By Vickie Yates Brown, Frost Brown Todd LLC, Louisville, KY
The Health Law Section held its 10 th anniversary Emerging Issues Conference (EMI) recently at the Disney Yacht Club Resort in Orlando, Florida. EMI was an overwhelming success. It is important to recognize and thank the Health Law Section staff and planning committee for a job well done. Their hard work, dedication, and attention to detail made this event an enjoyable, productive experience for all.
As is the tradition, the current chair of the Section delivers a Sate of the Section address at the conference. The address began by recognizing the attendees who have attended all 10 of the EMI conferences. In addition, present and past council members where recognized as well as the Section’s very capable staff and winner of the law student writing competition, Lauren Nufford. My State of the Section comments are set out below.
California Ends Balance Billing
By Angela M. Lai and M. Dylan McClelland, California Department of Managed Health Care, Sacramento, CA
The views presented are solely those of the authors.
The practice of “balance billing” by emergency room doctors is part of a contentious issue that has plagued the managed care industry, providers, and health care consumers for many years. On January 8, 2009, in a unanimous decision in Prospect Medical Group, Inc. v. Northridge Emergency Medical Group, the California Supreme Court declared balance billing unlawful in the context of emergency medical care. Where a health plan (i.e., an “HMO”) does not pay, in whole or in part, the amount charged by emergency room doctors, the doctors now must resolve billing disputes solely with the health plans. The providers may seek dispute resolution, or even sue the health plans if they wish, but they may no longer bill patients with a health plan for the disputed amount.
Crackdown on Medicare Part C and Part D Marketing in 2008: Will Past be Prologue?
By Daniel F. Murphy, Balch & Bingham LLP, Birmingham, AL
The 2008 presidential election year was a period of relative calm for many aspects of the healthcare industry. Medicare Part C and Part D plan sponsors, however, endured intensive regulatory activity last year, particularly in the arenas of marketing practices and agent and broker compensation. Due largely to a groundswell of well-publicized marketing abuses, both Congress and the Centers for Medicare & Medicaid Services (“CMS”) enacted sweeping changes to the rules governing Medicare Parts C and D marketing and compensation. Statements from legislators, as well as guidance from regulators, suggest that Medicare Advantage and Prescription Drug Plan sponsors (“MA-PDP Sponsors”) may remain in the healthcare regulatory crosshairs during 2009. This article traces the unusual evolution of the new Medicare Part C and Part D marketing and compensation rules and summarizes their content.
Collaboration for Quality -
Performance Management Arrangements
By James Pinna, Hunton & Williams LLP, Richmond, VA
Although extraordinarily advanced, the U.S. healthcare system is sometimes ineffective and lacking in quality. In an effort to respond to these issues, governmental and private payors are increasingly aligning payment incentives with improved patient outcomes. Some payors are also reducing payments for hospitals that fail to meet certain quality measures and refusing to pay hospitals for “never events.” Collaboration among hospitals and physicians is essential to achieving quality patient outcomes. One model for collaboration with physicians on quality patient outcomes is the so-called “performance management arrangement” (“PMA”).
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Managed Care & Insurance Interest Group
The Managed Care & Insurance Interest Group focuses on such issues as federal and state regulation of HMOs and other managed care organizations.
The IG is led by Chair Michelle Apodaca, Texas Hospital Association, Austin, TX and Vice-Chairs Denise Glass, Fulbright & Jaworski LLP, Dallas, TX; Leigh Anne Hodge, Balch & Bingham LLP, Birmingham, AL; Alice King, Hogan & Hartson LLP, New York, NY and Fred A. Smith III, Sedgwick, Detert, Moran & Arnold LLP, Chicago, IL.
If you would like to join the Interest Group, continue by clicking the following link: Health Law Section IG Sign-up Form.
ABA eSource Editorial Board
The ABA Health eSource Editorial Board is led by Chair Lisa Genecov, Locke Lord Bissell and Liddell LLP, Dallas, TX and editorial board members Michael E. Clark, Hamel Bowers & Clark LLP, Houston, TX; Adrienne Dresevic, Wachler & Associates, P.C., Royal Oak, MI; Marla Durben Hirsch, Potomac, MD and Conrad Meyer, Chaffe McCall, LLP, New Orleans, LA.
Do you want to communicate your ideas to thousands of other members through the wonders of cyberspace? To contribute a newsletter article on a health law topic, send us your ideas to Simeon.Carson@americanbar.org
|The opinions expressed are those of the authors and shall not be construed to represent the policies or positions of the ABA or the ABA Health Law Section. |
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