In this episode, hosts Joe Records and Payal Nanavati talk to Michelle Chipetine and Stacie Heller about recent developments regarding the nondiscrimination requirements of Section 1557 of the Affordable Care Act, including new rules proposed by the Biden Administration and litigation around the issue of discrimination on the basis of sex.
 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

More Changes to Section 1557 Nondiscrimination Rules

In this episode, host Payal Nanavati talks to Shelley Rosenberg and Joe Records about changes to the medical loss ratio (MLR) requirements impacting commercial coverage, particularly the limitations on what expenses issuers can include in their MLR numerators.
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

The Shrinking Medical Loss Ratio Numerator

In this episode, Joe Records and Payal Nanavati talk to Scott Douglas and Charlotte Freed about the mental health provisions in the federal gun safety legislation. The new law included billions in federal funds to support mental health care—a huge investment likely to have major impacts on the industry.
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Massive Federal Investment in Mental Health

This episode is the second part in a miniseries with Crowell Health Solutions, which is a strategic consulting firm that Crowell & Moring launched earlier this year to help healthcare organizations and technology companies transform health care by improving patient care and health outcomes, advancing health equity, and lowering health care costs through solutions like digital health innovations and value-based healthcare models.
In this episode, Janet Walker and Roma Sharma interview three leaders working at Ascension, which is one of the nation’s largest not-for-profit health systems with more than 2,600 sites of care, about how Ascension has prioritized health equity and population health initiatives, including its framework “ABIDE,” which is built upon the hallmarks of Appreciation – Belongingness – Inclusivity – Diversity – Equity.  The interviewees are Dr. Stacy Garrett-Ray (Senior Vice-President and Chief Community Impact Officer), Pamela Mitchell Boyd (Senior Director of ABIDE), and Nicole Commodore (Director, Community Impact and Advocacy).
 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
 
For more information, please see:
Crowell & Moring Unveils Crowell Health Solutions

Crowell Health Solutions Mini-Series Part 2 – A Health System’s Perspective on Prioritizing Health Equity

In this episode, host Joe Records talks to Gary Baldwin about the regulation of shared-risk arrangements in the state of California. They discuss the history of shared-risk arrangements in California, how the Department of Managed Health Care (DMHC) approaches these kinds of arrangements, and the kinds of issues entities should consider in approaching shared risk.
 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Shared-Risk Arrangements in California

This episode is the first part in a miniseries with Crowell Health Solutions, which is a strategic consulting firm that Crowell & Moring launched earlier this year to help healthcare organizations and technology companies transform health care by improving patient care and health outcomes, advancing health equity, and lowering health care costs through solutions like digital health innovations and value-based healthcare models.
In this episode, Troy Barsky interviews Michael Meng (the CEO of Stellar Health) about how technology has impacted, and continues to impact, health care delivery in light of regulatory changes focused on advancing value-based care.  Michael Meng is the CEO and co-founder of Stellar Health, which is a healthcare technology company focused on enabling success across the value-based care continuum by bridging the incentive gap between providers and payors.
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
For more information, please see:
Crowell & Moring Unveils Crowell Health Solutions
Stellar Health

Crowell Health Solutions Mini-Series Part 1 - The Intersection of Technology and Value-Based Care

In this episode, hosts Payal Nanavati and Joe Records talk to Katy Raffensperger, Todd Rosenberg, and Alexis Gilman about expectations for healthcare transactions in 2022.   The discussion captures how transactions involving health care companies may respond to legal, economic, and market circumstances, including lasting care delivery changes spurred by the COVID pandemic, antitrust scrutiny by federal regulators, inflation, and rising interest rates. 
 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

