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Health Industry Alert--October 6, 1999
Akin Gump Strauss Hauer & Feld LLP
On September 27, 1999, California Governor Gray Davis signed into law an impressive "package" of new health care bills affecting the managed care industry in California. Although many of the 21 new laws take effect as late as January 1, 2001, there is little question that the new legislation will have immediate and far-reaching effects on the managed care industry throughout the country.
An Overview of the Health Law Specialty
Cadwalader, Wickersham & Taft LLP
THE HEALTH CARE industry is the largest sector of the United States economy, accounting for $1 trillion in annual e.
Managed Health Care and You
Brian P. O'Conner 1 of Ginsberg & O'Connor, P.C.
Many individuals receive their major medical insurance through an employee benefit plan. Often, these employee plans are subscribers to a Health Maintenance Organization (HMO).
How to Resolve a Grievance with an HMO

This article details the HMO grievance process in the State of Florida.
Politics and Your Healthcare
Crow Law Offices, Inc.
The American public has always wanted quality, affordable healthcare and union families are no exception. Since 19.
Physician Incentive Plan Glossary of Terms
Dept. of Health and Human Services
Vocabulary list prepared by the Department of Health and Human Services of commonly used terms in physician incentive plan regulations and documents.
Managed Care Contracts - Key Provisions for Providers
Susan Leach DeBlasio of Tillinghast Licht LLP
The contract between a physician or other health care professional and a managed care organization (MCO) such as a provider-sponsored network, integrated delivery system, health maintenance organization, or other health care plan, is the fundamental document which frames, defines and governs their relationship. Contractual provisions can affect payment, office organization, practices and procedures, and confidential records as well as clinical decision-making.
Managed Care: Managed Costs or Managed Medicine?
Tillinghast Licht LLP
Many people believe that the rising costs of medical care in the United States, and the increasing numbers of ordinary citizens who cannot afford it, have combined to threaten this country's social and economic health. By the year 2000, unless fundamental changes occur in the health care delivery and financing system, these costs will rise to $1.6 trillion, or 16.4 percent of the GNP.
Rhode Island's New Consumer Orientated Health Care Law: A Model
Susan Leach DeBlasio of Tillinghast Licht LLP
Health care professionals and providers, insurance companies and health maintenance organizations ("HMOs"), and individual consumers and groups are all praising the passage of the "Health Care Accessibility and Quality Assurance Act" (the "Act") by the Rhode Island legislature this July. Patterned after the American Medical Association's "Patient Protection Act," the new law empowers the state Department of Health to regulate and monitor managed care plans to ensure a proper balance between the rights of the plan, the people who pay the premiums, and the patients who receive the care.
Medicare: Administrative Appeal Process and Judicial Review
T. Daniel Hollaway of Hollaway & Gumbert, PC
By this time, virtually all medical providers are routinely providing services to Medicare beneficiaries who have .
HMO Medical Directors and Professional Sanctions
Cadwalader, Wickersham & Taft LLP
ONE OF THE ONGOING accomplishments of managed care has been the ability of health maintenance organizations (HMOs) .
Managed Care Contract Issues
Matthew Brunson Roberts of Nexsen Pruet
This article reviews managed care contract issues and suggests providers should negotiate clean claim language and penalties for the payors failure to pay such clean claims within a timely manner.
New External Appeal Law in New York
Jackie Huchenski of Moses & Singer LLP
The New York State Legislature recently passed a law permitting independent external appeals for denials of covera.
Fact Sheet: Protecting Medicare Beneficiaries After HMOs Withdraw
Dept. of Health and Human Services
Fact sheet prepared by the Department of Health and Human Services which describes how Medicare beneficiaries benefits are protected when an HMO withdraws its existing Medicare contract.
New Outpatient PPS Regulations and Provider-Based Status
Robert B. Ramsey of Buchanan Ingersoll & Rooney PC
On April 7, 2000, the Health Care Financing Administration (HCFA) issued final regulations regarding the P.
Larsen Reins In HMOs; No New Regulations Needed

As Insurance Commissioner Steven B. Larsen ends his first year as head of the Maryland Insurance Administration ("M.
Questions and Answers for Medicare Beneficiaries Who Lose Managed Care Coverage
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which provides answers to questions about non-renewals of Medicare contracts by certain managed care programs and the choices available to beneficiaries and Medicare for supplemental insurance.
Exceptions for Specific Delivery Systems and Health Care Providers and Suppliers
Broad and Cassel
The proposed Stark II regulations have also carved out specific exceptions for certain providers and suppliers of h.
PSOs: A New Opportunity for Providers
Jodi B. Laurence of Broad and Cassel
For many years, hospitals and physicians have been lobbying to be able to contract directly with Medicare beneficia.
Medicare+Choice Offers Opportunities for Providers
Deborah W. Larios of Waller Lansden Dortch & Davis LLP
The Medicare+Choice program may be the most significant change in Medicare since its inception in 1965, according .
The Health Insurance Reform Act of 1996
Gabriel L. Imperato of Broad and Cassel
The Health Insurance Reform Act of 1996 ("Act"), which goes into effect July 1, 1997, contains sweeping revisions o.
Rate Regulation Under California's Prop 216: Costs Without Benefits
Hilary N. Rowen of Thelen LLP
This article is a critical look at what impact propositions 214 and 216 will have on health care providers and their ability to set fees for their services.
The Antitrust "Dos" and "Don`ts" for Physician Networks
Coudert Brothers LLP
As the health care industry continues to move from traditional fee-for-service arrangements to managed-care concep.
HCFA Clarifies Private Contracting Position
Deborah W. Larios of Waller Lansden Dortch & Davis LLP
The Fall 1997 Health Law Newsletter reported on a provision in the Balanced Budget Act which, when read literally, .
Operational Policy Letter: Medicare + Choice (M+C) Organization Appeal and Grievance Data Disclosure Requirements
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services which provides information on Medicare + Choice organization appeal and grievance data disclosure requirements.
New Insurance Requirements for Networks
Rodger L. Hochman of Broad and Cassel
In the recently ended 1997 legislative session, the Florida Legislature passed a bill which could seriously affect .
Records Management Programs: An Essential Element of Corporate Compliance
Anne Novick Branan of Broad and Cassel
On August 14, 1997, the Wall Street Journal reported that federal prosecutors claimed to have evidence that Columbi.

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