News & Analysis as of

Managed Care Contracts

The Broadest Impact:  2018-19 New York State Managed Care Budget Highlights

by Farrell Fritz, P.C. on

This, the last of our posts on the 2018-19 New York State Health Budget (the “Enacted Budget”), focuses on an area of healthcare that has perhaps the broadest impact of the sector as a whole — managed care. ...more

A Renewed Focus: 2018-19 New York State Intellectual and Developmental Disabilities Budget Highlights

by Farrell Fritz, P.C. on

Since the beginning of the administration of Governor Andrew Cuomo, there has been a strong emphasis on reform of the acute, primary, and long term care systems, and, particularly with the recent focus on the opioid crisis,...more

2018-19 New York State Healthcare Budget

by Farrell Fritz, P.C. on

In the wee hours of the morning on March 30, almost two days ahead of the April 1 deadline, the Legislature passed and the Governor signed a $168.3 billion State Budget for the 2018-19 fiscal year. ...more

Healthcare Fraud & Abuse Review 2017

by Bass, Berry & Sims PLC on

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Government Survives Dismissal of Remaining FCA Claims in Managed Care Case

by Bass, Berry & Sims PLC on

In U.S. ex rel. Poehling v. UnitedHealth Group, Inc., the U.S. District Court for the Central District of California partially granted UnitedHealth’s motion to dismiss the government’s FCA claims, which were based on the...more

Manatt on Medicaid: 10 Trends to Watch in 2018

Medicaid has entered a period of volatile change, unprecedented in its 51-year history. With 74 million members nationwide,1 Medicaid provides health coverage to more than one in four Americans, ensuring access to...more

[Event] 4th Annual West Coast Ambulatory Surgery Center Seminar - March 7th, Los Angeles, CA

by Nossaman LLP on

Please join Nossaman LLP and the California Ambulatory Surgery Association (CASA) on Wednesday, March 7, 2018 for the 4th Annual West Coast Ambulatory Surgery Center Seminar in Los Angeles. During this one-day program,...more

Abrupt Closure of SynerMed Shakes Up Medical Management Industry

by Nossaman LLP on

SynerMed, a Southern California-based physician management company, will be shutting down, per an email from its CEO earlier this month. Recently, the company had come under increasing scrutiny by health plans and California...more

Payor Approaches to Cost Concerns: Considerations for Provider Contracting and Revenue Cycle

by Pierce Atwood LLP on

Hospitals and health systems face ongoing pressure to migrate away from fee-for-service models, reduce costs, and improve quality. From MACRA to commercial risk arrangements to self-insured employer cost containment models,...more

OIG Work Plan – September 2017 Update

by Baker Ober Health Law on

Beginning in June 2017, the OIG began making monthly Work Plan updates. These monthly updates create some practical challenges for health care providers and compliance professionals trying to make operational and compliance...more

The Rise of Managed Care Audits and Reimbursement Demands in the Wake of the ACA

If the summer of 2017 demonstrated anything, it is that health care remains a complex and contentious industry. One of its many complications stems from the natural tension between health care providers and health care...more

SuperVision - Labor & Employment Law Insights - September 2017

...This issue of SuperVision is dedicated to questions our friends and clients may have regarding insurance and benefit topics. While not a common part of the Labor & Employment field, Spilman prides itself on having...more

In Removing HSD Tables From Applications, CMS Opens the Door to Medicare Advantage Growth

by Faegre Baker Daniels on

Recently, the Centers for Medicare & Medicaid Services (CMS) released its draft 2019 Medicare Advantage application. Health plans seeking to participate in the Medicare Advantage (MA) program for the first time or expanding...more

Beware of TennCare Reimbursement and Prescribing Issues - TennCare Completes Implementation of the ACA's Medicaid Registration...

Due to recent TennCare changes, health care providers not registered with TennCare should consider registering to avoid issues in prescribing for TennCare patients and to preserve TennCare revenue. ...more

New Jersey’s Telemedicine Law: What Providers Need to Know

by Foley & Lardner LLP on

New Jersey has a new telemedicine law, recently signed by Governor Chris Christie. The law cements the validity of telehealth services in the Garden State, establishes telemedicine practice standards, and imposes telehealth...more

State Releases Medicaid Managed Care Invitation to Negotiate

Last Friday, July 14, 2017, the Florida Agency for Health Care Administration (AHCA) released its long awaited Invitation to Negotiate (ITN) for State Wide Medicaid Managed Care services. The ITN, one for each of the 11...more

STATE BUDGET UPDATE: In A Historic Move, House Votes To Override 11 of the Governor's Vetoes From State Budget

by Roetzel & Andress on

The last time the Legislature voted to override multiple state budget vetoes was exactly forty (40) years ago to this day on July 6, 1977 under then Governor James Rhodes (R) and former longtime House Speaker Vern Riffe (D)....more

Antitrust Challenge to Narrow Network Products – 7th Circuit Rules in Favor of Exclusive Agreement

by Ruder Ware on

The health care market has recently seen a resurgence in narrow network products. To a significant degree, the resurgence of these products has been driven by the need for managed care plans looking for new avenues to help...more

IRS Guidelines Provide Greater Flexibility to Nonprofit Borrowers

by Polsinelli on

New guidelines from the Internal Revenue Service substantially overhaul safe harbors that have existed for 20 years. Specifically, the IRS recently released Revenue Procedure 2017-13 (“Rev. Proc. 2017-13”), which establishes...more

Healthcare Fraud and Abuse Review 2016

by Bass, Berry & Sims PLC on

Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare...more

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

Participating in New York's CDPAP Is Necessary to Maintain Your Caseload

by FordHarrison on

Radio, newspaper, and subway ads are driving Medicaid home care clients and home care workers to abandon traditional home care agency programs for the greater flexibility and freedom of choice of New York’s Consumer Directed...more

IRS Issues New Guidelines for Qualified Management Contracts for Facilities Financed with Tax Exempt Bonds

by Dickinson Wright on

Health care providers with facilities financed with tax exempt bonds need to be aware of recent changes to the IRS rules for qualified management contracts. On August 22, 2016, the IRS issued Rev. Proc. 2016-44 which...more

Governor Kasich Releases $144 Billion State Budget Proposal - What You Need to Know

by Roetzel & Andress on

Yesterday, Governor Kasich released the executive version of the state’s two-year operating budget (Fiscal Years 2018-2019), which includes proposed spending of over $144 billion during the biennium. Similar to his previous...more

Texas OIG Turns Over New Leaf: MCOs Must Turn Attention to SIUs

by Strasburger & Price, LLP on

More active SIUs may mean more scrutiny of Medicaid providers - The Texas Office of Inspector General (OIG) has just completed its first full year of reforms under a new Inspector General. 2017 may reveal whether these...more

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