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Payers, Plans, and Managed Care

 
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​AHLA's Payers, Plans, and Managed Care Practice Group (PPMC PG) keeps you up to date on all legal issues concerning health plans, insurers, third-party administrators, pharmacy benefit managers, and other hybrid organizations.

​PG Topical Library

Exclusive to PPMC PG members, this Library is a hub for AHLA content related to your practice area, including exclusive PG content and a selection of AHLA member and non-dues content.

News and Analysis

Education and Resources

  • Managed Care Contracting Toolkit 
    PG Toolkit: Last updated on February 28, 2019
    This Toolkit is organized in the order of a typical managed care contract and outlines general principles that should be considered when negotiating contract provisions as a Provider or Managed Care Organization (MCO). Where applicable and unambiguous, sample contract language has been marked as either MCO- or provider-friendly, or neutral. Important principles have been listed at the beginning of each section to provide a roadmap and some general thoughts for contracting parties.

  • Practical Considerations for Analyzing Telemedicine and Telehealth Legal Issues
    - PG Toolkit: Published on September 21, 2017
    This Toolkit covers all of the basics and need-to-know legal issues affecting telemedicine and telehealth today.

  • Pharmacy Maximum Allowable Cost (MAC) Laws: A 50 State Survey
    - PG Toolkit: Published on August 8, 2017
    This 50 state survey on pharmacy maximum allowable cost (MAC) laws summarizes the laws of each state regarding how they govern the way payers—including pharmacy benefit managers (PBMs)—can reimburse pharmacies for products dispensed to patients.

  • HIPPA Authorization Checklist
    - PG Toolkit: Published on April 25, 2016
    In-house counsel, compliance personnel, health information professionals, and outside litigation counsel are sometimes tasked with reviewing an authorization for the release of medical records to determine whether the authorization is compliant with Health Insurance Portability and Accountability Act (HIPAA) regulations. This Toolkit provides a convenient practice tool that can be saved as a quick guide for reviewing authorizations for HIPAA compliance.

  • HSAs, FSAs, LPFSAs, and HRAs—Keeping It All Straight!
    - PG Toolkit: Published on March 28, 2016
    High deductible health plans coupled with Health Savings Accounts and Health Reimbursement Arrangements are growing in popularity as health care costs continue to increase. Many employers also offer their employees Flexible Spending Arrangements and Limited Purpose Flexible Spending Arrangements. It can be difficult to keep track of the different acronyms and requirements that apply to each type of arrangement. This Toolkit provides a handy reference tool that can help keep them all straight.

  • Factors to Consider When Thinking About Retaining Outside Counsel on a Compliance Matter
    - PG Toolkit: Published on February 3, 2016
    This Toolkit outlines the key considerations for when inside counsel should hire outside counsel to assist with a regulatory issue.


Webinars

Register for Upcoming:

Purchase On-Demand:

May 14, 2019 2:00 PM-3:30 PM Eastern
February 19, 2019 2:00 PM-3:30 PM Eastern
January 8, 2019 2:00 PM-3:30 PM Eastern

Educational Calls

Included In Your PG Membership:


Leadership

Payers, Plans, and Managed Care Practice Group Leaders

Image of LeahStewart
Leah B. Stewart Chair Dell Medical School at UT Austin Austin, TX (512) 495-5146 Email
Image of XavierBaker
Xavier Baker Vice Chair - Research & Website Crowell & Moring LLP Washington, DC (202) 624-2842 Email
Image of ArdithBronson
Ardith M. Bronson Vice Chair - Publications DLA Piper LLP (US) Miami, FL (305) 423-8562 Email
Image of KarenPalmersheim
Karen R. Palmersheim Vice Chair - Membership Cigna Glendale, CA (818) 500-6497 Email
Image of MelissaWong
Melissa Wong Vice Chair - Educational Programs Holland & Knight LLP Boston, MA (617) 305-2156 Email
Image of JaniceZiegler
Janice H. Ziegler Vice Chair - Strategic Planning and Special Projects Dentons US LLP Washington, DC (202) 408-9158 Email
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Kate McDonald Social Media Coordinator McDermott Will & Emery LLP Washington, DC (202) 756-8803 Email

Health Plan Affinity Group Leaders

Image of AnnieShieh
Annie Hsu Shieh Chair Central Health Plan of California Diamond Bar, CA (626) 388-2390 x2885 Email
Image of Nichole Hines
Nichole Hines Vice Chair Humana Inc Miramar, FL (305) 626-5179 Email
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Brian Vick Vice Chair Blue Cross Blue Shield of North Carolina Durham, NC (919) 765-4071 Email
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Jeremy Earl Vice Chair - Educational Programs McDermott Will & Emery LLP Washington, DC (202) 756-8189 Email

Managed Care Contracting Affinity Group Leaders

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Jeff Joseph Wurzburg Chair Norton Rose Fulbright San Antonio, TX (210) 270-7186 Email
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Ryan Morgan Vice Chair Polsinelli PC Denver, CO (434) 962-6434 Email
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Saira Shah Vice Chair Community Health Choice Needville, TX Email

Medicare Advantage and Part D Affinity Group Leaders

Image of EmilyMoseley
Emily A. Moseley Chair Strategic Health Law Chapel Hill, NC (919) 749-5678 Email
Image of MelissaHulke
Melissa J. Hulke Vice Chair CVS Caremark Scottsdale, AZ (480) 661-3611 Email
Image of MelissaBorrelli
Melissa Borrelli Vice Chair - Publications Mazars USA LLP Sacramento, CA (916) 501-7430 Email

 

​Health Insurance Topical Community

Join the conversation! This Community discusses issues related to the operation and regulation of health maintenance organizations, managed care payers, and employee health benefit plans, including related liability, health insurance, and payment issues. PPMC PG members are automatically enrolled in this Community.

​PPMC PG Affinity Groups

The Health Plan Affinity Group provides, obtains, and facilitates information exchange and best practices among lawyers who represent health plans or who work at health plans, and focuses on the unique issues these lawyers face.

The Managed Care Contracting Affinity Group addresses areas of particular concern to any entity that enters into managed care contracts, including all types of managed care organizations, payers, and providers.

The Medicare Advantage and Part D Affinity Group focuses on issues related to the two major programs providing private health plan options to Medicare beneficiaries.

All publications and resources produced by these Affinity Groups are available in the PPMC PG Topical Library. To enroll, complete and return the enrollment form or call AHLA's Member Service Center at (202) 833-1100, prompt #2.

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