J. Peter Rich

J. Peter Rich

McDermott Will & Emery

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Medicaid Managed Care Update: Program Integrity Proposals Include Mandatory Reporting of Overpayments by Medicaid Managed Care...

CMS seeks to impose more rigorous program integrity requirements for contractors and states. This article is part of a series that takes an in-depth look at several proposals that would affect managed care organizations,...more

6/18/2015 - CMS False Claims Act Health Care Providers Managed Care Contracts Medicaid Overpayment

Medicaid Managed Care Update: CMS Proposes a National Medicaid MLR Standard

States would have the option to create binding Medicaid MLR requirements modeled after existing commercial market MLR standards. This article is part of a series that takes an in-depth look at several proposals that...more

6/11/2015 - CMS Health Care Providers Managed Care Contracts Medicaid Medical Loss Ratio

Medicaid Managed Care Update: CMS Proposes Broad-Reaching Reforms to Modernize Medicaid Managed Care

The proposals strive to balance increased federal government oversight and administration with continued recognition of, and flexibility for, state managed care programs. This is the first article in a series that takes...more

6/11/2015 - CHIP CMS Health Care Providers Healthcare Managed Care Contracts Medicaid Medical Loss Ratio

Challenges Facing “Narrow” Provider Networks on the ACA Health Care Insurance Exchanges

In This Issue: - The Driving Forces Behind the Trend Toward Narrower Networks - The Trade-Off - Regulatory, Legislative and Litigatious Responses to Narrower Networks Across the Nation - Judicial and CMS...more

4/21/2015 - Affordable Care Act Health Insurance Health Insurance Exchanges Legislative Agendas Medicare Qualified Health Plans

Sharp Questions Dominate Supreme Court Oral Arguments Regarding the Challenge to the Availability of ACA Premium Tax Credits

On March 4, 2015, the Supreme Court of the United States heard oral arguments in King v. Burwell, the highest profile challenge to the Affordable Care Act (ACA) since the Supreme Court’s 2012 decision to uphold the law. The...more

3/10/2015 - Affordable Care Act Health Insurance Health Insurance Exchanges King v Burwell Oral Argument Popular SCOTUS Tax Credits

CMS ACO Proposed Rule to Extend One-Sided Risk Track While Incentivizing Performance-Based Risk

On December 1, 2014, the U.S. Centers for Medicare & Medicaid Services (CMS) released a 429-page Proposed Rule setting forth significant changes that will affect the evolution of the Medicare Shared Savings Program (MSSP) and...more

12/22/2014 - ACOs CMS Healthcare Medicare Shared Savings Program Proposed Regulation

Full D.C. Circuit to Rehear ACA Premium Tax Credit Case

The full U.S. Court of Appeals for the D.C. Circuit has vacated the 2-1 panel decision issued July 22, 2014, in Halbig v. Burwell, which struck down the Internal Revenue Service (IRS) Rule providing for Affordable Care Act...more

9/5/2014 - Affordable Care Act Appeals Halbig v Burwell Health Insurance Exchanges IRS SCOTUS Tax Credits

U.S. Appeals Courts Issue Conflicting Decisions on Whether ACA Permits Tax Subsidies of Health Care Coverage Purchased Through...

On July 22, 2014, three-judge panels of the U.S. Courts of Appeals for the District of Columbia and Fourth Circuits issued conflicting decisions regarding whether the Affordable Care Act (ACA) permits federal tax credits for...more

7/25/2014 - Affordable Care Act Halbig v Burwell Healthcare IRS King v Burwell Subsidies Tax Credits

The Assault on the ACA Continues in the Federal Appeals Courts

Combative oral arguments were seen in two high profile federal court challenges to the Patient Protection and Affordable Care Act of 2010 (ACA). The Supreme Court of the United States heard a vigorous oral argument...more

4/10/2014 - Affordable Care Act Healthcare Healthcare Reform Tax Credits

Feds’ Argument in Favor of Premium Tax Credit Gains Momentum, Still Under Attack in Federal Courts

A second federal district court judge has ruled in favor of the government on one of the most serious challenges to the Patient Protection and Affordable Care Act of 2010 (ACA). The court dismissed a challenge to the...more

2/27/2014 - Affordable Care Act Healthcare Healthcare Reform Premiums Tax Credits

Federal Judge Permits ACA Premium Tax Credits in States with Federally Facilitated Exchanges

A federal district court judge has ruled in favor of the government on one of the most serious challenges to the Patient Protection and Affordable Care Act of 2010 (ACA). The court rejected a challenge to the availability of...more

1/24/2014 - Affordable Care Act Healthcare Healthcare Reform Tax Credits

Court Challenges Threaten ACA Premium Tax Credits in State with Federal Facilitated Exchanges

Two federal district court judges will likely rule in early 2014 on pending challenges to the availability of premium tax credits under the Patient Protection and Affordable Care Act of 2010 (ACA). The plaintiffs in both...more

1/3/2014 - Affordable Care Act Health Insurance Exchanges Healthcare IRS Tax Credits

CMS Announces Participants in Bundled Payment Initiative

The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced the health care organizations chosen to participate in the Bundled Payments for Care Improvement (BCPI) Initiative. The BCPI Initiative represents a...more

2/7/2013 - BPCI Bundled Payments CMS Fee-for-Service Healthcare Medicaid Medicare

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