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WolfePack Wisdom

A comprehensive legal resource page with original commentary and key takeaways on critical topics impacting our clients industries.

The Affordable Care Act – What is at stake?

The U.S. Supreme Court’s decision in California v. Texas poses a threat to the healthcare system as millions of Americans could lose health insurance coverage if the Affordable Care Act (the “ACA”) is struck down.  The main issues before the Court are as follows:  Does the coalition of states led by Texas have standing to

Substance Use Disorder Services Level of Care Disputes

Substance use disorder (“SUD”) services are generally performed on a continuum of care, as defined by the American Society of Addiction Medicine (“ASAM”). The five broad levels of care, from least to most intensive, are Early Intervention, Outpatient Services, Intensive Outpatient (“IOP”/Partial Hospitalization Services (“PHP”), Residential/Inpatient Services, and Medically Managed Intensive Inpatient Services.   Performing services

Reference-Based Pricing

Payors are using reference-based pricing (“RBP”) to cut health plan costs, saying goodbye to traditional participating provider (“PPO”) networks.  Reference-based pricing is a healthcare cost containment model that limits what a payor will pay a provider for healthcare goods and services. Most insurers these days use RBP for certain out-of-network benefits. However, this becomes problematic