Health Insurance and HMO Regulation

The firm represents HMOs, indemnity insurers and risk-bearing providers in obtaining licensure and complying with applicable federal and state law and regulations. To steer clients through the maze of state and federal regulatory requirements governing health plans, Davis Wright Tremaine has organized a multi-office health plan regulation working group of attorneys, which includes former in-house counsel to the Blue Cross Blue Shield Association and to national HMOs and health insurers.

With the advent of capitation and other risk-based payment mechanisms, health care providers are more often functioning in a manner that may subject them to state regulatory schemes. The firm's attorneys assist in structuring integrated delivery systems and developing health plan-provider contractual relationships in order to minimize regulatory burdens. In this regard, the firm regularly monitors the activities of the National Association of Insurance Commissioners (NAIC) and various state regulatory bodies responsible for licensing health insurers and HMOs.

Examples of Davis Wright Tremaine's health insurance and HMO regulatory practice include:

• Developing of the network of contracts necessary to health plan operations, including group subscription agreements, evidence of coverage documents, provider agreements and grievance procedures.



• Obtaining state registration and federal qualification for HMOs under the Federal HMOs.



• Assisting health plan clients in the development and governmental approval of new plan products, including Medicare risk, Medicaid and workers' compensation managed care plans.

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