Health Headlines –February 2, 2026

CMS Proposes Revised Conditions for Coverage for Organ Procurement Organizations

On January 30, 2026, CMS published a proposed rule (2026 Proposed Rule) that clarifies parts of the agency’s requirements for recertification of Organ Procurement Organizations (OPOs). In particular, the proposed rule attempts to address certain ambiguities and operational challenges that have arisen in connection with the new recertification process established by CMS’s December 2020 final rule (2020 Final Rule).

Background

In 2000, Congress rejected CMS’s reliance on limited outcome metrics to measure OPO performance. It directed CMS to establish a recertification process that relies on both process measures and multiple outcome measures to assess OPO performance over a four-year period.  Congress instructed that CMS’s measures of performance should go beyond considering only donor potential and instead also take account of other related factors in each OPO’s designated service area that are relevant to evaluating performance and increasing organ donation.

In 2019, President Trump signed Executive Order 13879, “Advancing American Kidney Health,” directing the HHS Secretary to improve the procurement and utilization of organs from deceased donors.

CMS responded by promulgating its 2020 Final Rule. The 2020 Final Rule established a new three-tier system that ranks OPOs based on the calculation of two limited outcome metrics (a donation rate and transplantation rate). Tier 1 OPOs—those deemed by CMS to be in the top 25% for both their donation rate and transplantation rate—are recertified; Tier 2 OPOs —those deemed to have one or both of their calculated rates above the median but below the top 25%—must compete to retain their service areas; Tier 3 OPOs—those deemed to have one or both calculated rates below the median—will be decertified and barred from participating in the nation’s organ donation system. The 2020 Final Rule also established a phased implementation schedule, with the two new outcome metrics taking effect on August 1, 2022, and the first recertification cycle based on those metrics set to conclude on July 31, 2026.

The 2020 Final Rule is available here.

The Final Rule is currently subject to litigation in lawsuits filed across the country, including in federal district courts in the Middle District of Florida, in the District of Columbia, and in the District of North Carolina. The lawsuits challenge CMS’s 2020 Final Rule on grounds that it does not comply with the statute or the requirements of reasoned decision-making under the Administrative Procedure Act.

As OPOs, transplant hospitals, and other stakeholders prepared for this inaugural cycle, several procedural and interpretive questions emerged that the 2020 Final Rule did not expressly address. CMS subsequently issued this 2026 Proposed Rule in an effort to address these questions.

Key Proposed Definitions

The 2026 Proposed Rule introduces several new and revised definitions:

• Adverse Event: CMS proposes to streamline the existing definition of an “adverse event” by removing specific examples from 42 C.F.R. § 486.302 and relocating them to Quality Assurance and Performance Improvement (QAPI) requirements at 42 C.F.R. § 486.348(c). The proposed examples of adverse events subject to relocation include (i) transmission of an infectious or communicable disease or malignancy from a donor to an organ recipient; (ii) avoidable loss of a medically suitable potential donor for whom consent for donation has been obtained; (iii) deviations from current standards of practice or OPO procedures that result in loss of a patient, potential donor, or transplantable organ(s); (iv) delivery of an organ that was not for the intended recipient or whose blood type does not match; (v) an organ that is lost, or delayed and arrived too late to be transplanted; and (vi) an organ that arrives in a condition incompatible with transplantation. CMS asserts that this change would eliminate any confusion that the list of examples constitutes an exhaustive list of adverse events.
• Unsound Medical Practices: CMS proposes to define “unsound medical practice” as failures by OPOs that create an imminent threat to patient health and safety or pose a risk to patients or the public. Such practices would include but are not limited to (1) failures in governance; (2) patient or potential donor evaluation and management; and (3) procurement, allocation, and transport practices and procedures. CMS also provided a few examples of unsound medical practices, including (1) failure to ensure a potential donor is declared dead according to applicable State law and hospital policies; (2) negligent or deliberate failure to perform necessary and customary tests to determine whether a potential donor meets exclusionary criteria; and (3) pursuing patients with inappropriately high neurologic function as potential donors.
• Donor: CMS proposes to revise the definition of “donor” to clarify that an individual from whom only the pancreas is procured and used specifically for islet cell research is included in the definition for purposes of the donation rate outcome metric.
• Organ: CMS proposes to remove pancreata used for islet cell research from the definition of “organ,” thereby excluding such pancreata from the organ transplantation rate outcome metric. In other words, research activity would no longer count as a transplant for purposes of the transplantation rate outcome metric. A pancreas that is used for islet cell research without a transplant to a patient on the OPTN waiting list, however, would still count towards the donation rate outcome metric. In contrast, a pancreatic islet allotransplant to a patient on the OPTN waiting list would be included in both the transplantation rate and donation rate outcome metrics, regardless of whether it is conducted under standard or research protocols.
• Medically Complex Donor and Organs: CMS proposes to define “medically complex donor” as a donor whose medical history requires special or additional considerations to identify the best recipient for the organs, including all Donation after Cardiac Death (DCD) donors and donors with elevated Kidney Donor Profile Index (KDPI) scores of 50 or more. A “medically complex organ” would be defined as an organ procured from a medically complex donor. These definitions are linked to a proposed new QAPI requirement at 42 C.F.R. § 486.348(e) that would require OPOs to (1) assess policies and procedures regarding medically complex donors and organs; (2) track performance metrics including consent rates, recovery rates, and transplantation rates at least annually; and (3) implement actions to improve performance when opportunities are identified.