What to Expect in Healthcare Transactions in 2022

In this episode, hosts Payal Nanavati and Joe Records talk to Matt Vicinanzo about developments in False Claims Act litigation – including materiality, scienter, and government dismissal authority, among others – and how those developments may have a unique impact on companies in the health care industry.
For more information please see:
"The Top FCA Developments of 2021," Government Contracts Bullet Points (February 25, 2022). Contacts: Brian Tully McLaughlin, Lyndsay A. Gorton, Nkechi Kanu, Payal Nanavati, Matthew Vicinanzo.
"Payers, Providers, and Patients – Oh My!: FCA Dismissals Under the Granston Memo," Podcast: Payers, Providers, and Patients – Oh My! (June 26, 2019). Contacts: John T. Brennan Jr., Joe Records, Payal Nanavati.
"Payers, Providers, and Patients – Oh My!: Data Analytics and FCA Investigations," Health Care Alert (January 21, 2021). Contacts: Michael Shaheen, Joe Records, Payal Nanavati.

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

What Health Care Companies Should Know about Developments in FCA Litigation

In this episode, hosts Payal Nanavati and Joe Records talk to Troy Barsky and Roma Sharma about their reflections on the first year of implementation of new regulations implementing the major fraud and abuse statutes — the Stark Law and Anti-Kickback Statute (AKS) — including discussing challenges, opportunities, and outstanding questions about the new exceptions and safe harbors for value-based care.
 
For more information please see:
"CMS Issues Sweeping Reform to Modernize the Stark Law: Part I," Health Care Alert (November 30, 2020). Contacts: Troy A. Barsky, John T. Brennan Jr., Lidia Niecko-Najjum, Roma Sharma.
"OIG Issues Final Rule to Update AKS Safe Harbors: Part II," Administrative Law Alert (February 25, 2021). Contacts: Troy A. Barsky, Jodi G. Daniel, Michael Shaheen, Lidia Niecko-Najjum, Joe Records, Matthew Vicinanzo.

 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Reflecting on the First Year of the 2020 Stark & AKS Regulations

In this episode, hosts Payal Nanavati and Joe Records talk to Jodi Daniel and Savanna Williams about the latest developments in interoperability, including challenges of implementing recent CMS and ONC regulations and expectations about potential enforcement of these rules. 
For more information please see:
"HHS Finalizes Sweeping Regulations on Interoperability of Health Information and Information Blocking" 
"Balancing The New Interoperability Rules With Existing Privacy Laws: Challenges for Payers" 
"CMS Expands on Patient Access and Interoperability Requirements for Health Plans" 

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

The New World of Health Data Interoperability

In this episode, hosts Payal Nanavati and Joe Records talk to Janet Walker and Mercy Care’s CEO, Lorry Bottrill about the ways in which the government and health plans are addressing the social determinants of health (SDOH), which are the conditions in which people are born, live, learn, work, play and age and they affect a wide range of health, functioning, and quality-of-life outcomes. 
 
Lorry has been a leader in Arizona’s health care community for more than 25 years.  In this episode, she shares recent examples of Mercy Care’s efforts to address SDOH through collaboration with the Arizona Health Care Cost Containment System (AHCCCS or “ACCESS”), Arizona’s Medicaid agency. 
 
For more information please see:
Mercy Care
CDC Notice of Funding Opportunity: Closing the Gap with Social Determinants of Health Accelerator Plans
CMS Innovation Center Strategy Refresh
AHCCCS Whole Person Care Initiative

 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
You can follow Lorry Bottrill here.

How Health Plans Can Address Social Determinants of Health

In this episode, hosts Payal Nanavati and Joe Records talk to Lidia Niecko-Najjum and John Brennan about the legal issues that investors, providers, and innovators should be prepared to navigate when considering offering Ketamine-assisted treatment, including the federal and state laws and regulations related to the practice of medicine, licensure, and many other issues. 
Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Business and Clinical Considerations for the Ketamine Industry

In this episode, host Payal Nanavati talks to Joe Records about recent enforcement activities under the Mental Health Parity and Addiction Equity Act (MHPAEA), including federal agencies’ requests for insurers to submit comparative analyses of their non-quantitative treatment limitations.  Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
Materials discussed in this episode:
H.R.133 - Consolidated Appropriations Act, 2021
Department of Labor, Self-Compliance Tool
"COVID Relief and Appropriations Legislation Includes Mental Health Parity Compliance and Oversight Requirements," Health Care Alert (December 23, 2020). Contacts: Michael W. Lieberman, Lauren R. Nunez, Joe Records.

