Read more about Steven J. Williamson
Read more about Steven J. Williamson
Teaming up with Ali Ferrando at Brothers Smith, LLP, the Walnut Creek, CA Primerus firm, Kathryne spoke on the panel together with two corporate counsel: Spiwe Jefferson, General Counsel at Asset Marketing Services, LLC and Abagail Adams, General Counsel for the National Association of Homebuilders.
The four-person panel spoke on “How to Balance Being a Department of ‘Yes’ With Risk Mitigation” in the conference’s largest ballroom, with 400 corporate counsel in attendance. The event is very high exposure and had roughly 4000 attendees.
Read more about: Jizell K. Lopez
By Michael G. Polis and Rawan N. Khalili
The No Surprises Act (the “Act”)[1], signed into law on December 27, 2020 by the U.S. Congress, took effect on January 1, 2022. The Act was passed with the goal of addressing “surprise medical bills” for patients who unknowingly obtain medical services from providers outside of their network. The Act provides significant protections for patients, however, providers ought to be aware of the impacts of the Act on their practice. This article will summarize Section 112 of the Act, which establishes the “Good Faith Estimate”[2] requirements for providers.
What is a Good Faith Estimate?
The Good Faith Estimate (“GFE”) requires providers to make “Good Faith” estimates of services available to self-insured patients. Practitioners are required to provide reliable and accurate cost estimates for self-insured individuals, which must include all “co-providers,” (i.e. anesthesiologist-anesthetist, facility fee, and other fees related to the medical procedure).
Providers have some flexibility with the estimate, and while it’s not necessarily completely binding, a patient can dispute the bill if it’s at least $400 over the GFE.
The Good Faith Estimate includes the following:
A GFE is a timely written notice that is signed by the patient. According to guidance from the U.S. Department of Health and Human Services (“HHS”):
If the patient is a minor, the GFE should be signed by a legal guardian or whoever is obligated to pay for the service. The GFE should also include an itemized list of items or services that are reasonably expected to be furnished or provided to the patient related to the procedure.
A revised GFE must be provided if the facility or practitioner becomes aware of changes to the scope of the services provided. If the scope has changed, the prior GFE shall be revoked and a new GFE be provided before the procedure is undertaken.
Unexpected items or services provided during a Procedure.
[1] Enacted as part of the Consolidated Appropriations Act 2021 (CAA-21)) (Pub. L. 116-260, 134 Stat. 1182 (2020)): [1] 42 U.S.C. § 300gg-136
The “unexpected” item or service must be truly unforeseen, sudden, or unanticipated. The rule of thumb is to provide “worst case” scenarios in the GFE. If “worst case” scenarios are not included in the GFE, the service that was not included in the GFE may be disputed. The likelihood of success is low in a dispute between a patient and seasoned practitioner related to whether the GFE included anticipated reasonable fees and costs in a fee dispute. That being said, it’s best to have the GFE include all “expected” costs related to the services provided. While the Act suggests providing the estimate at least three business days before the scheduling of services, it is best practice to have the practitioner’s office staff discuss and review the GFE (or a revised GFE) with the patient several days before the scheduled procedure.
Notice of the No Surprises Act
Along with the Health Insurance Portability and Accountability Act (“HIPAA”) policies, practitioners should post “No Surprises Act” and “Good Faith Estimate” notices on their website and in office. Provider offices should also be prepared to provide oral notices of a patient’s ability to receive a GFE. Should a patient require the notice in accessible formats and in different languages, provider offices should be prepared to make those available.
Additionally, providers should post the separate required notice about surprise billing for out-of-network services. HHS has drafted model language to use for both these notices.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
Mustafa R. Karim was featured in this Primerus article. To read more, follow the link below: https://www.primerus.com/article/persistence-pays-young-california-lawyer
Read more about: Daniel L. Egan
Wilke Fleury is extremely proud to have five attorneys recognized in The Best Lawyers in America and three attorneys recognized in the Best Lawyers: Ones to Watch in America! Best Lawyers has been regarded by lawyers and the public for more than 40 years as the most credible measure of legal integrity and distinction in the United States. Congratulations to this talented group!
Read more about: Suzanne M. Nicholson
By: Mena M. Arsalai, Kimberly V. Martinez, and Alexandra J. Porter
In a significant development marking a pivotal moment in California’s healthcare landscape, the Office of Health Care Affordability (“OHCA”) has broadened its regulatory oversight of healthcare transactions. The California Office of Administrative Law recently approved OHCA’s regulations under which “health care entities” are required to notify OHCA of “material change transactions” at least 90 days before closing for transactions finalized on or after April 1, 2024 (the “CMIR Regulations”).
