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
December 2024
TDI Releases Balance Billing Biennial Report.
TDI has released its Balance Billing Report as required under SB 1264. The report provides data for calendar years 2020-2023. It includes a wealth of information about the out-of-network billing dispute resolution process TDI manages in relation to certain out-of-network services billed under commercial fully-insured health insurance and HMO plans in Texas. Notably, TDI has to date received over one million requests for arbitration or mediation through the IDR portal, including over 500,000 requests in 2023 alone. The report also highlights trends in in-network participation among several provider types.
Fall 2024
HHSC MCO Policy and Operational Changes Improvement Project
Responding to concerns expressed by numerous Medicaid MCOs and trade associations, HHSC has created a workgroup to evaluate its policy and operational change processes and develop recommendations. It is currently seeking MCO input. Items under discussion include reduced frequency and a more regular cadence for policy and operational changes and prospective, not retrospective, reimbursement adjustments.
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.
FFa
Upcoming Reporting Deadlines:
-
Gag Clause Prohibition Compliance Attestation (CMS) -- due December 31