Risk Bearing Entity Requirements: Massachusetts
This blog discusses the regulatory requirements that apply to risk-bearing entities in Massachusetts, including recent updates introduced by Chapter 343 of the Massachusetts Acts of 2024.
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Insights by Alexandra Shalom
Alexandra (Allie) Shalom is a senior counsel and health care lawyer with Foley & Lardner LLP and member of the Health Care Practice Group and co-chair of the firm’s Health Care & Life Sciences Sector’s Payor Provider Convergence Area of Focus.
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AHLA Health Care Transactions Conference 2025
Foley partner Leah D’ Aurora Richardson and senior counsel Alexandra Shalom, co-chair of the firm’s Payor/Provider Convergence Area of Focus, are speaking at the American Health Law Association’s (AHLA) Health Care Transactions conference on May 5-6.
Massachusetts: Expansion of Oversight Authority — New Notice of Material Change Form for Health Care Transactions
The Massachusetts Health Policy Commission, an independent state agency that works to improve affordability of health care for residents of the Commonwealth, released Advance Guidance for “Providers” and “Provider Organizations” considering transactions subject to the HPC’s updated Notice of Material Change process.
Private Equity and Health Care – A Policy Discussion
Foley partner Larry Vernaglia, co-chair of the firm’s Providers of Health Care Services Area of Focus, and senior counsel Allie Shalom, co-chair of the firm’s Payor/Provider Convergence Area of Focus, are speaking in Healthcare Financial Management Association’s upcoming webinar titled “Private Equity and Health Care – A Policy Discussion” on April 30.
Medicare Payment Model Trends and Economic Drivers – Awaiting Direction from Trump Administration
The Medicare program continues to face long term financial pressures associated with inflationary effects on health care costs and the growing wave of aging baby boomers. The Medicare Trust Fund, which is often viewed as a foil for health care affordability, has long faced a proverbial financing question.
Massachusetts: New Year, New Law — Governor Signs “An Act enhancing the market review process” (House Bill No. 5159)
On January 8, 2025, Governor Maura Healey signed into law H.B. 5159, “an Act enhancing the market review process.”
Massachusetts “Patients First Act” Implementation and Enforcement Re-Extended
The Massachusetts Senate proposed an amendment on Monday December 2, 2024, that would delay implementation and enforcement of the 2021 Patients First Act addressing health care cost transparency.
Risk Bearing Entity Requirements: An Introduction
Providers and provider organizations are increasingly contracting with payors to manage specific patient pools and diseases on a risk basis.
New HCPCS for Advanced Primary Care Management
The Center for Medicare & Medicaid Services issued the display copy of the final Calendar Year 2025 Physician Fee Schedule on November 1, 2024, which included three new Healthcare Common Procedure Coding System codes for advanced primary care management.