Recent Mental Health Parity Enforcement Activities

In this episode, hosts Payal Nanavati and Joe Records talk to partner Steve McBrady, who led the Crowell & Moring team that represented Maine Community Health Options in the long running Affordable Care Act §1342 “risk corridors” litigation that ended with U.S. Supreme Court decision in favor of Maine and companion insurers. 
Materials discussed in this episode:
Client Alert: Supreme Court Rules in Favor of Health Plans in Landmark $13 Billion Affordable Care Act Case
Firm News: Maine Community Health Options Wins U.S. Supreme Court Ruling Enforcing Government Payment Obligation Under Affordable Care Act ‘Risk Corridor’ Cases

The ACA Risk Corridors Case

In this episode, hosts Payal Nanavati and Joe Records talk to partner Michael Shaheen, who recently served as a Trial Attorney with the Fraud Section of the DOJ.  Michael sheds some light on what potential FCA targets can do to understand and rebut DOJ’s use of data analytics to pursue FCA investigations.

Data Analytics and FCA Investigations

In this episode, hosts Payal Nanavati and Joe Records are joined by Xavier Baker and special guest Tim Murray, Director & Senior Consulting Actuary in Wakely Consulting Group’s New York office, to discuss the actuarial perspective on the cost of COVID-19. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Rating in the Time of COVID

In this episode, hosts Payal Nanavati and Joe Records are joined by Todd Rosenberg and Sam Krause to discuss ERISA preemption of state regulation of pharmacy benefit managers (PBMs) in light of the upcoming U.S. Supreme Court hearing in Rutledge v. Pharmaceutical Care Management Association. Payers, Providers, and Patients – Oh My! is Crowell & Moring’s biweekly health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.
 
Materials Discussed in this Episode
"Payers, Providers, and Patients – Oh My!: Pharmacy Benefit Managers," Podcast, November 13, 2019
"Payers, Providers, and Patients – Oh My!: Removal under ERISA," Podcast, September 11, 2019

ERISA Preemption of State PBM Regulation

In this episode, host Payal Nanavati talks to Amanda DiSanto and Joe Records about the potential implications of the Supreme Court’s recent decision in Bostock v. Clayton County, Georgia, which addressed the rights of gay and transgender individuals under Title VII of the Civil Rights Act of 1964. Specifically, Amanda and Joe discuss what the ruling may mean for Section 1557 of the Affordable Care Act, including HHS's recent revisions to the nondiscrimination regulations.
Materials Discussed in this Episode
"Supreme Court Adopts Expansive Interpretation of Sex Discrimination Under Title VII," Client Alert, June 15, 2020
"Trump Administration Scales Back Obama-era Healthcare Nondiscrimination Regulations," Client Alert, June 16, 2020

Bostock and HHS’s Nondiscrimination Regulations

In this episode, hosts Payal Nanavati and Joe Records talk to Jacinta Alves and Matt Vicinanzo about provisions in federal legislation that are aimed at easing the pandemic’s impact on the health care industry, including the processes and requirements for the Provider Relief Fund.  

Who CARES: The Provider Relief Fund and Other CARES Act Provisions

In part two of our two part series on what providers should know about COVID-19, hosts Payal Nanavati and Joe Records discuss federal and state guidance with Brian McGovern. The first episode included a discussion of challenges that providers’ may face as employers. This episode touches on the various federal and state guidance issued in response to COVID-19 that may impact health care providers.
Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.

Payers, Providers, and Patients – Oh My!

Payers, Providers, and Patients – Oh My!

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