Copyright 2019 by Susan M. Erickson, Esq.

Primary Areas of Practice

Contract Drafting/Editing/Negotiation

  • Provider contracts with managed care organizations (“MCOs”), including value-based, incentive       arrangements

  • MCO delegation agreements with behavioral health, vision, dental, disease management, nurse hotline and PBM subcontractors

  • Telemedicine, telehealth, and delegated credentialing agreements 

  • Third-party administrator and utilization review services agreements

  • Management services and health care consulting agreements

  • Settlement agreements between MCOs and health care providers

  • Single-case agreements between MCOs and non-network providers

 

Operational and Regulatory Compliance

  • Review and draft comments to Medicaid managed care, Medicare Advantage and Medicare-Medicaid Plan (“MMP”) contracts between MCOs and state Medicaid agencies and/or CMS

  • Review and draft comments to state and federal regulations affecting Medicaid, SCHIP, Medicare, MMP, the Exchange/marketplace plans and general health care and insurance matters

  • State licensure – compliance matters, filings and administrative penalty matters including drafting of corrective action plans

  • Policy and procedure review and revision for compliance purposes, including HIPAA privacy and security policies and business associate requirements

  • Interpretation and education on Medicaid, HMO, health insurance and general health laws, from both state and federal sources

 

Health Plan Coverage Documents and Provider Network Filings

  • Draft and edit on- and off-Exchange evidences of coverage and certificates of coverage, group policy forms, and ancillary documents for HMOs and PPOs

  • Draft Medicaid and Medicare member handbooks and provider manuals

  • Prepare and file service area expansion applications

  • Develop and file network adequacy access plan materials

 

Interface with State and Federal Agencies

  • Draft and file letter briefs to protect company information requested in an Open Records request submitted to a state or federal agency

  • Prepare responses to member, provider and legislative complaints filed against the MCO

  • Attend stakeholder and workgroup meetings at the Texas Health and Human Services Commission, the Department of Aging and Disability Services, and the Texas Department of Insurance