Once a material change notice (“MCN”) is filed, OHCA has 60 days to decide whether to (i) conduct a cost and market impact review (“CMIR”) of the proposed transaction or (ii) waive such review. OHCA is required to conduct a CMIR if the proposed transaction poses a risk of significant impact on market competition, the state’s ability to meet cost targets, or costs for purchasers and consumers.
The first MCN filing was deemed completed on April 12, 2024. While this filing offered a first look at how OHCA will manage its CMIR process, the contemplated transaction in the filing did not relate to the sale of a business. Rather, as described in the notice, the submitter entered into the transaction solely as an accommodation to the landlord and its new operator/tenant. “Submitter is not ‘selling’ its business, but is agreeing to transfer the business operations to the new operation when the new operator obtains its license to operate the Facility.” Based on the facts of this notice, OHCA ultimately decided to waive the CMIR.
OHCA recently entertained its second MCN filing[1]. Unlike the first filing, this transaction contemplated the sale of a business, Invitae Corporation, a biotechnology company that provides genetic testing services. Invitae Corporation filed for Chapter 11 bankruptcy, and the bankruptcy court approved the sale of Invitae Corporation’s assets to Laboratory Corporation of America Holdings, a national provider of clinical laboratory services. The second MCN filing was deemed completed on June 5, 2024.
This latest MCN filing described the transaction as “an asset sale, through which LabCorp Genetics, Inc., a newly formed entity, will acquire certain assets of Invitae Corporation in accordance with the negotiated Asset Purchase Agreement and certain requirements under the bankruptcy code.” The goal of the transaction was described as “for Invitae to sell its assets to pay its creditors and settle its executory debts, while maintaining patient access to Invitae’s services.”
OHCA concluded its review by waiving the CMIR. A few of the details in this notice that may have helped OHCA reach this conclusion include the following:
Each MCN filing is significant because it provides guidance on how OHCA will interpret and enforce the relatively new CMIR Regulations. California healthcare entities will benefit from closely reviewing each MCN filing and as more filings are made, we will gain a better understanding of the process.
Wilke Fleury is extremely proud that several of its incredible attorneys have been selected as 2024 Northern California Super Lawyers or Rising Stars! Super Lawyers rates attorneys in each state using a patented selection process and publishes a yearly magazine issue that produces award-winning features on selected attorneys. Congratulations to this talented group:
2024 Super Lawyers:
2024 Rising Stars:
Check out the full profile on Trevor by following this link: https://online.fliphtml5.com/yzguw/lraj/#p=10
By: Jizell K. Lopez
On September 30, 2023, Governor Gavin Newsom signed California Senate Bill 553 (“SB 553”) into law. Among other things, SB 553 added section 6401.9 to the California Labor Code, which requires that virtually all employers, implement a workplace violence prevention plan by no later than July 1, 2024.
The California Occupational Safety and Health Act of 1973 (“Cal-OSHA”) already imposes many safety-related obligations on employers, including the requirement that they establish, implement, and maintain an effective injury and illness prevention program (“IIPP”). SB 553, which is the first law of its kind in the nation, now requires that employers in non-healthcare settings take additional steps to address the specific threat of workplace violence. As mentioned above, this new law covers virtually all employers. However there are some exceptions, including: places of employments with fewer than 10 employees—these locations must not be accessible to the public; teleworking employees; healthcare facilities already covered by Cal/OSHA’s Workplace Violence in Healthcare Standards; law enforcement agencies; and certain public entity employers.
Starting July 1, 2024, covered employers must establish, implement, and maintain a Workplace Violence Prevention Plan and must meet four broad categories of obligations: (1) the creation of a workplace violence prevention plan; (2) the creation of a workplace violence incident log; (3) employee training requirements; and (4) recordkeeping requirements.
Creating a Workplace Violence Prevention Plan
The intention of this violence prevention program is to provide a roadmap to both employees and employers to address actual and potential incidents of workplace violence. By July 1st, employees and employers should be able to identify and mitigate against workplace violence incidents or threats. Labor Code section 6401.9 defines “workplace violence” as any action of violence or threat (excluding lawful acts of self-defense and defense of others) that occurs at a worksite. The Labor Code further provides definitions for four types of “workplace violence” that employers must be able to recognize and identify in its incident log and train employees to recognize these specific types of workplace violence:
For convenience, Cal-OSHA has released a model Workplace Violence Prevention Program for employers to use. This can be found directly on Cal-OSHA’s website.
Violent Incident Log Requirements
Employers must document and maintain a log of all incidents of workplace violence, even if the incident did not result in an injury. The log record must be based on information solicited from the employees who experienced the workplace violence, witness statements, and investigation findings. Further, the log must be anonymous and must be periodically reviewed.
