Payers, Providers, and Patients – Oh My!

Reflecting on the First Year of the 2020 Stark & AKS Regulations

In this episode, hosts Payal Nanavati and Joe Records talk to Troy Barsky and Roma Sharma about their reflections on the first year of implementation of new regulations implementing the major fraud and abuse statutes — the Stark Law and Anti-Kickback Statute (AKS) — including discussing challenges, opportunities, and outstanding questions about the new exceptions and safe harbors for value-based care.

 

For more information please see:

• "CMS Issues Sweeping Reform to Modernize the Stark Law: Part I," Health Care Alert (November 30, 2020). Contacts: Troy A. Barsky, John T. Brennan Jr., Lidia Niecko-Najjum, Roma Sharma.
• "OIG Issues Final Rule to Update AKS Safe Harbors: Part II," Administrative Law Alert (February 25, 2021). Contacts: Troy A. Barsky, Jodi G. Daniel, Michael Shaheen, Lidia Niecko-Najjum, Joe Records, Matthew Vicinanzo.

 

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

The New World of Health Data Interoperability

In this episode, hosts Payal Nanavati and Joe Records talk to Jodi Daniel and Savanna Williams about the latest developments in interoperability, including challenges of implementing recent CMS and ONC regulations and expectations about potential enforcement of these rules. 

For more information please see:

• "HHS Finalizes Sweeping Regulations on Interoperability of Health Information and Information Blocking" 
• "Balancing The New Interoperability Rules With Existing Privacy Laws: Challenges for Payers" 
• "CMS Expands on Patient Access and Interoperability Requirements for Health Plans" 

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

How Health Plans Can Address Social Determinants of Health

In this episode, hosts Payal Nanavati and Joe Records talk to Janet Walker and Mercy Care’s CEO, Lorry Bottrill about the ways in which the government and health plans are addressing the social determinants of health (SDOH), which are the conditions in which people are born, live, learn, work, play and age and they affect a wide range of health, functioning, and quality-of-life outcomes. 

 

Lorry has been a leader in Arizona’s health care community for more than 25 years.  In this episode, she shares recent examples of Mercy Care’s efforts to address SDOH through collaboration with the Arizona Health Care Cost Containment System (AHCCCS or “ACCESS”), Arizona’s Medicaid agency. 

 

For more information please see:

• Mercy Care
• CDC Notice of Funding Opportunity: Closing the Gap with Social Determinants of Health Accelerator Plans
• CMS Innovation Center Strategy Refresh
• AHCCCS Whole Person Care Initiative

 

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

You can follow Lorry Bottrill here.

Business and Clinical Considerations for the Ketamine Industry

In this episode, hosts Payal Nanavati and Joe Records talk to Lidia Niecko-Najjum and John Brennan about the legal issues that investors, providers, and innovators should be prepared to navigate when considering offering Ketamine-assisted treatment, including the federal and state laws and regulations related to the practice of medicine, licensure, and many other issues. 

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Recent Mental Health Parity Enforcement Activities

In this episode, host Payal Nanavati talks to Joe Records about recent enforcement activities under the Mental Health Parity and Addiction Equity Act (MHPAEA), including federal agencies’ requests for insurers to submit comparative analyses of their non-quantitative treatment limitations.  Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Materials discussed in this episode:

• H.R.133 - Consolidated Appropriations Act, 2021
• Department of Labor, Self-Compliance Tool
• "COVID Relief and Appropriations Legislation Includes Mental Health Parity Compliance and Oversight Requirements," Health Care Alert (December 23, 2020). Contacts: Michael W. Lieberman, Lauren R. Nunez, Joe Records.

The ACA Risk Corridors Case

In this episode, hosts Payal Nanavati and Joe Records talk to partner Steve McBrady, who led the Crowell & Moring team that represented Maine Community Health Options in the long running Affordable Care Act §1342 “risk corridors” litigation that ended with U.S. Supreme Court decision in favor of Maine and companion insurers. 

Materials discussed in this episode:

• Client Alert: Supreme Court Rules in Favor of Health Plans in Landmark $13 Billion Affordable Care Act Case
• Firm News: Maine Community Health Options Wins U.S. Supreme Court Ruling Enforcing Government Payment Obligation Under Affordable Care Act ‘Risk Corridor’ Cases

Data Analytics and FCA Investigations

In this episode, hosts Payal Nanavati and Joe Records talk to partner Michael Shaheen, who recently served as a Trial Attorney with the Fraud Section of the DOJ.  Michael sheds some light on what potential FCA targets can do to understand and rebut DOJ’s use of data analytics to pursue FCA investigations.

Rating in the Time of COVID

In this episode, hosts Payal Nanavati and Joe Records are joined by Xavier Baker and special guest Tim Murray, Director & Senior Consulting Actuary in Wakely Consulting Group’s New York office, to discuss the actuarial perspective on the cost of COVID-19. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

ERISA Preemption of State PBM Regulation

In this episode, hosts Payal Nanavati and Joe Records are joined by Todd Rosenberg and Sam Krause to discuss ERISA preemption of state regulation of pharmacy benefit managers (PBMs) in light of the upcoming U.S. Supreme Court hearing in Rutledge v. Pharmaceutical Care Management Association. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

 

Materials Discussed in this Episode

• "Payers, Providers, and Patients – Oh My!: Pharmacy Benefit Managers," Podcast, November 13, 2019
• "Payers, Providers, and Patients – Oh My!: Removal under ERISA," Podcast, September 11, 2019

Bostock and HHS’s Nondiscrimination Regulations

In this episode, host Payal Nanavati talks to Amanda DiSanto and Joe Records about the potential implications of the Supreme Court’s recent decision in Bostock v. Clayton County, Georgia, which addressed the rights of gay and transgender individuals under Title VII of the Civil Rights Act of 1964. Specifically, Amanda and Joe discuss what the ruling may mean for Section 1557 of the Affordable Care Act, including HHS's recent revisions to the nondiscrimination regulations.

Materials Discussed in this Episode

• "Supreme Court Adopts Expansive Interpretation of Sex Discrimination Under Title VII," Client Alert, June 15, 2020
• "Trump Administration Scales Back Obama-era Healthcare Nondiscrimination Regulations," Client Alert, June 16, 2020