Author
Ronald T. Luke, JD, PhD
Ronald T. Luke, JD, PhDPresident

On January 29, 2021, RPC filed an amicus curiae brief with the Texas Supreme Court on the case In re K&L Auto Crushers, LLC. A copy of the brief is available here. The Court has already heard oral arguments on the case. Many briefs from the parties and amici can be found on the Court’s website. P.M. Schenkkan and Matthew Baumgartner with Graves Dougherty Hearon & Moody, PC, are counsel to RPC.

Research and Planning Consultants, LP (RPC) also submitted amicus briefs on healthcare payments in In re North Cypress Med. Ctr. Operating Co., 559 S.W.3d 128 (Tex. 2018). RPC filed this amicus brief to discuss two new and important federal laws: (1) CMS’s Price Transparency Rule, which requires hospitals to disclose payments from all sources, including in-network contracts, and (2) the No Surprises Act, included in the stimulus legislation signed into law on December 27, 2020, which regulates out-of-network payments to hospitals and professionals based on the median of the payor’s in-network contract prices.

RPC filed the amicus brief to show the Court:

  1. The new federal laws focus on network rates between insurers and providers, which have often occasioned trade secret disputes. As to hospitals, CMS’s Price Transparency Rule makes these negotiated rates public, greatly weakening any argument for trade secret protection.
  2. Both new federal laws underscore the importance of knowing network rates in resolving payment disputes. This is especially important as to healthcare services provided under letters of protection in personal injury cases, for two reasons:

(a) No public database in Texas publishes the negotiated rates of commercial insurers and employer-sponsored (ERISA) plans by provider for all services;

(b) No public database in Texas publishes the negotiated rates of Medicare and Medicaid managed care organizations by provider for all services.

It is particularly important in this case to require the hospital to disclose its network payment rates and its acquisition cost for surgical implants. Its charges for implants account for most of its total charges, and the hospital’s mark-up over the cost of the implants it bought from a vendor is likely to be unreasonable.

View RPC’s Amicus Brief here