Accountable Care Organizations

Health Care

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In various phases of their accountable care organization (ACO) projects, Stevens & Lee assists health systems, hospitals, physician practices and other health care providers in the context of participation in governmental programs, such as the Medicare Shared Savings Program, and comparable programs and initiatives involving commercial payors.

Specifically, we provide legal advice and consultation in connection with the following:

  • Exploratory and planning phases of ACO initiatives
  • The development of ACO entities, governing documents, key policies and participation arrangements
  • Assessment and evaluation of invitations to join existing ACOs
  • Negotiation of participation agreements with payors
  • The application process to participate in governmental programs

Stevens & Lee is also experienced in matters involving the development of integrated delivery systems, clinically integrated multi-provider networks and other managed care organizations, such as preferred provider organizations (PPOs) and health maintenance organizations (HMOs), payor-provider managed care joint ventures, and innovative clinical care/reimbursement models, such as accountable care organizations and medical homes, among others. We have assisted a wide range of provider/managed care clients throughout the phases of their life cycles, from initial exploration and strategic planning to formation, organization and capitalization. We also have assisted in licensure and compliance assessments and their dealings with regulators, other providers or managed care entities, vendors and the governmental payors administering managed care programs with respect to Medicaid/Medical Assistance and Medicare, among other programs.

We also closely monitor governmental actions and regulations related to such initiatives and have submitted comments to proposed regulations on behalf of interested clients. As a result of our unique experience, our attorneys have been invited to speak and publish materials related to ACOs, integrated delivery systems and other health care reimbursement initiatives and innovations.

As part of our work in this area, we assist clients in complying with various laws affecting these integrated delivery systems, including: antitrust laws; the Stark Law; the Anti-Kickback Statute and Civil Monetary Penalties Law; fraud and abuse laws; insurer and managed care licensure/regulation; federal, state and local tax matters; IRS regulations governing tax-exempt organizations; labor and employment issues; employee benefits regulation; and health reform preparation and adaptation. We also assist clients with issues pertaining to HIPAA, information technology, electronic medical records maintenance and data privacy as they relate to the collaboration required by ACOs and other integrated delivery systems.

Franklin_Harriett

Harriet Franklin

Shareholder

hf@stevenslee.com

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Valley Forge: 610.205.6014

Gritz_Clayton

Clayton Gritz

Associate

cg@stevenslee.com

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Valley Forge: 610.205.6359

Henefer_Tom

E. Thomas Henefer

Shareholder

eth@stevenslee.com

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Reading: 610.478.2223

Hennessey_Daniel

Daniel J. Hennessey

Shareholder

djh@stevenslee.com

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Valley Forge: 610.205.6011

Reading: 610.478.2093

Hogan_John

John M. Hogan

Shareholder

jho@stevenslee.com

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Valley Forge: 610.205.6013

Honart_Charles

Charles M. Honart

Shareholder

cmh@stevenslee.com

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Valley Forge: 610.205.6017

Judge_Joanne

Joanne M. Judge

Shareholder

jmj@stevenslee.com

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Lancaster: 717.209.5866

Reading: 610.478.2226

King_Richard

Richard J. King

Shareholder

rjk@stevenslee.com

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Wilmington: 302.425.3303

Marshall_Chip

Joseph W. “Chip” Marshall, III

Vice Chairman

chip.marshall@stevenslee.com

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Philadelphia: 215.751.1240

McEvilly_Walt

Walter P. McEvilly, Jr.

Of Counsel

wpm@stevenslee.com

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Wilmington: 302.425.3300

Moak_Doug

Douglas L. Moak

Associate

dm@stevenslee.com

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Valley Forge: 610-205-6005

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Kirsten McAuliffe Raleigh

Shareholder

kmr@stevenslee.com

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Valley Forge: 610.205.6015

Tammany_Tom

Thomas M. Tammany

Shareholder

tmt@stevenslee.com

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Princeton: 609.987.5339

Valley Forge: 610.205.6342

Urban_Cathy

Catherine Reese Urban

Shareholder

cru@stevenslee.com

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Valley Forge: 610.205.6021

Wilhelm_Stephanie

Stephanie A. Wilhelm

Associate

sawi@stevenslee.com

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Valley Forge: 610.205.6022

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