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Showing 3 posts from January 2019.

On Friday, January 25, 2019, the Department of Managed Health Care (DMHC) published its latest draft of a proposed regulation that will dramatically expand the scope of arrangements subject to licensure under the Knox-Keene Act. The regulation breaks with the DMHC’s longstanding policies and threatens to disrupt common provider payment arrangements in California, including hospital risk pools, bundled payment arrangements, and accountable care organizations (ACOs), and to stifle innovation in the area of value-based payments.

Under the proposed regulation, a Knox-Keene license would be required for an entity to accept “global risk,” which is defined as the acceptance of a “prepaid or periodic charge” in exchange for assuming “both professional and institutional risk.” (28 C.C.R., proposed § 1300.49, subds. (a) & (b)(1).) The statute has long defined health care service plans in reference to providing or arranging for health care services in exchange for a “prepaid or periodic charge.” However, the regulation provides a new definition of that term that encompasses payments made “at the start or end of a predetermined period… that may be fixed either in amount or percentage of savings or losses in which the entity shares.” (28 C.C.R., proposed § 1300.49, subd. (a)(4).) Providers that engage in shared risk arrangements, which involve fee-for-service payments with shared savings payable after a set period of time, even those involving upside risk only, may be subject to licensure under the new rule. Read More ›

On December 14, 2018, the Department of Health and Human Services (“HHS”) issued a request for information (“RFI”), asking for feedback on how to change certain regulations issued pursuant to the Health Insurance Portability and Accountability Act (“HIPAA”). The RFI seeks information on how best to remove obstacles to efficient care coordination while also protecting patients’ health information, as well as how to encourage providers to share information for treatment and care coordination, making it easier to share information with parents and caregivers in dealing with the opioid crisis. Comments or information regarding changes to the HIPAA regulations must be submitted to HHS on or before February 12, 2019. Then, the agency will still need to go through the regulatory rulemaking process to implement any proposed changes after the RFI process is complete. Read More ›

Hooper, Lundy & Bookman announced today that six attorneys have been promoted. The promotions reflect the firm’s commitment to retaining and promoting the best talent in the healthcare industry. Consistent with the firm’s dedication to advancing women to leadership, four of the six individuals are women.

“These individuals represent the best of Hooper, Lundy & Bookman’s strengths, including the breadth of our health care provider practice across the litigation, business, and regulatory practices, and our first-in-class talent. We are especially pleased that so many women are represented in these promotions.” said managing partner Mark Reagan. “These individuals achieved their well-deserved promotions through hard work and dedication to serving our clients at the highest levels of excellence.” Read More ›

For media assistance, please contact Maura Fisher at 202-580-7714.