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Sheppard Mullin Richter & Hampton LLP

State-Directed Payments, Value-Based Care, and the “One Big Beautiful” Bill: A Comprehensive Analysis

Among the many sweeping changes to the Medicaid program included in the One Big Beautiful Bill Act (“OBBBA”), Congress established new statutory caps on state-directed payments (“SDPs”) in Medicaid managed care. SDPs have...more

Bass, Berry & Sims PLC

Healthcare Trends & Transactions Q2 2025

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The healthcare mergers and acquisitions (M&A) market remained active in Q2 2025, with several sectors including physician practice management (PPM), clinical research, and digital health experiencing continued investment and...more

Smith Anderson

OBBB Act Brings Major Medicaid Changes: What North Carolina Providers Need to Know

Smith Anderson on

The One Big Beautiful Bill Act (P.L.119-21) (the “OBBB”) passed by slim margins in the U.S. Senate (51-50) and U.S. House (218-214) and was signed into law by President Trump on July 4, 2025....more

Bass, Berry & Sims PLC

13th Annual Healthcare Fraud & Abuse Review - 2024

Bass, Berry & Sims is pleased to announce the release of the 13th annual Healthcare Fraud & Abuse Review examining important healthcare fraud developments in 2024. Compiled by the firm's Healthcare Fraud & Abuse Task Force,...more

Greenbaum, Rowe, Smith & Davis LLP

The CMS Managed Care Final Rule: Access Standards, Consumer Surveys, Payment Standards and More for Managed Medicaid and CHIP

Greenbaum healthcare attorneys Neil M. Sullivan and Jennifer A. Belardo analyze the CMS’s Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule – and its impact on states, healthcare providers, and...more

Bass, Berry & Sims PLC

Healthcare Trends & Transactions Q2 2024

Bass, Berry & Sims PLC on

Deal volume across the healthcare industry generally appears to have steadied despite headwinds. The general sentiment is that buyers have adapted to the current interest rates and are gritting their teeth and pressing...more

Sheppard Mullin Richter & Hampton LLP

The Intersection of Artificial Intelligence and Utilization Review

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the California Medical...more

McDermott+

CMS Finalizes Major Reforms to Medicaid, Part 2: Medicaid Managed Care Reg

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Medicaid Regs Part 2! Last week, Regs & Eggs took a deep dive into the Ensuring Access to Medicaid Services final reg, one of two regs that the Centers for Medicare & Medicaid Services (CMS) released to add new requirements...more

McDermott+

Looking Forward: Top Policy Areas for 2024

McDermott+ on

Happy New Year! As we enter 2024, we want to lay out some of the main regulatory issues (both new and old) that McDermott+Consulting will be tracking over the next year. While these may evolve, we think they are still...more

Bass, Berry & Sims PLC

Healthcare Trends & Transactions Q3 2023

Bass, Berry & Sims PLC on

After steadying during Q2, it appears the overall volume of deals in the healthcare industry declined in Q3 compared with Q2, and year-to-date 2023 is still down from last year. A slumping economy has no doubt played a large...more

Nossaman LLP

Managed Care Plans Take Note: OIG’s Managed Care Strategic Plan

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With the tremendous growth of managed care over the last several years, the Medicare and Medicaid programs have had to transform how they fund health care for approximately 100 million enrollees. According to the Department...more

Littler

New York Department of Health Sets New Due Dates for Submission of Home Care Worker Wage Parity Compliance Certifications and...

Littler on

On September 21, 2023, the New York Department of Health (DOH) issued guidance addressing the due dates for Medicaid Managed Care Organizations (MMCOs), Certified Home Health Agencies (CHHAs), Licensed Home Care Services...more

Troutman Pepper Locke

California Court of Appeal Affirms Grant of Summary Judgment Against Health Care Provider in Win for Managed Care Payors and...

Troutman Pepper Locke on

The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare (United), finding that United did not...more

McDermott Will & Schulte

Top Takeaways | 2023 Physician Practice Management & ASC Symposium | Maximizing Managed Practice Value & Operations

In this moderated session, a panel of senior executives and stakeholders with significant experience in optimizing physician practice management valuations discussed how managed practices can add substantial value by...more

Nossaman LLP

CMS Attempts to Reduce Appointment Times for Medicaid and CHIP Patients - How Will This Impact Your Managed Care Plan?

Nossaman LLP on

A recent survey found that the average wait time for a new patient to see a physician in 15 of the largest cities in the U.S. was 26 days, up from 24.1 days in 2017.  Timely access to health care providers has long been an...more

Burr & Forman

Hot Topics in Health Care May 2023

Burr & Forman on

Proposed Protections for Patient Data Related to Reproductive Care - On April 12, 2023, the Office for Civil Rights (OCR) at the U.S. Department of Health & Human Services (HHS) proposed a new rule to strengthen HIPAA...more

Bass, Berry & Sims PLC

Healthcare Transactions Q2 2022

Bass, Berry & Sims PLC on

With some exceptions, healthcare M&A activity is down this year compared to the record-breaking highs of 2021. Those exceptions include the hospital sector, which is still seeing fewer but significantly larger (i.e., billion...more

Sheppard Mullin Richter & Hampton LLP

California Department of Managed Health Care Opposes AB 1249

On Monday, August 8th, the Deputy Director of Legislative Affairs of the Department of Managed Health Care (the “Department”) released a letter of opposition (the “Letter”) to Assembly Bill 1249 (“AB 1249”). The Letter was...more

Hinshaw & Culbertson LLP

Attention Health Care Providers: California Adopts Restricted Knox-Keene Licensure/Exemption Requirements

The California Department of Managed Health Care (the "DMHC"), which regulates Health Care Service Plans, recently adopted a regulation regarding general licensure requirements for health care providers ("Entities") that...more

Buchalter

The DMHC’s Final Guidance on the General Licensure Regulation (“Restricted Health Plans”) The Lull Before the Storm

Buchalter on

On Friday, June 14, 2019 the Department of Managed Health Care (the “Department”) issued All Plan Letter 19-014 (OLS) (“APL”) containing its formal guidance regarding implementation of the General Licensure Requirements (for...more

Sheppard Mullin Richter & Hampton LLP

New Regulation Clarifies DMHC’s Position Regarding Knox-Keene Licensing

After a protracted comment period, the California Department of Managed Health Care (the “Department”) formally adopted its much anticipated “global risk” regulation (the “Regulation”), which will go into effect on July 1,...more

American Conference Institute (ACI)

[Event] Forum on Managed Care Litigation – Devising Comprehensive Defense Strategies for the MCO Industry – May 16th-17th,...

With a constantly changing political spectrum and considerable uncertainty affecting both MCOs and providers, we have developed this year’s agenda to address the latest developments impacting litigation in the managed care...more

Burr & Forman

New Medicaid RCOs Raise Antitrust Issues for All Participating Health Care Providers

Burr & Forman on

Physicians and other health care providers who were practicing in the 1990s were involved in numerous attempts to organize themselves in order to be able to participate in and even financially survive the onslaught of managed...more

Baker Donelson

HRSA Issues Long-Awaited 340B Program Omnibus Guidance Proposal

Baker Donelson on

After much anticipation, the Health Resources and Services Administration (HRSA) late last week released its 340B Drug Pricing Program Omnibus Guidance Proposal (the Proposal). HRSA indicates that its goal in issuing the...more

McGuireWoods LLP

North Carolina General Assembly Week in Review

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NC State Government is currently operating under a Continuing Resolution (CR), SB 560, 2015 Continuing Budget Authority. This CR is set to expire at 11:59 pm on August 31, 2015. With less than two weeks before the CR...more

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