• Posts by James M. Reilly
    Associate

    James Reilly provides legal guidance to clients in the healthcare industry. He ensures healthcare entities are able to deliver high quality services to their patients while complying with government agency regulations. He also ...

Is the Friendly PC at Risk? What Happens Next with Envision’s Litigation?

Almost two years ago, the American Academy of Emergency Medicine Physician Group (AAEM-PG) filed suit in the Superior Court of California against Envision Healthcare Corporation (Envision). The suit concerned Envision’s takeover of a contract to provide healthcare services at an emergency department at Placentia Linda Hospital from AAEM-PG. … 

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

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 of Health & Human Services’ Office of Inspector General (OIG), 2022 saw half of Medicare enrollees receive coverage through Medicare Advantage plans. As a result, government spending on Medicare Advantage was $403B, or about 50% of all Medicare funds. Similarly, 81% of current Medicaid enrollees receive some component of their coverage through managed ...

CA DHCS Announces New MLR Requirements on Subcontractors, Including IPAs, RBOs and RKKs

California’s Department of Health Care Services (DHCS) is in the final stages of establishing new Medical Loss Ratio (MLR) requirements in Medi-Cal Managed Care. Most significantly, the guidelines specify that the MLR program, which previously applied to Medi-Cal managed care plans, will now also apply to certain of their subcontractors, including risk-bearing providers. … 

CDC Updates Guidance on Opioid Prescriptions

In a shift from prior policy, the Centers for Disease Control and Prevention (CDC) proposed on February 22, 2022, new guidelines for prescribing opioid painkillers. The new guidance largely avoids figures on dosage strength and length of prescription and warns against abruptly or rapidly discontinuing pain pills for chronic pain patients. It directs physicians to individualize the process and use their best judgement in determining whether to prescribe opioids, and when they do, to start with the lowest effective dosage. The proposed guidelines encourage physicians to weigh ...

Posted in Managed Care
Understanding the HHS 2023 Proposed Rule

The Department of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for the 2023 Proposed Rule on January 5, 2022. Generally, the proposed rule aims to bolster the regulatory framework supporting the marketplace and expand access to health insurance coverage options. 

Our Health Law Ticker is a one-stop resource for everything new and noteworthy in healthcare law. We cover recent developments in healthcare legislation, healthcare reform, Medicare/Medicaid, managed care, litigation, regulatory compliance, HIPAA, privacy, peer review, medical staffs and general business operations for healthcare companies and licensed healthcare professionals.

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