Managed Care

At Mitchell Williams, our insurance regulatory team represents accident and health insurance companies and HMOs on transactional and regulatory matters across the country.  As federal and state regulation of health insurers and HMOs become more intertwined in a fluid marketplace, we work with companies to strategically develop and implement cost-effective ways to meet their business objectives.

We work with national and regional health insurers, HMOs, other managed care organizations, third party administrators and self-funded plans on a wide range of regulatory and transactional matters. We assist insurance company clients in navigating the regulatory environment created by the NAIC’s solvency initiative, providing advice on insurance company invested assets, risk based capital, holding company systems, enterprise risk, own risk solvency assessments and corporate governance issues.

Our lawyers advise our HMO and health insurance clients in matters of licensing, approvals and regulatory compliance at the federal and state level. We provide compliance and operations advice to health plans, health insurers, TPAs, provider organizations, and others that are participating in commercial health insurance products.

We have advised companies for many years in the specialized areas of Medicare Advantage and managed Medicaid plans, including reviewing both state and federal regulatory issues.  We understand the annual CMS clock for Medicare Advantage and work with companies, often on a significant multistate scale, to enter new markets under tight time pressures.  When working with clients on Medicaid related matters, we understand the significant variances by state and have assisted clients through issues both with state insurance departments and state Medicaid agencies.

Our services include:

  • Advising and assisting on managed care contract negotiations and on regulatory matters
  • Affordable Care Act (ACA) regulations, evolving compliance and implementation, and strategic opportunities
  • Development of strategic alliances
  • Payor-provider joint ventures
  • Fraud and abuse
  • HIPAA and state law privacy and security matters
  • State HMO and insurance laws
  • Medicaid managed care
  • Medicare Advantage/Medicare Part D
  • Mental health parity
  • Peer review and credentialing
  • Specialty/excepted benefit health plans
  • Discount programs
  • Disease management
  • Utilization review and medical bill review
  • Workers' compensation
  • Self-funded
  • MEWAs
  • Premium tax and related issues
  • Prescription Drug Plans – Medicare Part D