C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

Marisa E. Adelson

Marisa E. Adelson

Marisa Adelson is an associate in Crowell & Moring’s San Francisco office, where she practices in the Health Care and Antitrust groups. In her health care practice, Marisa represents managed care payors and provides counseling on regulatory compliance. Marisa’s antitrust practice primarily involves complex antitrust recovery litigation. Marisa has an active pro bono practice and currently represents a client from South Asia seeking asylum in the United States.

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Digital Health, Big Data, Cybersecurity, and Privacy – Four Key Takeaways from C&M’s Digital Health Strategies Conference

Posted in Health IT, HIPAA & Privacy
In late June, Crowell & Moring partnered with Accenture to host a comprehensive one-day conference on legal issues affecting the digital health landscape. The program covered a wide range of topics, some of which you can read more about via the following links: Developing Digital Health Platforms; the Health Care Economy’s Internet of Things; and… Continue Reading

In Case You Missed It . . . Five Key Takeaways in Developing Digital Health Platforms

Posted in Health IT
On June 23, Crowell & Moring and Accenture co-hosted the Fostering Innovative Digital Health Strategies Conference in Crowell’s D.C. office. The goal of the conference was to take a comprehensive look at all of the business and legal issues that need to be addressed as health care organizations and technology companies are considering innovative strategies… Continue Reading

Network Adequacy for Medicaid Managed Care: New Standards under the Final Rule

Posted in Medicaid
The Medicaid Managed Care Final Rule addresses managed care plan network issues while preserving significant flexibility for the states in designing the standards.  The Rule adds a new regulation (42 C.F.R. § 438.68) on network adequacy standards for medical care and Long-Term Services and Supports (LTSS) as well as one related to availability of services… Continue Reading

Senate Health IT Bill May Get Traction

Posted in Health IT, HIPAA & Privacy
A key event in Congress affecting health information technology occurred last week when two members of the Senate HELP Committee issued a discussion draft of their bipartisan legislation on health information technology (health IT).  This ambitious bill addresses many of the same areas as other recent bills, including information blocking, transparency, a star rating system… Continue Reading

U.S. Copyright Office Authorizes New Access to Medical Device Programs and Data under Digital Millennium Copyright Act

Posted in FDA, Health IT
On October 28, 2015, the U.S. Copyright Office of the Library of Congress (the “Office”) issued a Final Rule containing several exemptions to the Digital Millennium Copyright Act that expanded access to medical device computer programs and the patient data they generate.  The Digital Millennium Copyright Act allows intellectual property holders to install “technological protection… Continue Reading

2016 Payment Notice Proposed Rule: Potential Changes to EHBs, Rate Review, and Other ACA Tweaks

Posted in Health Care Reform & ACA
On November 26, 2014, the U.S. Department of Health and Human Services (HHS) released its proposed Notice of Benefit and Payment Parameters for 2016, also known as the “Payment Notice.” Now that HHS has completed the majority of its major rulemakings implementing the Affordable Care Act, the annual Payment Notice has become the recurring opportunity… Continue Reading

CMS Launches ACO Investment Model for Rural and Underserved Areas

Posted in Health Care Reform & ACA, Medicare
On October 15, 2014, the Centers for Medicare & Medicaid Services (“CMS”) launched a new accountable care organization (“ACO”) program that aims to encourage new Medicare Shared Savings Program (“MSSP”) ACOs in rural and underserved areas. The program, known as the ACO Investment Model, provides up to $114 million to as many as 75 ACOs… Continue Reading

CMS & OIG Continue ACO Fraud and Abuse Waivers for Another Year

Posted in Fraud, Waste & Abuse, Health Care Reform & ACA
On October 16, 2014, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”) announced the continuation of the Accountable Care Organization (“ACO”) fraud and abuse waivers for an additional year. The Affordable Care Act (“ACA”) authorized creation of the Shared Savings Program to facilitate development of ACOs in Medicare.… Continue Reading

CCIIO Issues New Guidance on Grace Periods for Non-payment of Premiums in Exchanges

Posted in Exchanges, Health Care Reform & ACA
On July 16, 2014, the Consumer Information and Insurance Oversight (CCIIO) division of the Centers for Medicare & Medicaid Services (CMS) released an Enrollment Bulletin for the individual markets of Federally-facilitated Exchanges (FFEs) about grace periods for premium non-payment. The Bulletin addresses when grace periods related to terminations for premium non-payment fall across enrollment periods… Continue Reading

California Insured with Cancelled Plans Get Continued Coverage for Non-Participating Providers under New Law

Posted in Health Care Reform & ACA
On March 20, Governor Jerry Brown signed AB 369, mandating that plans allow Californians whose individual health plans were canceled by the Affordable Care Act to continue to receive coverage for their non-participating providers through treatment for pregnancy, cancer, and chronic conditions, among others. The bill passed unanimously and as an urgency measure, allowing it… Continue Reading

Obama Administration Authorizes Renewal of Non-ACA Compliant Individual and Small Group Policies; State Regulatory Response Varies

Posted in Exchanges, Health Care Reform & ACA
On November 14, 2013, under increasing political pressure, President Obama announced that the Administration temporarily will allow insurers to renew some individual and small employer policies for 2014—even if these plans do not meet certain Affordable Care Act requirements, such as Essential Health Benefits. The new rules permit insurers, until October 1, 2014, to renew… Continue Reading

OPM Issues Proposed Rule on Exchange-based Healthcare for Congress and Congressional Staffers

Posted in Exchanges, Federal Employees Health Benefits Program (FEHB), Health Care Reform & ACA
On August 7, 2013, the Office of Personnel Management (OPM) released a proposed rule on federal employee health benefits for members of Congress and congressional staff. The Affordable Care Act (ACA) contains a provision requiring Congress and their staff to obtain health insurance coverage via an Affordable Insurance Exchange or a health plan created by… Continue Reading

CCIIO Issues Marketplace FAQ on Consumer Income Verification

Posted in Exchanges, Fraud, Waste & Abuse, Health Care Reform & ACA
On August 5, 2013, the Centers for Consumer Information & Insurance Oversight (CCIIO) issued a new Question and Answer (Q&A) on whether Marketplaces will verify consumer income as part of the eligibility process for advance payment of premium tax credits and cost-sharing reductions. The Q&A explained that Marketplaces will verify this information via documentation submitted… Continue Reading

Final Rule on Coverage of Preventive Health Services Issued

Posted in ERISA, Exchanges, Health Care Reform & ACA
On July 2, 2013, the Department of Health and Human Services (HHS) issued a final rule on coverage of certain preventive services under section 2713 of the Public Health Service Act, added by the Patient Protection and Affordable Care Act and incorporated into the Employment Retirement Income Security Act of 1975 and the Internal Revenue… Continue Reading

Medicare Advantage and Part D MLR Final Rule Issued

Posted in Health Care Reform & ACA, Medicare
On May 20, 2013, the Centers for Medicare and Medicaid Services (CMS) released the final regulations on the Affordable Care Act’s (ACA) medical loss ratio (MLR) requirements for Medicare Advantage and Medicare Prescription Drug Benefit Programs (PDP). The final MLR rule is largely identical to the proposed rule and generally tracks the requirements of the commercial… Continue Reading