OPO Designation and Multi-DSA Framework

CMS’s proposed rule seeks to clarify OPO designation and establish a framework that would enable OPOs to manage service areas separately. The current regulatory structure does not address potential situations in which an OPO is responsible for multiple designated service areas and is assigned by CMS different tier designations.

Under the proposal, CMS would evaluate each OPO’s service area separately during the recertification process, using its two limited outcome metrics. CMS would then remove the OPO’s designation for any service area where CMS has assigned the organization a Tier 3 ranking without necessarily decertifying the entire OPO. Taking this approach would enable CMS to selectively prevent an OPO from continuing to serve an area where CMS has assigned the OPO to a lower tier while allowing the OPO to retain its designation for other service areas where CMS has assigned the OPO to a higher tier. An OPO would remain certified if it has at least one service area that CMS concludes satisfies its two outcome metrics (Tier 1 or Tier 2) and meets all other regulatory requirements. Conversely, an OPO assigned by CMS to Tier 3 in all of its designated service areas would be decertified and prevented from participating in the nation’s organ donation system.

When an OPO is designated to more than one service area (through a change in control or ownership, competition, or successor assignment), the OPO may choose to consolidate its designated service areas or maintain separate service areas (or some combination if more than two service areas are involved). CMS proposes that an OPO would be evaluated as a single entity across all designated service areas when applying its minimum process requirements, making clear that although an OPO may be assigned different tier rankings based on the application of CMS’s two outcome metrics in different service areas, OPOs must satisfy CMS’s minimum process requirements at all times and in all of their designated service areas.

CMS also proposes that OPOs that are assigned a service area by CMS would be provided additional time before becoming subject to CMS’s two outcome metrics for recertification purposes—specifically, in the final assessment period of the following agreement cycle. According to CMS, this extended timeframe would allow the newly assigned OPOs an opportunity to meet CMS’s two outcome metrics. In addition, CMS proposes to clarify rare instances when CMS may forgo the competitive bidding process and temporarily designate an OPO to a designated service area, considering factors such as contiguity to the service area, performance on outcome measures, history of compliance with process performance metrics, and willingness to perform responsibilities for the remainder of the designation period.

Non-Renewal of Tier 2 OPO Agreements

CMS proposes to clarify that OPOs assigned a Tier 2 ranking in their designated service area would be recertified but must compete to retain their service area or obtain a different service area. An important distinction between OPOs assigned a Tier 3 ranking and those assigned a Tier 2 ranking is that CMS has deemed only Tier 3 ranked OPOs to be out of compliance with its two outcome metrics for that service areas. If a Tier 2 OPO is unsuccessful in competing to retain its service area and not assigned to a different service area, the OPO’s agreement with CMS would not be renewed, but the OPO would still be eligible to compete or otherwise be selected for designation to an open service area throughout the next four-year recertification cycle.

CMS’s proposed rule states that OPOs assigned to Tier 2 that CMS decides should not be permitted to continue to be responsible for their service area have no appeal rights to challenge CMS’s decision. CMS states in the proposed rule that denying Tier 2 organizations any administrative review process is consistent with CMS’s policy that “our competition decision is final.” If the OPO is not successful in competing for a different service areas, the OPO would be decertified and would be afforded the limited appeal rights for the decertification.

Requirements for Certification

Many stakeholders have objected to CMS’s 2020 Final Rule on grounds that CMS plans to decertify or replace dozens of OPOs and note that, under the statute and existing regulations, CMS has no authority to certify new OPOs.

In response, CMS proposes to remove the regulatory requirement at 42 C.F.R. § 486.303(e) that limits certification to OPOs recertified between January 1, 2002 through December 31, 2005. Upon further review and while previously declaring the opposite, CMS no longer believes that the statute is best read to require all qualified OPOs to have been previously certified as of January 1, 2000. CMS instead now takes the position that whenever the agency initially certifies or recertifies that an OPO meets the Secretary’s performance standards within a 4-year period, OPOs must demonstrate at the end of that period that they still meet the agency’s performance standards. If permitted under the statute, removing this requirement would eliminate a regulatory barrier that previously prevented the Secretary from implementing a process for the certification of new OPOs.

CMS asserts that changing its regulations would address concerns about market consolidation by creating a more diverse and robust market that enhances competition among OPOs, potentially introducing innovation from new entities and increasing the number of organs available for transplant. 

