Philip Peisch helps clients navigate complex issues and disputes arising out of government-sponsored health care programs. Mr. Peisch has particular expertise regarding the Affordable Care Act (ACA), Medicaid and the Children Health Insurance Program (CHIP). He also counsels clients with respect to Medicare reimbursement; the ACA’s health benefit exchanges; regulation of private health insurance; and other state and federal rules and policies governing the health care industry.
Mr. Peisch advises state agencies, providers, pharmaceutical companies, and other clients on issues related to government-sponsored health care programs, including with respect to:
- The ACA’s premium stabilization programs (risk corridors, risk adjustment, and reinsurance);
- Reimbursement for long-term services and supports;
Medicaid and CHIP coverage of services for individuals with serious mental illnesses and/or intellectual disabilities;
The ACA’s Medicaid expansion and Alternative Benefit Plan requirements;
Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) reimbursement;
Provider donations and taxes;
- Medicaid Disproportionate Share Hospital (DSH) payments;
Medicare and Medicaid Graduate Medicaid Education (GME) payments;
The ACA’s health insurance market reforms, including the essential health benefits requirements and rules governing the health care exchanges;
- Medicare reimbursement policies; and
- Reimbursement for and regulation of services delivered through telehealth technology.
Mr. Peisch represents state agencies in litigation stemming from the operation of their Medicaid programs, including before the HHS Departmental Appeals Board and in federal court. He also represents clients responding to HHS OIG audits.