, and voided checks. These risk areas can result in unclaimed credit balances for varying reasons, such as overpayment and payment of the same bill by multiple sources. Healthcare providers and insurance companies periodically engage in settlement audits to resolve open items. However, a healthcare provider may make adjustments and write-offs to accounts receivable arising from a settlement, thus creating tension with the statutory anti-limitation provisions of unclaimed property law.
FEDERAL PREEMPTION
Although all 50 states and the District of Columbia have enacted unclaimed property laws, federal laws may preempt their ability to exert jurisdiction and regulate certain (otherwise) unclaimed property. Federal preemption can often be raised as a defense in the healthcare industry where federal law robustly governs the space (such as Medicare) or conflicts with state unclaimed property laws. For example, these defenses can be raised when federal law either establishes or abrogates property rights, claim obligations, and periods of limitation.
PROMPT PAY STATUTES AND RECOUPMENT
Prompt pay statutes are generally designed to ensure that physicians and medical providers are recovering their payment claims with insurance providers in a timely manner. Most states contain laws that typically include (1) a period in which claims are required to be processed, (2) types of claims covered, and (3) penalties for failure to comply. The statutes’ deadlines for making payments typically range from 15 to 60 days, depending on the state. Moreover, recoupment provisions in many states provide that refunds of paid claims by insurers are barred after the expiration of a specific period of time from the date of payment. Under these provisions, insurers cannot avoid this requirement via their contracts with the provider. Individual state statutes will render different results related to the coordination of benefits for federally funded plans such that there is either no recoupment period or a longer one. The finer details of prompt pay and recoupment statutes are important for states and their auditors to understand and, if not properly accounted for in an audit or VDA, can lead to vastly overstated results.
BUSINESS-TO-BUSINESS EXEMPTION
Some states exempt business-to-business payments and/or credit due from unclaimed property reporting. The scope of these exemptions can vary widely and sometimes contain traps for the unwary, requiring careful review before they are broadly implemented into a provider’s reporting process. In many states, there are viable defenses to unclaimed property audit assessments seeking payor funds held by a provider.
REVENUE RECOGNITION BASED ON CONTRACT
Contractual allowance adjustments and accounts receivable credit reclasses in the contractual allowance account can give the appearance of unclaimed property if not resolved timely, accurately, and with the appropriate supporting documentation. Examples of accounts that can give rise to potential unclaimed property credits include expired or outdated contracts between a healthcare provider and insurance company, unaccounted contract revisions or adjustments, and others that are unique to the healthcare industry to account for the complex flow of funds between patient, provider, and payor.
M&A DEALS
Unclaimed property results can vary significantly based on the terms and type of deal. It is best practice for unclaimed property counsel to be involved in healthcare deals to ensure any potential unclaimed property is accounted for. The typical failure to maintain records in a searchable manner post-acquisition may result in either (1) false positives during the next audit in an address review or (2) a windfall for the state of formation if an estimation is performed. Reviewing key provisions in the agreement when conducting a deal can identify complications that may arise and ensure the parties proactively account for any risk and maintain the records needed.
False Claims Acts
Many state False Claims Acts (FCAs) permit a private party (a relator) with knowledge of past or present underpayments to the government to bring a sealed lawsuit on its behalf. When these suits are successful, the relators receive 15% to 30% of any judgment or settlement recovered, which includes treble damages of the alleged unclaimed property liability and interest, per occurrence penalties, and even costs and attorneys’ fees.
In California ex rel. Nguyen v. U.S. Healthworks, Inc., the plaintiff brought a suit alleging that the failure to report credits as potential overpayments violated California unclaimed property law and the state FCA. The California attorney general filed an unclaimed property complaint in intervention against the healthcare provider, identifying the ongoing failure to comply with state unclaimed property law as a key factor in the attorney general’s decision to pursue the case under California’s FCA before agreeing to settle for $7.7 million in 2023.
Other states, including New York, are actively involved in aggressively enforcing their unclaimed property laws as punitively as possible through state FCAs. The U.S. Healthworks case is a cautionary tale for healthcare providers that have not robustly analyzed their unclaimed property law compliance practices.
Medicare Telehealth Gets Another Temporary Lifeline – Will Congress Make it Permanent?
