Overview
Managed care organizations trust attorney Kevin Malone to help them understand and navigate their most difficult legal, compliance, and strategic risks and opportunities.
Kevin draws on more than a decade of experience working at the highest levels of health care financing policy and law to help managed care organizations navigate the web of federal and state regulations and program policies governing the health care financing system. Kevin is a go-to lawyer on issues concerning the Mental Health Parity and Addiction Equity Act (the federal parity law), delivery systems for Medicare-Medicaid dually eligible beneficiaries (such as special needs plans and the Programs of All-Inclusive Care for the Elderly (PACE)), and demonstration models for Medicare and Medicaid.
Kevin also advises providers ranging in size from large hospital systems to start-up health and telehealth companies on legal and strategic matters involving corporate formation, licensing, and third-party payment and coverage with a particular focus on value-based payment strategies. Provider organizations rely on his experience with managed care organizations and government regulators to develop successful strategies for market entry and growth.
Kevin also represents a number of national behavioral health specialty societies, providing legal support and strategic advice on trends in the regulation of utilization management and efforts to license intellectual property to managed care entities for inclusion in medical necessity criteria.
Through the firm's affiliate, EBG Advisors, Inc. (EBGA), and EBGA's affiliate, National Health Advisors, LLC, Kevin also offers strategic counsel in health policy and on health care reimbursement changes.
He joined Epstein Becker Green in 2016 after six years in health care financing policy roles at the U.S. Department of Health and Human Services, most recently with the Centers for Medicare & Medicaid Services (CMS).
Prior to joining Epstein Becker Green, Kevin served as a Health Insurance Specialist with the duals office, where he was the federal lead for implementing demonstration programs that aim to integrate the financing and delivery of Medicaid and Medicare benefits for dually-eligible beneficiaries in Illinois, New York State, and Washington State. Kevin was a lead in the development of a new federal demonstration model for individuals with disabilities based on the PACE model, expanding the model of care to new populations. Previously, he worked with the Disabled and Elderly Health Programs Group at CMS, developing a new policy for the identification and counseling of the medically frail within the Medicaid Expansion population.
As a Public Health Analyst with the Substance Abuse and Mental Health Services Administration (SAMHSA) prior to joining CMS, Kevin managed multiple multimillion-dollar federal procurements and led the agency’s efforts to help substance abuse and mental health treatment providers implement advanced contracting, billing, and care coordination practices. In addition, he spearheaded SAMHSA’s efforts at public and private insurance enrollment following the enactment of the Affordable Care Act.
Before joining HHS, Kevin served as a Peace Corps volunteer in Zambia, where he founded the nation’s first male-focused domestic violence prevention project.
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Focus Areas
Services
Experience
- Serves as a seconded general counsel for a regional health plan with responsibility for managed care and government program matters.
- Serves as acting general counsel for a national laboratory network benefit management and technology company.
- Develops and serves as program manager for the nation’s first third-party commercial accreditation program assessing insurers’ capacity to comply with the requirements of the federal parity law. As part of this role, Kevin developed the nation’s first enterprise-software solution for insurers and managed care entities’ parity compliance.
- Serves as outside counsel to regional and national health insurers and managed care companies on compliance with:
- federal parity law,
- the Medicare Advantage program,
- Medicaid managed care and managed long-term care programs,
- PACE,
- state insurance and utilization review laws, and
- state and federal laws and programs governing value-based reimbursement.
- Serves as strategic advisor and outside counsel to multiple national behavioral health medical specialty societies on the development and deployment of behavioral health clinical guidelines, intellectual property, and transactional matters.
- Serves as strategic advisor and outside counsel to a quasi-public Medicaid pre-paid inpatient health plan (PIHP) providing managed care business strategy, government relations, and legal representation covering transactional and compliance matters in an ongoing redesign of the state’s Medicaid delivery system.
- Serves as outside counsel to a multistate, for-profit PACE company.
- Serves as outside counsel to multiple national telemental health companies on state law compliance, third-party payment, and coverage compliance and negotiations.
- Provides strategic counseling and transactional support to private equity and venture capital firms and other potential investors in managed care, behavioral health, and long-term care industries.
- Represents hospitals and health systems in value-based contract negotiations and regulatory disputes with major national payors.
- Advises states and trade associations on the design and implementation of Medicaid health delivery systems, especially those targeting Medicare-Medicaid dual-eligible beneficiaries.
Recognition
- The Best Lawyers in America, “Ones to Watch,” Health Care Law (2022-2024)
- Washington, DC, Rising Stars, Health Care (2022-2024)
- The Legal 500 United States, Healthcare: Health Insurers (2023)
Credentials
Education
- The George Washington University Law School (J.D.)
- Washington University in St. Louis (B.A.)
