Overview

Attorney Kevin Malone helps health care organizations navigate the most complex regulatory, transactional, and strategic issues in managed care and delivery system reform.

Managed care organizations, provider groups, value-based enablement companies, and trade associations seek Kevin’s advice on matters involving, among other things:

  • Medicare Advantage,
  • special needs plans (SNPs),
  • Medicaid managed care organizations,
  • commercial insurers,
  • participants in the Program of All-Inclusive Care for the Elderly (PACE),
  • Medicare Shared Savings Program (MSSP) and ACO REACH entities,
  • self-funded group health plans,
  • third-party administrators, and
  • pharmacy benefit managers.

Guidance on Dual-Eligible Systems, Value-Based Care, and Integrated Health Care Models

With a distinguished body of work on dual-eligible delivery systems and the Mental Health Parity and Addiction Equity Act, Kevin is also a trusted counselor on value-based payment arrangements, risk-bearing structures, and corporate governance for integrated care models. His practice bridges regulatory compliance, business strategy, and dispute resolution, allowing clients to operate confidently in a fast-evolving health care environment.

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Government Policy Experience

Before entering private practice, Kevin served in senior policy roles at the Centers for Medicare & Medicaid Services (CMS), where he developed financing and delivery models for dual-eligible beneficiaries, advanced PACE expansion, and shaped Medicaid policy for medically frail populations. He also worked at the Substance Abuse and Mental Health Services Administration (SAMHSA), focusing on behavioral health integration, billing, and insurance enrollment under the Affordable Care Act.

Thought Leadership and Industry Accreditation

Kevin is a frequent speaker and author on managed care law and policy. He also serves as an accreditation reviewer for URAC’s Mental Health Parity Accreditation Program, assessing compliance with federal parity requirements and industry best practices, and teaches Managed Care Law & Policy as an adjunct professor at The George Washington University Law School.

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Focus Areas

Experience

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  • Currently serves as a seconded general counsel for a regional health plan with responsibility for managed care and government program matters.
  • Served as acting general counsel for a national laboratory network benefit management and technology company.
  • Advises multiple behavioral health medical specialty societies on developing strategies and licensing programs to commercialize medical necessity criteria, including structuring agreements, protecting intellectual property, and ensuring compliance with federal and state parity requirements.
  • Represents value-based enablement companies in establishing innovative risk management and contracting structures to support risk-bearing activities and value-based programs for health systems, primary care groups, and multi-specialty networks.
  • Counseled a major managed care organization in a significant arbitration matter involving a value-based payment arrangement and capitation settlement dispute, including interpretation of applicable federal and state regulatory frameworks.
  • Represents independent practice associations, management services organizations, and Medicare Advantage plans in strategies related to dual-eligible SNP (D-SNP)—including institutional SNP—market entry and operations, delegation and program management, CMS program audits, and regulatory oversight.
  • Represents MSSP ACOs and ACO REACH entities, including high-needs ACOs, in structuring corporate governance, compliance programs, contracting, and strategic planning.
  • Represents payer- and provider-led PACE organizations in complex corporate structuring and real estate matters involved in establishing and operating PACE programs in multiple jurisdictions, including New York and California.
  • Guides Medicare-Medicaid plans, D-SNPs, and PACE organizations through licensure, contracting, and compliance with CMS and state regulatory frameworks.
  • Provides ongoing strategic and regulatory support to behavioral health providers, telehealth companies, and multi-state provider groups on licensure, network development, utilization management, and corporate practice of medicine issues.
  • Represents national trade associations, payers, base organizations, and provider entities in federal and state government advocacy, including regulatory comment drafting, executive policy meetings with agency leadership, and administrative litigation.

Recognition

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

Insights

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Insights

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