Managed care organizations trust Kevin Malone to help them understand and navigate their most difficult legal, compliance, and strategic risks and opportunities. As Practice Leader – Public Payers, Behavioral Health, and Long-Term Care, 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.
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.
From 2010 to 2016 after six years, Kevin served 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). 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, Kevin 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.