WILMINGTON, DE, January 19, 2017 – Stevens & Lee Shareholder Richard J. King and Associate Stephanie A. Wilhelm presented “Pennsylvania Community HealthChoices: An Overview of Managed Care Contracting” at a webinar held by LeadingAge PA, an association of not-for-profit services, on January 5, 2017.
Mr. King and Ms. Wilhelm provided an overview of Pennsylvania’s Community HealthChoices (CHC), an initiative that will use managed care organizations to coordinate health care coverage and long-term services and support for eligible individuals receiving Pennsylvania’s Medical Assistance with an emphasis on placement in care communities over facilities. They outlined CHC’s purpose, provider enrollment process, eligible providers and payment, and benefits including how CHC facilitates an individual’s integration into a managed care community. They also provided an overview of managed care contracting strategies and discussed the effect of the CHC initiative on managed care contracting and reimbursement through an analysis of the provider role in both fee-for-service and managed care packages.
Mr. King concentrates his practice in health law, with emphasis on federal and state regulatory compliance and third party reimbursement, including Medicare, Medicaid and non-governmental commercial payers. He also represents health care providers in litigation matters in federal and state courts and before the Provider Reimbursement Review Board, Federal Administrative Law Judges and state administrative agencies, including the Bureau of Hearings and Appeals of the Pennsylvania Department of Public Welfare.
Mr. King has represented more than 100 nursing homes, hospitals and personal care facilities in state and regulatory proceedings, including survey, certification and certificate of need matters. He has appealed Medicaid and Medicare disputes in which additional reimbursement for hospital and nursing home clients was obtained and has defended clients in insurance, health care, commercial and franchise law matters.
Mr. King’s health care transactional experience includes structuring, negotiating and executing healthcare provider merger and affiliation, medical practice acquisitions, complex managed care contracts and counseling clients on compliance with federal and state laws, including the Anti-Kickback Statute, HIPAA and the physician self-referral prohibitions (Stark).
Mr. King has an M.P.H. in Health Policy and Management from Harvard University, a J.D. from the University of North Carolina School of Law and a B.A., with distinction, from the University of Virginia.
Ms. Wilhelm concentrates her practice in health care regulatory and transactional matters, including mergers and acquisitions, joint ventures, licensing, fraud and abuse, corporate governance, reimbursement and HIPAA. She advises a spectrum of health care providers, including health care systems, hospitals, nursing facilities, physicians, medical laboratories, home care companies and pharmacies. She received a J.D., magna cum laude, from Pennsylvania State University’s Dickinson School of Law, and a B.A. from Columbia University. While in law school, she served as Senior Editor of the Penn State Law Review.