Turmoil and Trouble Buffets Washington

Vaccine mandates expand; transparency faces new lawsuit

The U.S. Department of Health and Human Services (HHS) has ordered its healthcare employees to get the COVID vaccine, making it the second federal agency to do so, after the Veterans Administration (VA) a few weeks ago.

President Biden has already required federal workers and contractors to either be vaccinated or wear masks and social distance – the difference here is that the VA and HHS have now made vaccination mandatory for their healthcare workers, and they are not giving unvaccinated employees the option to simply wear masks and social distance.

The Pentagon then announced that all U.S. military personnel will be required to be vaccinated, starting Sept. 15.

At the state level, Washington State followed California last week by requiring most of their state employees and all government healthcare workers to be vaccinated by mid-October.

In response to hospitalization spikes due to COVID, the governor of Texas last week asked hospitals in the state to voluntarily postpone elective procedures. Texas is also recruiting out-of-state healthcare workers to help, while the governor of Arkansas announced that there were only eight intensive care beds available in the entire state.

Back in Washington, D.C., the U.S. Chamber of Commerce has filed suit against HHS about the healthcare price transparency rules. As listeners may remember, there are several different price transparency requirements that both healthcare providers and payers must  implement.  

First, the hospital price transparency rules – which have been in effect since January of this year – require hospitals to post the prices of more common procedures in what are called machine-readable files, including the prices they have negotiated with specific insurers. Remember that the American Hospital Association (AHA) fought these requirements in court, but ultimately lost to the Trump Administration. 

This latest suit by the Chamber of Commerce centers on the transparency rules that apply to healthcare payers. Like the hospitals’ requirements, the Transparency in Coverage rules require payers to post their negotiated rates.

The argument the Chamber is making in the lawsuit is that these publicly posted rates will not be helpful to consumers, because they’ll be on huge, unwieldy spreadsheets – and based on codes that most consumers will not understand. Therefore, the lawsuit argues, these machine-readable files do not meet their statutory intent of making healthcare prices transparent to consumers. Even the regulators admit that these files will be pretty much unreadable by anyone’s naked eye.

Unfortunately, this is the same argument that the AHA used against the hospital transparency rules, and, as we know, the hospitals lost that argument. The current administration’s defense in this newest lawsuit will be the same the previous administration used against the hospitals; that is, releasing reams of unreadable pricing data, they say, will provide other entities, like third-party app developers and data companies, the opportunity to make this information usable and useful for consumers. Think of how app developers now use databases full of airline data to make travel information usable by consumers.

We’ll see how the lawsuit fares; in the meantime, payers have until Jan. 1 to get these machine-readable files up on their websites, and the Biden Administration has promised enforcement against both hospitals and payers that refuse to post the data.

Programming Note: Listen to Matthew Albright and his Legislative Update sponsored by Zelis, Monday on Monitor Mondays, 10 Eastern.

Facebook
Twitter
LinkedIn

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Breast Biopsy Billing: Guidance-Driven Coding for Accurate Reimbursement

Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.

May 21, 2026

Mastering OB GYN Coding Accuracy: Precision Coding for Compliance and Reimbursement

Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.

May 14, 2026

2026 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.

April 13, 2026

2026 ICD-10-CM/PCS Coding Clinic Update: Fourth Quarter

Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.

December 14, 2026

Trending News

Featured Webcasts

Reengineering Utilization Management: Building an Adaptive Model for the New Payer Era

Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.

May 20, 2026

Compliance for the Inpatient Psychiatric Facility (IPF-PPS): Minimizing Federal Audit Findings by Strengthening Best Practices

Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.

April 9, 2026

Mastering MDM for Accurate Professional Fee Coding

In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.

March 31, 2026

The PEPPER Returns – Risk and Opportunity at Your Fingertips

Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.

March 19, 2026

Trending News

Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →

Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24