Legislative and Regulatory Strategies » Print This Page

Our attorneys have significant experience assisting clients and their government relations teams to both: (1) proactively identify new legislative and regulatory strategies that result in sustainable benefit; and (2) model the impact and develop a strategy to address legislative and regulatory changes as they are proposed.

Our proactive approach to government reforms includes evaluating potential changes in program structure or reimbursement, analyzing how those changes will impact each client from an operational and reimbursement standpoint, and then advising those clients of both the potential opportunities to request changes in the reforms and the policy rationale supporting those changes.  Additionally, we work to identify changes in government programs that, although not currently under consideration by the government, would be advantageous to our clients and consistent with existing government policy.  In those cases, we assist the provider to develop and model the reform, prepare educational materials regarding the impact of the reform and its policy support and, when the law allows, educate the governmental entity and third-party stakeholders regarding the requested reform.

We also assist clients to evaluate the impact of unexpected reforms in government programs and, if those reforms are detrimental, to identify and explain needed changes to those reforms.  When these reforms are inconsistent with existing law, we also assist clients to challenge the reforms in informal, administrative and judicial settings.

Examples of our past legislative and regulatory strategies work include:

  • Working with State Medicaid agencies to prepare administrative regulations and the necessary public notice documents to implement Medicaid reforms, including Medicaid rate changes, new Medicaid supplemental reimbursement programs and administrative changes.
  • Working with State Medicaid agencies to develop comprehensive strategies for implementing the transition of a portion of their patient population from traditional Medicaid fee-for-service reimbursement to a Medicaid managed care program, while avoiding any disruption in Medicaid supplemental reimbursement to participating providers.
  • Helping individual hospitals and statewide associations to model the impact of Medicaid reimbursement reforms, including proposals to implement provider fees/assessments, and preparing policy-based arguments to either support or defeat these proposals.
  • Advising clients regarding the applicability of proposed Medicaid 1115 Waiver Terms and Conditions and assisting them with formal comments during the rulemaking process.
  • Developing strategies for hospital coalitions to address the equitable allocation of State Medicaid reimbursement.
  • Monitoring and analyzing changes in the administrative regulations governing Medicaid claims reimbursement and advising providers on the impact of these changes.
  • Assisting hospitals to model the impact of reforms in state Medicaid Disproportionate Share Hospital programs and present public comments in response to these reforms.
  • Assisting a group of behavioral health hospitals to model the impact of a proposed change in their Medicaid reimbursement methodology, identify an alternate methodology that more accurately compensates the types of services they provide, prepare educational materials regarding the rationale supporting the alternate methodology, and then draft the legislation necessary to direct the Medicaid agency to implement that methodology.