Epstein Becker Green

Client Services

• Exploration: Feasibility, Marketing Analysis, Planning, Pro Forma, Regulatory License and Infrastructure Requirements, Legal Structuring Options, Expansion Planning, Financial Reserves Planning, Banking/Finance Strategy
• Development: Application, Licensing, Comprehensive Legal, Strategic and Operational Support on Structuring, Applications, Government Relations, Financing, Licensing
  
• Operations: Audit Prep, Growth, Operations, Training/Coaching, Outside General Counsel Services on All Legal and Regulatory Issues Facing PACE Organizations, Including Federal and State Compliance, Government Relations, Corporate Counseling, Employment Law, Litigation, Contracting, Privacy/Security, Banking and Tax Matters

Key Employees and PACE Experience

Kevin Malone and Helaine Fingold are the key leaders, but they work closely with the more than 350 health care and employment law attorneys at Epstein Becker Green (EBG) and the robust consulting team at EBG Advisors to provide comprehensive support to PACE organizations.

Kevin Malone, Partner

Kevin is a nationally regarded expert on PACE. He serves as the seconded general counsel with responsibility for PACE programs in two states and as outside counsel to four organizations with current PACE programs or in various stages of development. 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), 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 and Washington. Kevin was a lead in developing 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 identifying and counseling individuals who are medically frail in the Medicaid Expansion population.

Helaine Fingold

Helaine is a member of the firm in the Baltimore, MD, office. Her clients range from small start-ups to large corporate entities with multiple subsidiaries, including Medicare Advantage (MA), PACE, Medicaid and other managed care plans; provider entities; vendors to providers and managed care companies, including administrative support entities, providers of software and online services, agents/brokers/field marketing organizations, and advertising/marketing entities. Her practice focuses on the regulation of Medicare managed care, including MA, Part D, dual-eligible individuals and PACE demonstrations; Medicaid managed care; commercial managed care products, including surprise billing; and behavioral health, including mental health parity. Helaine helps clients understand and address state licensure rules that apply to their business; develop and submit PACE, MA, Qualified Health Plan (QHP) and other managed care applications for qualification; respond to deficiencies in PACE and Medicare Advantage applications; appeal the denial of PACE and MA applications; challenge and get withdrawn federally issued compliance notices for allegedly failing to comply with PACE or MA regulations and guidelines; and identify and correct noncompliance with PACE and Medicare managed care laws and regulations. Before building her private practice, Helaine gained 20 years of experience in the federal government, including 13 years at CMS working on PACE, Medicaid, MA/Part D and ACA implementation, as well as seven years at MedPAC. During her time at CMS, she was part of the team that implemented the MA program prior to its roll-out in 2006. She also worked with the team that implemented the Affordable Care Act requirements applicable to federal and state health care marketplaces, QHPs, and individual and small group commercial insurance. Her government experience includes serving as general counsel for the Medicare Payment Advisory Commission.

Began Providing Technical Assistance for PACE

2016

PACE Clients Served

6

PACE Applications Submitted

3

PACE Organizations Moved from Market Feasibility to Ongoing Operations

4

State Rate-Setting Experience

As counsel to PACE, Medicare and Medicaid managed care organizations, EBG and EBG Advisors, including actuarial resources, have extensive experience developing and negotiating Medicaid capitated rates. As regulators at CMS prior to joining EBG, members of the EBG team have experience working with rate-setting processes for Medicaid and Medicare programs.