Health practices expand, AHLA names new president

Several firms have recently taken advantage of experienced attorneys’ readiness to make career shifts by expanding their health practices. McDermott Will & Emery (McDermott) and Greenberg Traurig, LLP (Greenberg) have chosen to welcome these additions as partners. In addition, Ogletree Deakins is proud to announce that one of its shareholders was named as the next president of the American Health Lawyers Association (AHLA).

AHLA leadership

The AHLA has selected Rob Niccolini, a shareholder with Ogletree Deakins and co-chair of the firm’s health care practice group, to serve as president of the association for fiscal year (FY) 2019-2020. The AHLA board of directors is tasked with selecting the president, and AHLA Board President Charlene McGinty stated that Niccolini is a thoughtful leader with a strong work ethic and commitment to the health law industry. Niccolini has served as chair and vice-chair of several committees and groups within the AHLA.

New partners

Michael Austin has chosen to return to McDermott as a partner in the firm’s Miami location. Austin served as hiring partner at DLA Piper, leading his office’s health care litigation practice, before choosing to return to McDermott—where he worked for over a decade early in his career. Austin’s practice will focus complex health care litigation matters.

Russell (Chip) Gaudreau III is now a shareholder in Greenberg’s New York City’s location. His practice focuses on counseling large pharmaceutical and medical device companies involved in complex product liability litigation. He joins Greenberg after serving for several years as a partner at Reed Smith.

New hires

Polsinelli expanded its California health care practice for the second time this year by hiring three new attorneys. Erin Muellenberg, Richard Rifenbark, and Anna Suda will support the firm’s clients in regulatory and compliance matters, including fraud and abuse issues and health care transactions.

States try to manage expectations for Medicaid managed care

When CMS updated regulations regarding Medicaid managed care in May 2016, it was the first significant update to these regulations since 2002. Over the past year, as speakers at the American Health Lawyers’ Association Institute on Medicare and Medicaid Payment on March 29, 2017, noted, states have started the multi-year process of complying with the new rules, while dealing with resources issues at the state level and political change in Washington, D.C.

About 80 percent of the 73 million Medicaid enrollees are in some kind of managed care program, according to Lindsey Browning with the National Association of Medicaid Directors. Thirty-nine states and the District of Columbia have contracted with managed care entities to deliver care to all or some of their Medicaid beneficiaries.

Four options

Prior to the issuance of the revised regulations (81 FR 27498, May 6, 2016) states had basically one option for putting a managed care plan in place—requesting a Medicaid state plan amendment from HHS. Under the revised regulations states now have four options to implement managed care waivers under various provisions of the Social Security Act: (1) a Sec. 1932 state plan waiver; (2) a Sec. 1915(a) waiver (waiving competitive procurement process); (3) a Sec. 1915(b) waiver, requiring all enrollees, including dual eligibles and children with special health care needs to enroll in managed care; and (4) a Sec. 1115 waiver (which may permit coverage of services not otherwise covered in Medicaid) (see CMS modernizes Medicaid managed care, Health Law Daily, May 6, 2016).

James Golden, director, Division of Managed Care Plans at CMS, noted that full implementation of the revised regulations will take three to five years, and that the key to success is how well states work with affected stakeholders—both managed care entities and beneficiaries. “CMS expects the states to take the lead in setting standards,” Golden said.

State challenges

Browning highlighted two key challenges that states face – setting up adequate networks of providers so managed care beneficiaries can actually access health care; and limited staff capacity to drive expansion of Medicaid managed care alongside a number of other Medicaid related regulations.

Impact of new administration

A further complication, Browning noted, is the new Trump Administration and new leadership for HHS and CMS. She noted that the new CMS Administrator, Seema Verma, indicated an interest in re-examining all recent rules related to Medicare and Medicaid during her confirmation hearing. Browning also pointed to the Executive Order issued by President Trump which requires all agencies to create a Task Force to review existing regulations with the goal of repealing many of them. Browning noted that both Verma and HHS Secretary Tom Price are interested in increased state flexibility around health programs.

In addition, Browning said that any changes to the Affordable Care Act (ACA) (P.L. 111-148) may impact the new Medicaid managed care regulations, for example, she noted that a key goal of the managed care rule was alignment with qualified health plan requirements under the ACA. Would this change if the ACA’s health insurance Exchanges are eliminated? Finally, she said that any structural changes to Medicaid would likely require revised managed care rules.