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Payers, Plans, and Managed Care

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​AHLA's Payers, Plans, and Managed Care Practice Group (PPMC PG) keeps you up to date on all legal issues concerning health plans, insurers, third-party administrators, pharmacy benefit managers, and other hybrid organizations.

​PG Topical Library

Exclusive to PPMC PG members, this Library is a hub for AHLA content related to your practice area, including exclusive PG content and a selection of AHLA member and non-dues content.

News and Analysis

AHLA Articles

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.
AHLA On-Demand Education


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Educational Calls

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This web part is not available for non FBA zones.
This web part is not available for non FBA zones.
This web part is not available for non FBA zones.
This web part is not available for non FBA zones.
This web part is not available for non FBA zones.
This web part is not available for non FBA zones.

​Health Insurance Topical Community

Join the conversation! This Community discusses issues related to the operation and regulation of health maintenance organizations, managed care payers, and employee health benefit plans, including related liability, health insurance, and payment issues. PPMC PG members are automatically enrolled in this Community.

​PPMC PG Affinity Groups

The Health Plan Affinity Group provides, obtains, and facilitates information exchange and best practices among lawyers who represent health plans or who work at health plans, and focuses on the unique issues these lawyers face.

The Medicare Advantage and Part D Affinity Group focuses on issues related to the two major programs providing private health plan options to Medicare beneficiaries.

All publications and resources produced by these Affinity Groups are available in the PPMC PG Topical Library. To enroll, complete and return the enrollment form or call AHLA's Member Service Center at (202) 833-1100, prompt #2.

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 Educational Calls

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