Colin focuses on federal health care program payment and operational issues affecting stakeholders with concerns ranging from licensure and survey and certification issues to complex prospective payment system methodologies and coverage, coding and reimbursement strategies for new services and technologies. He advises stakeholder sectors on novel and evolutionary payment systems changes affecting diverse sectors, including insurers, manufacturers, providers and suppliers at the Centers for Medicare and Medicaid Services (CMS). He also represents health care entities under investigation by congressional committees and other law enforcement agencies.
Colin works regularly with clients to craft legislative and regulatory solutions to sophisticated operational and reimbursement problems in Medicare, Medicaid and Exchange-based insurance programs. He previously served as a health policy adviser and counsel to the United States Senate Committee on Finance where he worked on a small team responsible for policy development of major initiatives in Medicare, Medicaid and private insurance, including the creation and evolution of Medicare’s outpatient prescription drug program, or Part D. He also helped break new bipartisan health care coverage ground with the creation of the Health Care Tax Credit (HCTC), which launched new private coverage options for certain U.S. workers displaced by trade agreement outcomes.
- Counsel to leading national organization of kidney dialysis centers since 2004, consulting and advising providers through significant systems changes including the development of the End Stage Renal Disease Prospective Payment System (ESRD PPS), the operation of ACA insurance systems for individuals with ESRD, and numerous other payment and operational challenges faced by providers that care for one of the Medicare program’s most vulnerable populations.
- Counsel to leading national association of home health and hospice providers, guiding and developing creative solutions for new regulatory requirements imposed by the ACA and implementing strategies to mitigate payment reductions mandated by the law.
- Counsel to the leading national manufacturer of device and diagnostic products focused on women’s health.
- Counsel to leading national MSSP participant organizations.
- Counsel to leading national issuers of certified Qualified Health Plan products offered on state, partnership and federally-facilitated exchanges.
- Counsel to health care entities under investigation by congressional committees, the Department of Health and Human Services Office of Inspector General (OIG) and individual United States attorney offices and private plaintiffs in health care whistleblower cases.
- Works with congressional committees, CMS, state Departments of Insurance, Exchange Boards and the Centers for Consumer Information and Insurance Oversight (CCIIO) to provide consensus-based resolution to new and novel issues arising out of the Affordable Care Act (ACA) and in preceding major Medicare bills Colin has been involved with over the last ten years.
- In the wake of the ACA, Colin serves issuers, providers and consumer groups on implementation issues, including insurance and delivery system reforms, counseling clients on Centers for Medicare and Medicaid Innovation Center (CMMI) award initiatives and demonstration projects, including the Medicare Shared Savings Program (MSSP), End Stage Renal Disease Seamless Care Organization (ESCO) and Bundled Payments for Patient Care Improvement (BPCI) programs.
- Works with the National Association of Insurance Commissioners (NAIC) and patient groups on insurance coverage issues and marketplace guidance development.
- Served as one of the United States Senate Committee on Finance’s lead staff members on the advent of enforcement of the Health Insurance Portability and Accountability Act of 1996, and served as the Committee’s point of contact for Medicare’s fee-for-service ambulatory and managed care programs.
- Worked with then-Chairman Senator Charles E. Grassley (R-IA) on federal False Claims Act issues, including the filing of amicus briefs on the Senator’s behalf in federal courts, and serving as liaison to the enforcement community and the OIG on Medicare and Medicaid program integrity issues.
On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) released for public display a proposed rule to implement Section 101 of the Medicare Access and CHIP Reauthorization Act (MACRA), which repealed the Sustainable Growth Rate (SGR) methodology for updates to the Medicare Physician Fee Schedule and replaced it with a new Merit-Based Incentive Program System for eligible physicians (Proposed Rule). MACRA, which was signed into law in April 2015, made significant reforms to the Medicare physician payment system aimed at rewarding quality and value over volume.
May 6, 2016
The U.S. Supreme Court’s decision in King v. Burwell: A multipractice team of Alston & Bird attorneys discusses the decision and its implications for the health care and health insurance industries, administrative law litigation and employers.
June 26, 2015
“King v. Burwell: The Supreme Court Hears the Case About Health Insurance Subsidies,” ABA Business Tax Quarterly, June 2015.
Within just a few hours of each other on Tuesday, July 22, 2014, two federal circuit courts of appeals made headline news with conflicting decisions on a core provision of the Affordable Care Act (ACA) in Halbig v. Burwell and King v. Burwell. This advisory discusses the rationale of each decision, the next steps in the procedural process, the policy and political reactions, and the practical implications in the event the Halbig decision is not overturned, including issues relating to employer penalties, exchanges, and related provisions.
July 31, 2014
- Health Care Compliance Association
- District of Columbia Bar
- Massachusetts Bar
- American Health Lawyers Association, Regulation, Accreditation and Payment Group