Over the past few years, changes in healthcare have driven fundamental changes in the relationship between providers and Managed Care Organizations. Medicare and Medicaid are front and center in these changes. Successful systems need new ways to look at managed care contract negotiations.

On May 18, 2023, Greenbaum attorney Neil M. Sullivan will be a panelist for a live CLE webinar on “Managed Care Contracts: Medicare and Medicaid Considerations.” The program, presented by Strafford, will examine essential questions including:

  • How have the changes in healthcare and the shift to Medicare and Medicaid impacted the negotiation of managed care agreements?
  • What are some proven approaches for providers’ counsel in negotiating favorable provisions in managed care contracts?
  • What are the most commonly disputed issues during contract negotiations and practical approaches for resolving them?
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Photo of Neil M. Sullivan Neil M. Sullivan

Of Counsel, Corporate and Healthcare

Neil’s healthcare and insurance law practice has a particular emphasis on the intersection of healthcare finance and healthcare delivery systems. He has significant experience assisting both healthcare providers and insurance companies in the negotiation and drafting of provider-payer…

Of Counsel, Corporate and Healthcare

Neil’s healthcare and insurance law practice has a particular emphasis on the intersection of healthcare finance and healthcare delivery systems. He has significant experience assisting both healthcare providers and insurance companies in the negotiation and drafting of provider-payer contracting agreements, including participation in commercial, Medicare Advantage and managed Medicaid networks, and provides representation in insurer compensation disputes.

He regularly represents and counsels health plans and healthcare providers in regulatory compliance and filings, and alternative financial models for healthcare delivery, including Medicare Advantage (Part C) and managed Medicaid plans, Organized Delivery Systems (ODS), Accountable Care Organizations (ACO), Multiple Employer Welfare Arrangements (MEWA), and health system equity ownership or participation in insurance organizations. He has provided his expertise in complex regulatory requirements in conjunction with multiple lawsuits.

Neil served as Assistant Commissioner of the New Jersey Department of Banking and Insurance (NJ DOBI) from 2010-2014, a period of fundamental change in both the healthcare and insurance sectors. This encompassed the implementation of the Affordable Care Act (ACA) and the Dodd-Frank Wall Street Reform and Consumer Protection Act, the emergence of alternative financial models for health care delivery, and the transition to electronic health records and implementation of the ICD-10 mandate.

In his role, he had overall responsibility for the implementation of insurance reforms under the ACA, including the establishment of a high-risk pool and feasibility study of health insurance exchanges, and rationalizing conflicting points of state and federal law. He served as the DOBI Commissioner’s designee on the NJ Individual Health Coverage (IHC) and Small Employer Health (SEH) program boards, the Mandated Health Benefits Advisory Commission, and the NAIC Regulatory Framework Task Force and Senior Issues Committee and acted as liaison with the Centers for Medicare & Medicaid Services (CMS) over ACA implementation.

Results may vary depending on your particular facts and legal circumstances.

Contact information:

nsullivan@greenbaumlaw.com | 973.577.1804 | vCard  | LinkedIn

For more information visit the Greenbaum, Rowe, Smith & Davis LLP website.