The log must include the following information:
Employee Training
Employers must also provide employee training regarding the hazards specific to that employer’s workplace by July 1, 2024 and annually thereafter. The training must address all of the following:
Recordkeeping Requirements
Finally, employers must also comply with certain recordkeeping obligations and retention periods as follows:
Conclusion
California’s new Workplace Violence Prevention Program is a landmark initiative aimed at enhancing worker safety and reducing the risk of violence in the workplace. As the July 1, 2024, implementation date approaches, employers must prepare to comply with the new regulations by developing comprehensive and effective Workplace Prevention Plans. This proactive approach not only protects employees but also fosters a culture of safety and respect in California’s workplaces, setting a precedent for other states to follow.
On January 1, 2024, the federally enacted Corporate Transparency Act (“CTA”) came into effect. The CTA requires certain entities to disclose information regarding their beneficial owners to the Financial Crimes Enforcement Network by the end of the year. These reporting requirements seek to prevent private use of shell entities as a tool to facilitate money laundering and other financial crimes.
As the deadline quickly approaches, closely held businesses should examine their reporting requirements.
Who is required to report?
Reporting companies are corporations, limited liability companies, limited liability partnerships, and other similar entities created by, or registered to do business under, “the filing of document with a secretary of state or similar office under the law of a State or Indian Tribe.”[1] This definition includes non-profit corporations and trusts that have secretary of state filings.
What companies qualify for exemption?
The CTA provides several exemptions which generally cover entities already subject to other federal reporting requirements.[2]
Wilke Fleury LLP is delighted to announce the addition of its newest partner – Islam M. Ahmad. Mr. Ahmad is a talented addition to the firm’s leadership. He brings with him a wealth of experience, and is a forward-thinking leader who will be invaluable to the firm’s leadership. His practice focuses on real estate and business law with a specific focus on litigation and insurance coverage matters.
“We are incredibly excited to welcome Islam to the partnership. He is tireless in pursuit of our clients’ goals, and in doing so employs both creative legal tactics and common sense. He is an asset to our firm and his admission to the partnership is well-deserved,” said Steve Williamson, Managing Partner.
Wilke Fleury LLP is a thriving mid‐sized general practice law firm located in California’s capitol. Our attorneys offer broad expertise, creativity, and strong ties to local businesses, families, and individuals, making Wilke Fleury LLP one of the region’s most respected and long‐standing law firms. Our support of local charitable organizations, universities, law schools, political interests and the community reveals the character of the firm and our sincere commitment to the Sacramento region.
Wilke Fleury is excited to announce that it has promoted two associates to the position of Senior Counsel — Mena Arsalai and Jizell Lopez. Mena and Jizell have demonstrated professional excellence and contribute greatly to the firm’s multi-generational leadership.
“Promoting Mena and Jizell to Senior Counsel is a reflection of the skill and dedication they bring to the practice of law, and an acknowledgement of their value to the firm. They understand our clients’ needs and work incredibly hard to achieve their goals. We are fortunate to have them on our team, and I congratulate them both!” – Steve Williamson, Managing Partner.
Senior Counsel at Wilke Fleury have at least six years of experience delivering high-quality legal services, collaborate with partners on the development and management of key practice areas, and actively mentor junior lawyers.
Mena Arsalai‘s practice focuses on supporting health care providers in regulatory and transactional matters. She has experience in drafting purchase agreements and ancillary transaction documents, healthcare facility licensing, healthcare acquisitions, physician contracting, and compliance. Prior to joining Wilke Fleury, Mena was an associate attorney at a Sacramento-based boutique law firm specializing in health law, mergers and acquisitions, and securities law.
Jizell Lopez is a civil litigation defense attorney who primarily represents employers in federal and state court litigation and before administrative agencies regarding all manner of employment claims, including single-plaintiff lawsuits, class action lawsuits, and wage and hour representative lawsuits. Jizell’s practice includes regularly defending employers against allegations of harassment, discrimination, wrongful termination, retaliation, wage and hour non-compliance, and more. In addition to her litigation experience, Jizell regularly counsels employers regarding the full range of California employment law compliance and litigation prevention. A large part of her practice also includes negotiating and drafting employment agreements, separation and severance agreements, and working closely with employers to develop effective personnel policies. Prior to joining Wilke Fleury, Jizell has represented both employers and employees. This has allowed her to utilize unique perspectives when counseling and defending employers, particularly with the ever-changing nuances of California employment law. Jizell chose to focus her practice on labor and employment defense because even when employers have the best intentions, there are far too many instances that result in costly and time-consuming litigation that could have been prevented or mitigated.