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The CMS Managed Care Final Rule: Access Standards, Consumer Surveys, Payment Standards and More for Managed Medicaid and CHIP

By Jennifer A. Belardo & Neil M. Sullivan on December 20, 2024
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Greenbaum healthcare attorneys Neil M. Sullivan and Jennifer A. Belardo analyze the CMS’s Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule – and its impact on states, healthcare providers, and health plans navigating the Medicaid landscape – in this article recently published by the HFMA’s New Jersey Chapter in its Garden State Focus magazine.

Photo of Jennifer A. Belardo Jennifer A. Belardo

Associate, Healthcare

Jennifer’s practice supports the firm’s representation of healthcare industry clients in litigation, including matters related to insurance defense and coverage, professional liability defense, white collar criminal matters, medical staffing and peer review disciplinary actions, restrictive covenants, breach of contract, professional licensure…

Associate, Healthcare

Jennifer’s practice supports the firm’s representation of healthcare industry clients in litigation, including matters related to insurance defense and coverage, professional liability defense, white collar criminal matters, medical staffing and peer review disciplinary actions, restrictive covenants, breach of contract, professional licensure and credentialing, and employment related claims. She has experience in various areas of commercial litigation, including business disputes and tort claims in New Jersey state and federal court, and has also represented clients in ethical grievance matters.

With a focus on guiding clients to a practical and efficient outcome, Jennifer takes a detail- oriented and analytical approach to her work. She is committed to uncovering the best possible solution for clients that will help them avoid future legal difficulties.

Results may vary depending on your particular facts and legal circumstances.

jbelardo@greenbaumlaw.com | 973.577.1864 | vCard | LinkedIn

For more information visit the Greenbaum, Rowe, Smith & Davis LLP website.

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Photo of Neil M. Sullivan Neil M. Sullivan

Of Counsel, Corporate and Healthcare

Neil’s healthcare and insurance law practice has a particular emphasis on the intersection of healthcare finance and healthcare delivery systems. He has significant experience assisting both healthcare providers and insurance companies in the negotiation and drafting of provider-payer…

Of Counsel, Corporate and Healthcare

Neil’s healthcare and insurance law practice has a particular emphasis on the intersection of healthcare finance and healthcare delivery systems. He has significant experience assisting both healthcare providers and insurance companies in the negotiation and drafting of provider-payer contracting agreements, including participation in commercial, Medicare Advantage and managed Medicaid networks, and provides representation in insurer compensation disputes.

He regularly represents and counsels health plans and healthcare providers in regulatory compliance and filings, and alternative financial models for healthcare delivery, including Medicare Advantage (Part C) and managed Medicaid plans, Organized Delivery Systems (ODS), Accountable Care Organizations (ACO), Multiple Employer Welfare Arrangements (MEWA), and health system equity ownership or participation in insurance organizations. He has provided his expertise in complex regulatory requirements in conjunction with multiple lawsuits.

Neil served as Assistant Commissioner of the New Jersey Department of Banking and Insurance (NJ DOBI) from 2010-2014, a period of fundamental change in both the healthcare and insurance sectors. This encompassed the implementation of the Affordable Care Act (ACA) and the Dodd-Frank Wall Street Reform and Consumer Protection Act, the emergence of alternative financial models for health care delivery, and the transition to electronic health records and implementation of the ICD-10 mandate.

In his role, he had overall responsibility for the implementation of insurance reforms under the ACA, including the establishment of a high-risk pool and feasibility study of health insurance exchanges, and rationalizing conflicting points of state and federal law. He served as the DOBI Commissioner’s designee on the NJ Individual Health Coverage (IHC) and Small Employer Health (SEH) program boards, the Mandated Health Benefits Advisory Commission, and the NAIC Regulatory Framework Task Force and Senior Issues Committee and acted as liaison with the Centers for Medicare & Medicaid Services (CMS) over ACA implementation.

Results may vary depending on your particular facts and legal circumstances.

Contact information:

nsullivan@greenbaumlaw.com | 973.577.1804 | vCard  | LinkedIn

For more information visit the Greenbaum, Rowe, Smith & Davis LLP website.

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  • Posted in:
    Health Care and Life Sciences
  • Blog:
    Healthcare Perspectives
  • Organization:
    Greenbaum, Rowe, Smith & Davis LLP
  • Article: View Original Source

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