Robert Belfort

Robert Belfort

Manatt, Phelps & Phillips, LLP

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Manatt on Medicaid: CMS Revises Process for Determining MMC Payments

In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more

6/22/2016 - Actuarial Values CMS Health Care Providers Managed Care Contracts Medicaid Medicaid Reimbursements Payment Rates

Manatt on Medicaid: CMS Dramatically Expands Guidance on MMC Plan Payment

Editor's Note: This "Manatt on Medicaid" is the sixth in a series of updates focused on CMS's new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will continue to explore key provisions of the regulations...more

6/17/2016 - Affordable Care Act CHIP CMS Healthcare Costs Managed Care Contracts Medicaid Medical Loss Ratio Provider Payments

Legal Issues Associated with Multi-Provider Alternative Payment Model

Since the passage of the Affordable Care Act (ACA), both federal and state policies have promoted the adoption of alternative payment models (APMs), providing financial incentives for groups of providers to improve care...more

5/23/2016 - ACOs Alternative Payment Models (APM) Anti-Kickback Statute Antitrust Violations CHIP DOJ Fraud and Abuse FTC HHS Hospital Mergers Hospitals Medicare Medicare Access and CHIP Reauthorization (MACRA) Physicians Sherman Act Stark Law

Health Update - April 2016 #2

How to Prepare for "Phase Two" HIPAA Compliance Audits: Tips on Getting Ready for Scrutiny - Editor's Note: Now that the Department of Health and Human Services (HHS) has announced that it is beginning the next round of...more

4/27/2016 - Affordable Care Act HIPAA Audits Hospitals Joint Venture NIST OCR Single Entity Rule

Health Update - February 2016

Better Late Than Never: CMS Provides Much-Needed Clarity on the 60-Day Overpayment Refund Requirements - On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the long-awaited final rule (Final...more

2/26/2016 - 60-Day Rule ACOs Affordable Care Act Antitrust Violations Certificate of Need CMS Health IT Interstate Commerce Knox Keene License Agreements Look-Back Measurement Period Medicaid Medicare Shared Savings Program Overpayment Recovery Time Limits Risk Allocation Telehealth

Health Update - December 2015

Lessons from Hawaii's Trailblazing ACA 1332 Waiver Proposal - Editor's Note: On September 9, Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's proposal focuses on the...more

12/22/2015 - Affordable Care Act CMS Contraceptive Coverage Mandate HHS Hospital Mergers IRS Long-Term Care Medicare Medicare Part B OIG Prescription Drugs Public Health Insurance Marketplace Religious Freedom SCOTUS Section 340B Split of Authority Stark Law Waivers

Medicaid Managed Care: What’s Ahead in 2015

Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more

3/3/2015 - Affordable Care Act CMS Healthcare Healthcare Reform Managed Care Contracts Medicaid Medicaid Expansion

Compliance Corner: Long-Term Care and the OIG Work Plan: As HHS Sharpens its Focus, Providers Should Set Their Sights on...

In the fall of 2014, the Department of Health and Human Services Office of Inspector General released its 2015 Work Plan, which highlighted HHS’s compliance focus areas in the upcoming year. As in past years, areas of...more

2/10/2015 - Compliance HHS Long Term Care Facilities Long-Term Care Medicaid Medicare OIG

Health Update - January 2015

Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk - Editor’s note: At the request of 23 public and private sector sponsors—including major life sciences companies, as well as U.S. and international...more

1/29/2015 - Clinical Trials Data-Sharing Healthcare Life Sciences Risk Assessment Risk Management

Health Update - September 2014

Engaging Patients While Addressing Their Privacy Concerns: The Experience of Project HealthDesign - Patients are using the Internet, personal health records (PHRs) and mobile applications or “apps” to collect and...more

9/24/2014 - EHR Healthcare Healthcare Reform Medical Devices Mobile Apps PHI Technology Telemedicine

Health Update - July 2014

Avoiding the Regulatory Land Mines of Commercial ACOs - While providers are showing great interest in creating ACOs to participate in the Medicare Shared Savings Program (MSSP), they are showing even greater enthusiasm...more

7/23/2014 - ACOs EHR Halifax Hospital Health Insurance Healthcare HIPAA Medicare Medicare Shared Savings Program Regulatory Standards Reporting Requirements Social Networks Stark Law

Health Update - May 2014

Litigation Arising from the Affordable Care Act: The Blessing and Curse of Interesting Times - The Affordable Care Act (ACA) has brought the most sweeping changes to the healthcare delivery and payment systems in the...more

5/22/2014 - Affordable Care Act CMS Data Breach Data Protection EHR Healthcare Healthcare Reform HIPAA Medicare PHI

Health Update - Feb 25, 2014

Integrating Physical and Behavioral Health: Strategies for Overcoming Legal Barriers to Health Information Exchange - A growing number of Medicaid officials believe that coordinating care across the physical and...more

2/26/2014 - Affordable Care Act CLIA Data-Sharing Eligibility Final Rules FTC Healthcare HHS HIPAA Hospital Mergers Medicaid Medical Records

Health Update - Jan 27, 2014

Going Digital with Patients: Managing Potential Liability Risks of Patient-Generated Electronic Health Information - Patients are increasingly using new electronic tools, such as personal health records and mobile...more

1/27/2014 - Affordable Care Act Cybersecurity Data Breach Data Protection EHR Health Insurance Exchanges Healthcare PHI Professional Liability

Final Mental Health Parity Rules Clarify Requirements Regarding Treatment Limitations and Plan Disclosure Obligations

On November 8, 2013, over three years after issuing interim final regulations, the Obama administration released final rules implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of...more

11/13/2013 - Healthcare MHPAEA Substance Abuse

Little Harm, Big Damages: AvMed Settlement Could Change the Landscape for Privacy Breach Class Actions

On October 21, Florida-based health insurer AvMed, Inc. (AvMed) settled a data breach class action lawsuit for $3 million, even though no plaintiffs in the class demonstrated that they had suffered identity theft or any other...more

11/13/2013 - Damages Data Breach Data Protection Identity Theft Invasion of Privacy Personally Identifiable Information PHI Settlement

CMS Creates Clarity and Confusion on Application of Fraud and Abuse Laws to Qualified Health Plans

On October 30, 2013, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to U.S. Representative Jim McDermott stating that HHS does not consider qualified health plans (QHPs) sold...more

11/13/2013 - Affordable Care Act Anti-Kickback Statute CMS Fraud and Abuse HHS Qualified Health Plans

HIPAA Omnibus Rule Reshapes Landscape for Health Care Privacy, Security Compliance

Originally published in Health IT Law & Industry Report, on January 23, 2013. On Jan. 17, 2013, the Office for Civil Rights of the U.S. Department of Health and Human Services (‘‘HHS’’) issued a long-awaited omnibus rule...more

1/25/2013 - Business Associates Data Protection Electronic Medical Records HHS HIPAA HIPAA Omnibus Rule HITECH Medical Records Patient Privacy Rights PHI

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