On March 15, 2025, President Trump signed a continuing resolution to avert a government shutdown, which included a critical six-month extension of Medicare telehealth flexibilities through September 30, 2025. This six-month extension provides a temporary reprieve from the looming expiration of telehealth waivers that have been in place since the COVID-19 Public Health Emergency (PHE). While this is a positive development, it underscores the ongoing uncertainty surrounding Medicare’s long-term telehealth policy—an issue that Congress must address with a more permanent solution. The healthcare industry has increasingly emphasized the need for regulatory certainty to support long-term planning, investment in telehealth infrastructure and sustained access to care for Medicare beneficiaries.
What the Extension Means for Providers
Medicare providers will continue to operate under the existing telehealth flexibilities for an additional six months. This means:
No Geographic or Site Restrictions – Medicare beneficiaries can receive telehealth services regardless of their location, including from their homes.
Expanded Practitioner Eligibility – A broader range of healthcare providers, including physical therapists, occupational therapists and speech-language pathologists, can continue furnishing telehealth services.
Coverage for Audio-Only Services – Medicare will maintain reimbursement for certain audio-only visits, which have been critical for reaching patients without reliable broadband access.
Hospital and Facility-Based Telehealth – Flexibilities allowing hospitals and health systems to use telehealth for certain hospital-at-home and outpatient services remain in place.
FQHCs and RHCs Participation – Federally Qualified Health Centers and Rural Health Clinics can continue to offer telehealth services, ensuring access in underserved areas.
Mental Health Flexibilities – The in-person evaluation requirement for mental health services delivered via telehealth has been deferred, allowing patients to continue receiving mental health care via telehealth.
For hospitals, health systems and provider groups that have invested heavily in telehealth infrastructure, this extension offers short-term stability. However, the uncertainty beyond September 2025 remains a pressing concern.
Industry Perspective on the Need for Regulatory Certainty
Since the expanded use of telehealth under Medicare, healthcare providers, hospitals and technology developers have adapted their care delivery models and made significant investments in telehealth infrastructure. Many industry stakeholders have highlighted the following considerations as Congress continues evaluating the long-term future of Medicare telehealth policy:
Regulatory Stability for Long-Term Decision-Making – Healthcare organizations make strategic decisions—ranging from workforce planning to technology investments—based on long-term regulatory and reimbursement expectations. Without a definitive, long-term Medicare telehealth policy, providers must plan within an uncertain framework, creating challenges in making sustainable investments.
Access to Care for Underserved and Rural Populations – Telehealth has played a key role in expanding access to care, particularly for rural and underserved populations who may face geographic, transportation or mobility barriers. Healthcare providers serving these communities have emphasized the importance of telehealth in maintaining access to primary care, specialty services and mental health treatment. Given the growing reliance on telehealth among Medicare beneficiaries, there is industry interest in ensuring continued access to these services beyond temporary extensions.
Innovation and Growth in Digital Health – The expansion of telehealth has supported technological innovation across the healthcare industry, from remote patient monitoring to AI-driven clinical documentation tools. Industry stakeholders have noted that uncertainty around Medicare’s long-term telehealth policy can impact investment in emerging digital health solutions, as healthcare organizations and technology developers assess future regulatory and reimbursement environments.
What’s Next? The Push for Permanent Reform
With the clock now ticking toward the new September 30, 2025, deadline, major healthcare organizations are advocating for permanent legislative action. The American Telemedicine Association (ATA) and American Hospital Association (AHA) continue to urge Congress to cement telehealth’s place in modern healthcare, emphasizing its role in expanding access, improving outcomes and addressing provider shortages. Similarly, several bipartisan efforts have been initiated to establish permanent telehealth policies:
1. Telehealth Modernization Act of 2024 (H.R. 7623)This bill seeks to permanently extend certain telehealth flexibilities that were initially authorized during the COVID-19 public health emergency.
2. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (H.R. 4189; S. 2016)This bill proposes to expand coverage of telehealth services under Medicare, aiming to remove geographic restrictions and expand originating sites, including to allow patients to receive telehealth services in their homes.
3. Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261)This bill aims to extend key telehealth flexibilities through 2026, including provisions for hospital-at-home programs and ambulance services.
While there appears to be bipartisan support recognizing telehealth as a vital component of modern healthcare delivery, a long-term solution is critical to ensuring that telehealth remains a viable and effective care delivery option for Medicare beneficiaries well beyond 2025. Providers should take advantage of the additional time to solidify their telehealth strategies while remaining engaged in advocacy efforts.
Stakeholders—including hospitals, health systems, provider groups and digital health technology companies —must continue urging Congress to pass permanent telehealth legislation that preserves access, ensures fair reimbursement and provides regulatory clarity.