The required reading materials will reflect the very dynamic changes occurring in this area of health law. As a result, there is no case book as relevant cases and related heath policy materials will be posted by the professor sufficiently in advance of the scheduled class and as changes in circumstances require. Students will be required to actively participate in class discussions, including assigned opportunities to advocate for various health policy positions as part of an overall class assessment of health law developments.

The course will analyze the commercial health insurance markets with a particular focus on the impact of the Affordable Care Act as well as the effect that ERISA has on health insurance reform. A comparison of state vs. federal law initiatives in the health insurance area will be a focus of the course. As part of this review, the Federal No Surprises Act and its implementing regulations will be addressed.

The use of private insurers to provide coverage to Medicare beneficiaries, including the Medicare Advantage Part C and Medicare Part D Programs will be analyzed. In addition, the course will assess how State Medicaid Programs contract with managed care plans to provide coverage to Medicaid recipients. This will include Arizona’s longstanding managed Medicaid Program known as “AHCCCS.”

The impact of prescription drug prices on health insurance premiums will be addressed. This includes efforts by health insurers to manage these costs, as well as state and federal law initiatives that attempt to control prescription drug prices.

Evolving changes in provider payment systems utilized by health insurers will be identified along with the dramatic shift away from the traditional fee-for-service model to payment innovations focused on quality outcomes and cost efficiencies. The potential for health care fraud and False Claims Act violations will be analyzed in the context of a federal managed care payment environment.

Finally, the role of the insured as a consumer of health care services will be explored. This will include the issue of financial engagement and the information consumers need to have about provider networks, health care costs, and quality outcomes to ensure the competitiveness of the health insurance marketplace. As part of this process, we will examine federal law and regulations governing hospital and health plan price transparency in order to assess how such information will likely benefit consumers in the health insurance marketplace.

Additional Information:
Credit Hours: 3
Grading Option: Letter Grade Only
Graduation Writing Requirement: No
Flexible/Upper-Level Writing Requirement: Yes
Skills Requirement: No
Simulation Course: No
Experiential Learning: No
Seminar: Yes
Prerequisite: It is recommended that students have taken a more general health law survey course or health law and policy course before enrolling in this course.
Special Withdrawal Course: No
Limited Enrollment Number: 15
Final Exam Given: No
Paper Or In-Class Presentation: Yes, Paper
Attendance Policy: Per Statement Of Student Policies
Teaching Method: In Person

* The law school has a policy that is used to calculate credit hours. Please see the Statement of Student Policies.