News & Analysis as of

Managed Care Contracts

Manatt, Phelps & Phillips, LLP

Community Reinvestment: Forging New Partnerships in Medicaid

At least 10 states have implemented, or are in the process of implementing, a community reinvestment requirement in which Medicaid managed care organizations (MCOs) are required to reinvest in the communities they serve to...more

Health Care Compliance Association (HCCA)

[Event] Managed Care Compliance Conference - February 3rd - 4th, Scottsdale, AZ

Focused education for compliance professionals in the managed care space - If your role involves compliance for a health plan provider, don’t miss our annual education and networking opportunity devoted specifically to...more

Manatt, Phelps & Phillips, LLP

New Guidance on Family Planning in Medicaid: Takeaways for States, Plans, and Providers

For states, managed care organizations, and providers—who all play a vital role in ensuring access to family planning services and supplies for the nearly 20 million women ages 18-44 enrolled in Medicaid1—the CIB reiterates...more

ArentFox Schiff

Sovereign Immunity in Managed Care Litigation: Federal Court Rejects Bid by State Plan Administrator to Dismiss Provider Suit

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On July 19, the US District Court for the Northern District of Texas denied a motion to dismiss Blue Cross Blue Shield of Texas (BCBSTX), which claimed sovereign immunity in a suit brought by a group of providers. In so...more

Holland & Knight LLP

Fiscal Intermediaries Sue NYDOH Over CDPAP Reimbursement Changes

Holland & Knight LLP on

A group of fiscal intermediaries (FIs) on July 22, 2024, filed a lawsuit against the New York State Department of Health (DOH) and its commissioner, Dr. James McDonald, alleging that the defendants disregarded established...more

Bass, Berry & Sims PLC

Healthcare Trends & Transactions Q2 2024

Bass, Berry & Sims PLC on

Deal volume across the healthcare industry generally appears to have steadied despite headwinds. The general sentiment is that buyers have adapted to the current interest rates and are gritting their teeth and pressing...more

Foley & Lardner LLP

Medicaid: CMS Final Rules Aim to Expand Access, Provide Parity with Commercial Markets

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS) published two significant updates to its Medicaid regulations on May 10, 2024. The two Final Rules, a Medicaid Access Rule and a Medicaid Managed Care Rule, impose new...more

McDermott+

It’s Raining Regs: CMS Releases Major Laboratory-Developed Test Reg in Midst of Massive Reg Storm

McDermott+ on

Over the last several weeks, the Biden administration has released numerous final regulations in order to “beat the clock” before it ticks down to the Congressional Review Act (CRA) deadline. The CRA authorizes Congress to...more

Sheppard Mullin Richter & Hampton LLP

The Intersection of Artificial Intelligence and Utilization Review

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the California Medical...more

Sheppard Mullin Richter & Hampton LLP

CMS Issues Final Rule on Medicaid and CHIP Managed Care Access, Finance, and Quality

On April 22, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule (CMS-2439-F), effective July 9, 2024, aimed at advancing healthcare access,...more

Hogan Lovells

CMS finalizes new standards and reporting obligations affecting Medicaid and CHIP managed care plans

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On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality Final Rule and the Ensuring Access to...more

Manatt, Phelps & Phillips, LLP

CMS Finalizes Sweeping Regulations for Medicaid Access, Managed Care, and HCBS

On Monday, April 22, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated final rules. Together, these rules reshape the federal regulatory landscape for Medicaid and the Children’s Health...more

McDermott+

CMS Finalizes Major Reforms to Medicaid, Part 2: Medicaid Managed Care Reg

McDermott+ on

Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more

McDermott+

Policy Update - CMS Releases Final Rule: Medicaid and CHIP Managed Care Access, Finance, and Quality

McDermott+ on

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality final rule. CMS finalized several substantial...more

Blank Rome LLP

Structuring and Maintaining Value-based Care Arrangements

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Episode 5: Structuring and Maintaining Value-based Care Arrangements - In this episode of BRight Minds in Healthcare Delivery, Blank Rome partner Barak A. Bassman joins host Eric Tower to talk about how to legally and...more

Rivkin Radler LLP

[Webinar] Healthcare Compliance Lunch & Learn Series: Defending Provider Audits - April 11th, 12:00 pm - 1:00 pm ET

Rivkin Radler LLP on

On Thursday, April 11, the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, will be presented by Rivkin Radler attorneys, Bob Hussar, Chris Kutner and Mary Aperance. The program, “Defending...more

Sheppard Mullin Richter & Hampton LLP

OIG Sparks Public Excitement about Managed Care and Alludes to Incoming Enforcement Guidance

“The American people deserve to know that the insurance companies receiving more than $700B annually in taxpayer funds are working to ensure you receive effective, high-quality care. Remember, you have rights and options to...more

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

Manatt, Phelps & Phillips, LLP

[Webinar] Bridging Public Health and Managed Care: A Collaborative Approach to Community Health Assessments - March 21st, 1:00 pm...

In the United States, public health and health care delivery have largely taken different and siloed approaches, with health care focused on the treatment of individuals and public health centered on the total population...more

Foley Hoag LLP

CMS Releases Request for Information on Medicare Advantage Data

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On January 30, 2024, CMS published in the Federal Register an RFI to seek input from the public regarding increased public releases of MA data to improve transparency in the program. CMS stated responses to this RFI may be...more

McDermott+

Regs During an Election Year: What’s on the Menu?

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Last week, McDermott+Consulting launched an election 2024 resource page, where you can find a 2024 health policy outlook and other insights into the November election. While regulations aren’t necessarily top-of-mind when...more

McDermott+

Looking Forward: Top Policy Areas for 2024

McDermott+ on

Happy New Year! As we enter 2024, we want to lay out some of the main regulatory issues (both new and old) that McDermott+Consulting will be tracking over the next year. While these may evolve, we think they are still...more

Manatt, Phelps & Phillips, LLP

MA Issues New Insurance Regulation on Provider Directories, Telehealth & Behavioral Health Parity

On November 24, the Massachusetts Division of Insurance (DOI) published revisions to its managed care consumer protection regulation, including new requirements related to health care provider directories, telehealth and...more

Sheppard Mullin Richter & Hampton LLP

CMS Promotes Competition, Transparency, Health Equity and More in the CY2025 Medicare Advantage and Part D Proposed Rule

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). The Proposed...more

McDermott Will & Emery

CMS Proposes to Prohibit Overrides in Medicare Advantage

McDermott Will & Emery on

On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding Contract Year (CY) 2025 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug...more

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