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.

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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

Experience

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  • 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

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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