Bar Admissions
- District of Columbia
- Massachusetts
- New York
Media
Events
Past Events
- Spring 2024
- October 24, 2022
- October 29, 2021
Insights
Insights
- Firm Announcements
Fourteen Epstein Becker Green Attorneys Named to the 2024 Washington, DC Super Lawyers and Rising Stars Lists
7 minute read - BlogsSAMHSA Final Rule Regarding OTPs Expands Access, Increases Flexibility for Patients5 minute read
- BlogsCMS Announces New Primary and Behavioral Health Care Integration Demonstration Model5 minute read
- PublicationsTop Ten Issues in Health Law 2024—Major Expansion of Federal Regulation of Managed Care Through the Mental Health Parity ...6 minute read
- PublicationsCalifornia Finalizes SB 184 Pre-Transaction Notice Requirements for “Material Change” Health Care Transactions ...26 minute read
- PublicationsMedicare Advantage, Part D, and More: Proposed Rule Outlines Significant Policy and Technical Changes for CY 2025 ...35 minute read
- PublicationsCalifornia Enacts Statute That Furthers Efforts to Move Toward a Unified Health Care Financing System11 minute read
- Firm Announcements
Epstein Becker Green Attorneys Recognized by 2024 Best Lawyers for Excellence in the Legal Profession
12 minute read - PublicationsCMS Announces the Making Care Primary Model, a Multistate Initiative to Strengthen Primary Care9 minute read
- Firm Announcements
Epstein Becker Green Earns National Recognition and High Rankings in the 2023 Edition of Legal 500
3 minute read - Firm Announcements
Thirteen Epstein Becker Green Attorneys Named to the 2023 Washington, DC, Super Lawyers and Rising Stars Lists
4 minute read - PublicationsBiden Administration Prioritizes Health Equity in Proposed Reforms to Medicare Managed Care33 minute read
- Firm Announcements
Epstein Becker Green Attorneys Recognized by 2023 Best Lawyers for Excellence in the Legal Profession
11 minute read - Media CoverageLaw360 Names the 10 Epstein Becker Green Attorneys Who Moved Up the Ranks in 20222 minute read
- PublicationsACO REACH Model: Legal Requirements for ACO Agreements with Providers8 minute read
- Firm Announcements
Thirteen Attorneys Named to the 2022 Washington, DC, Super Lawyers and Rising Stars Lists
5 minute read - PublicationsMental Health Parity: Increased Enforcement Efforts Highlighted in 2022 Report to CongressSpring 20222 minute read
- Publications2022 Mental Health Parity Report to Congress Highlights Increased Enforcement Efforts20 minute read
- PublicationsTri-Agencies Release Report on Mental Health Parity and Addiction Equity Act (MHPAEA) Compliance1 minute read
- Media CoverageKevin Malone, David Shillcutt Quoted in “DOL Says Employers Struggling with Mental Health Parity Law”4 minute read
- Media CoverageGary Herschman, Kevin Malone Discuss Private Equity’s Push into the Mental Health Space in Q&A with Dana Jacoby ...3 minute read
- Firm AnnouncementsEpstein Becker Green Announces 2022 Promotions6 minute read
- PublicationsU.S. Department of Labor Settles Unprecedented Lawsuit Against United Healthcare for Alleged Violations of the Mental ...2 minute read
- Media CoverageKevin Malone Quoted in “Employers on Hook for Mental Health Parity Despite New Target”4 minute read
- PublicationsBest Practices for Mental Health Parity: Considerations for ImplementationAugust 20213 minute read
- Firm AnnouncementsThirty-Five Epstein Becker Green Attorneys Recognized as “Ones to Watch” by The Best Lawyers in America 2022 ...5 minute read
- PublicationsU.S. Department of Labor Settles Unprecedented Lawsuit Against United Healthcare for Violations of the Mental Health ...12 minute read
- Firm AnnouncementsEpstein Becker Green Receives 2021 Beacon of Justice Award for “Redefining Justice”6 minute read
- PublicationsMental Health and Substance Use Disorder Parity Compliance: Documentation Requirements and Federal Enforcement ...March-April 20212 minute read
- PublicationsNew York’s Strict Requirements for Insurers’ Mental Health and Substance Use Disorder Parity Compliance and Oversight ...3 minute read
- PublicationsNew York's Strict Requirements for Insurers' Mental Health and Substance Use Disorder Parity Compliance and Oversight ...10 minute read
- PublicationsPost-Acute Care and "COVID-19 Centers of Excellence"9 minute read
- Media CoverageBloomberg Law "Weekend Read” Features Epstein Becker Green Insights on Health-Care Coverage and Reimbursement Amid ...2 minute read
- PublicationsINSIGHT: Health-Care Coverage and Reimbursement Amid Coronavirus2 minute read
- PublicationsFamilies First Coronavirus Response Act: Guidance for Health Care Providers and Plans Regarding COVID-1912 minute read
- Media CoverageKevin Malone Quoted in "ClearHealth Quality Institute Launches ParityManager™ Compliance Tool"1 minute read
- PublicationsNew Jersey's Surprise Medical Bill Law: Part 2: Comparison to New York's and California's "Surprise Bill" Laws2 minute read
- PublicationsNew Jersey's Surprise Medical Bill Law: Part 1: Regulatory Issuances by New Jersey Agencies16 minute read
- PublicationsExpansion of Medicare Advantage Supplemental Benefits: A New World of Opportunities for Providers5 minute read
- PublicationsExpansion of Medicare Advantage Supplemental Benefits: A New World of Opportunities for Providers4 minute read
- Media CoverageKevin Malone Quoted in "Minimize Business Risk When Patients Leave Against Medical Advice"3 minute read
- PublicationsNew Jersey’s Surprise Medical Bill Law: Implications and National Trends22 minute read
- PublicationsMental Health Parity: Compliance Steps for Plan Sponsors1 minute read
- PublicationsAssociation Health Plans: New Proposed Rule to Help Convert Small Businesses and Self-Employed Individuals into a Status ...13 minute read
- PublicationsSAMHSA Finalizes Additional Changes to the Confidentiality of Substance Use Disorder Patient Records Regulations ...20 minute read
- PublicationsAssessing President Trump's "Executive Order Promoting Health Care Choice and Competition"13 minute read
- PublicationsThe October Deadline for Compliance with Medicaid Mental Health Parity Requirements2 minute read
- PublicationsDespite White House Shake-Up, Value-Based Pay Is Here to Stay2 minute read
- Media CoverageHelaine Fingold, Kevin Malone Quoted in "Behavioral Health Benefits Shift with GOP Plan"1 minute read
- Media CoverageKevin Malone Quoted in "CMS Proposes to Give Three Duals Demos More Time to Bear Fruit"2 minute read