The Law Office of Susan M. Erickson, PLLC
Based in Austin, Texas, The Law Office of Susan M. Erickson provides high-quality legal services in the areas of managed care, Medicaid managed care, Medicare Advantage plans, health insurance regulatory and general health law.
THE FIRM
The Firm
Susan M. Erickson opened the firm in 2015 in Austin, Texas, to provide legal services in such areas as managed care and health insurance regulatory matters, Medicaid managed care, Medicare Advantage plans, and general health care law. Ms. Erickson has nearly 30 years of experience in these areas, gained during many years of practice with the insurance regulatory group of a major international law firm and as in-house general counsel to Texas' largest Medicaid managed care organization. She also spent time as in-house counsel to one of the leading digital health, AI-enabled value-based care companies, where she was lead counsel in drafting and negotiating innovative value-based care contracts with a range of commercial and government-sponsored payors.
CONTACT US
Tel: 512-762-5852
Fax: 512-_________
106 Dove Tail Ln.
Georgetown, TX 78628
Practice Areas
Health Insurance and Health Plan Regulatory and Transactional Matters
Medicaid Managed Care Law
Medicare Advantage Plans
General Health Care Law
News
March 29, 2024
TDI Delays Enforcement Date for PPO Network Adequacy Filings.
TDI issued a Bulletin on 3/28/24 notifying insurers of a one-month extension, until May 1, 2024, to submit the 2024 PPO/EPO network adequacy reports. The report format and adequacy standards have changed significantly since passage of HB 3359 during the 88th Legislature, 2023. TDI has proposed, but not yet adopted, rules to implement the statute, including the new waiver request and public hearing process. A copy of the proposed rules may be found here.
January 2024
CMS Issues Interoperability and Prior Authorization Final Rule.
On January 17, 2024, CMS issued a Final Rule that is intended to improve prior authorization processes and patient, provider, and payer communications through access to interoperable patient data. The Final Rule requires payers to implement several application programming interfaces by 2027. The Final Rule also shortens the timeframes within which payers must respond to standard and expedited prior authorization requests. It applies to Medicare Advantage plans, Medicaid and CHIP managed care plans, and QHPs offered on federally-facilitated exchanges.
TMarch 2024
TDI Reminds Providers and Carriers to Submit Notification of Catastrophic Event Impacting Claims
Health care providers and carriers impacted by the Change Healthcare cybersecurity event are reminded to submit written notification to the Department of any anticipated inability to comply with claims submission or adjudication and payment deadlines under the prompt payment rules. TDI has posted guidance on the notification process on the Prompt Payment page of its website.
Upcoming Reporting Deadlines:
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Prescription Drug Data Collection Report (CMS) -- due June 1
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Texas TPA Annual Report (TDI) -- due June 30