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Managed Care Law Manual Managed Care Law Manual

Managed Care Law Manual

By Jeanine Mazzorana
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Managed Care Law Manual is a unique legal guide specific to managed care filled with the facts health care attorneys, managed care organizations, and health care administrators need to make informed choices. This legal guide will help you know not only your legal obligations, but also those of your contracting partners, employers, third-party payers, physicians, and others so you can form the joint alliances that will be essential in the health care reform days ahead. This manual is always current with twice a year updates.

Managed Care Law Manual has been updated to include:

  • New information on CMS's proposed rule on the Medicare shared savings program for accountable care organizations
  • Up-to-date material on civil monetary penalty sanctions under the Health Insurance Portability and Accountability Act
  • Information on states that require coverage for autism treatment
  • Updated material on states that require health plans to cover patient care costs in clinical trials
  • Case law regarding unreasonable restraint of trade
  • New material on state external review laws
  • Recent ERISA case law addressing claims based on denial of coverage
  • Seff v. Broward County, a recent case dealing with voluntary wellness programs and the Americans with Disabilities Act (ADA)
  • New case law addressing false claims and credentialing
  • Recent OIG advisory opinions regarding the Anti-Kickback statute
  • Up-to-date material regarding state false claims acts
  • Information on the recently released IRS/Treasury Priority Guidance Plan
  • New CMS guidance regarding Medicare Advantage (MA) marketing and enrollment
  • Recent case law regarding mental health coverage

Note: Online subscriptions are for three-month periods.

Last Updated 12/10/2018
Update Frequency 3 times annually
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9780834205413
SKU 10044794-7777
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 000000000010048334
Table of Contents
  1. Managed Care Organizations, Affiliated Entities, and Integrated Delivery Systems
  2. Overview of Federal Regulation
  3. State Regulation of Managed Care
  4. Business Structures
  5. Antitrust
  6. External Review
  7. ERISA
  8. Trends in Managed Care Litigation
  9. Contracting
  10. Accreditation of Health Care Organizations
  11. Credentialing
  12. Fraud and Abuse Issues Affecting Managed Care Entities
  13. Special Issues for Tax-Exempt Organizations in Managed Care
  14. Contracting with the Government
  15. Pharmacy
  16. Behavioral Health Care
  17. Marketing
  18. Managed Care Compliance
  19. Electronic Information in Managed Care
  20. Resource