Payers, Plans, and Managed Care

• Navigating Indemnification Obligations in a Health Care Transaction: Managing Health Care Liability (AHLA Connections, November 2018)
  
  
• A New Look at Medicare Advantage: What Lawyers Need to Know to Advise or Contract with Medicare Advantage Plans Now (Journal of Health & Life Sciences Law, October 2018)
  
  
• UnitedHealth and the Medicare Advantage 60-Day Rule and What It Means for Traditional Medicare's 60-Day Overpayment Rule (AHLA Weekly, September 28, 2018)
  
  
• Managing Care in the Midst of a Natural Disaster: The Role of Public and Private Health Plans in Response and Recovery (AHLA Connections, July 2018)
  
  
• Exchanging Information in the Health Care Sector: A Guide to Managing Antitrust Risk (Journal of Health & Life Sciences Law, February 2018)

Education and Resources

• Planning for Health: A Health Plan Emergency Preparedness Checklist
  - PG Toolkit: Published on May 28, 2019
  This Toolkit features a handy checklist intended to provide health plans, including managed care plans, with a framework for developing and strengthening emergency preparedness plans to adequately prepare for both natural and man-made disasters. The checklist gives tips on coordinating with federal, state, tribal, regional, and local emergency preparedness systems and focuses on several key areas.
  
  
• Managed Care Contracting Toolkit 
  - PG Toolkit: Last updated on February 28, 2019
  This Toolkit is organized in the order of a typical managed care contract and outlines general principles that should be considered when negotiating contract provisions as a Provider or Managed Care Organization (MCO). Where applicable and unambiguous, sample contract language has been marked as either MCO- or provider-friendly, or neutral. Important principles have been listed at the beginning of each section to provide a roadmap and some general thoughts for contracting parties.
  
  
• Practical Considerations for Analyzing Telemedicine and Telehealth Legal Issues
  - PG Toolkit: Published on September 21, 2017
  This Toolkit covers all of the basics and need-to-know legal issues affecting telemedicine and telehealth today.
  
  
• Pharmacy Maximum Allowable Cost (MAC) Laws: A 50 State Survey
  - PG Toolkit: Published on August 8, 2017
  This 50 state survey on pharmacy maximum allowable cost (MAC) laws summarizes the laws of each state regarding how they govern the way payers—including pharmacy benefit managers (PBMs)—can reimburse pharmacies for products dispensed to patients.
  
  
• HIPPA Authorization Checklist
  - PG Toolkit: Published on April 25, 2016
  In-house counsel, compliance personnel, health information professionals, and outside litigation counsel are sometimes tasked with reviewing an authorization for the release of medical records to determine whether the authorization is compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. This Toolkit provides a convenient practice tool that can be saved as a quick guide for reviewing authorizations for HIPAA compliance.
  
  
• HSAs, FSAs, LPFSAs, and HRAs—Keeping It All Straight!
  - PG Toolkit: Published on March 28, 2016
  High deductible health plans coupled with Health Savings Accounts and Health Reimbursement Arrangements are growing in popularity as health care costs continue to increase. Many employers also offer their employees Flexible Spending Arrangements and Limited Purpose Flexible Spending Arrangements. It can be difficult to keep track of the different acronyms and requirements that apply to each type of arrangement. This Toolkit provides a handy reference tool that can help keep them all straight.
  
  
• Factors to Consider When Thinking About Retaining Outside Counsel on a Compliance Matter
  - PG Toolkit: Published on February 3, 2016
  This Toolkit outlines the key considerations for when inside counsel should hire outside counsel to assist with a regulatory issue.