Administrative Appeals Process

CMS proposes several changes to the OPO appeals process at 42 C.F.R. § 486.314. Key changes include:

• Timeline Modifications: The proposal changes the reconsideration request period from 15 business days to 20 calendar days; the CMS reconsideration decision period from 10 business days to 15 calendar days; the request for hearing period from 40 business days to 15 calendar days; and the hearing officer decision period from 20 business days to 90 calendar days.
• New Appeal Categories: CMS proposes to allow OPOs to appeal the removal of designation to a Tier 3 service area without decertification, in addition to appealing full decertification. This addresses the potential situation of an OPO being designated to more than one service areas, where the OPO may not be decertified because it has been deemed a Tier 1 or Tier 2 organization in at least one of its service, but may lose designation in a service area where it has been assigned a Tier 3 ranking.
• Burden of Proof: The proposed rule states that OPOs bear the burden of proof by a preponderance of the evidence to demonstrate that the notice of decertification or removal of designation should be reversed.
• CMS Administrator Discretionary Review: CMS proposes to codify a process at new 42 C.F.R. 486.314(l) for the CMS Administrator to elect to review or decline to review the hearing officer’s decision within 30 calendar days of receipt. If the Administrator elects to review, the Administrator must render a final decision within 45 calendar days of notification and may affirm, reverse, or remand the hearing officer’s decision.

Comment Solicitation and Discussion on Emerging Topics

The 2026 Proposed Rule also addresses and solicits public comments on potential future regulatory requirements:

• Conflicts of Interest: CMS has expressed concerns related to the relationships between OPOs and tissue banks and officials from local morgues and medical examiner offices, which are the original sources of data used for outcome metrics. CMS is also concerned about inadequate transparency and oversight for conflicts of interest among OPO leaders and governing board members. CMS is soliciting public comment on areas where conflicts may exist, including firewalls within OPOs, potential impacts of additional CMS requirements, and alternatives for addressing conflicts of interest among OPO staff and board members.
• Allocation Out of Sequence: CMS has expressed concern that the proliferation of allocating organs out of sequence, including the use of “open offers” to preferred transplant programs rather than to specific patients on the match run list, creates inequities in the procurement and transplant system that erode public trust.
• Automated Electronic Referrals: CMS is soliciting public comment on automated electronic referrals from donor hospitals.

Comment Deadline

Comments on the 2026 Proposed Rule must be received by March 31, 2026.

The 2026 Proposed Rule is available here, and the CMS Fact Sheet on the 2026 Proposed Rule is available here.

Reporter, Ahsin Azim, Washington, D.C., +1 202 626 5516, aazim@kslaw.com

CMS Announces Changes to CY 2027 Medicare Advantage Capitation Rates and Part D Payment Policies

On January 26, 2026, CMS released its Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice). The Advance Notice, which CMS releases annually, includes proposals for routine and technical updates to ensure the accuracy of MA and Part D payments. Specifically, CMS proposes limiting the diagnosis information MA and Part D plans can use for their risk adjustment data, updating its risk adjustment model, modifying its capitation rate methodology, and tweaking its Star Ratings measures for MA and Part D plans.  The proposed policies are expected to yield a payment increase of 0.09% or $700 million in MA payments to plans in CY 2027. CMS will accept comments on the proposals until February 25, 2026.

The Advance Notice includes proposals to address coding differentials between Medicare Advantage and Original Medicare for CY 2027. In working to improve its risk adjustment scores, CMS states that its work is informed by three guiding principles: “(1) simplicity to reduce day-to-day administrative burden for both plans and providers; (2) competition on creating value for patients where risk adjustment facilitates such competition equally for all varieties of plans irrespective of size or resources; and (3) payments that accurately reflect beneficiary health risk and facilitate the efficient use of healthcare resources, enhanced program integrity, and greater accountability.” Ultimately, CMS’s goal is to inspire confidence that it is holding down costs related to payments that do not lead to better health outcomes. 

The Advance Notice includes modifications to the MA risk adjustment model to more accurately reflect costs associated with treating different diseases and conditions. A notable proposal involves excluding diagnosis information from unlinked chart reviews. Plans often conduct retrospective chart reviews to try to uncover conditions that may have been missed during the initial round of documentation. When diagnosis codes are added to a beneficiary’s record during retrospective chart reviews, but they lack an associated, date-specific service record, these added codes are referred to as “unlinked.” Without a specific date to support a diagnosis, there is no direct evidence of a patient encounter with a clinician. In such circumstances, CMS has voiced concerns about coding accuracy, documentation, and potential overpayments. For CY 2027, CMS would not consider unlinked diagnosis codes for risk adjustment. Not surprisingly, CMS expects the payment impact of this proposal to affect MA organizations that use more unlinked chart reviews in reporting risk-adjustment eligible diagnoses for their enrollee population. 

The Advance Notice also proposes updating the Part D risk adjustment model. Updates include changing the Part D benefit for CY 2027 based on the Inflation Reduction Act; ensuring risk data more accurately reflect current costs; updating the sources of diagnostic data to be consistent with similar proposed policies for Medicare Advantage; and accounting for drug costs separately in MA prescription drug plans and standalone Part D plans. CMS’s stated aim with these changes is to enhance overall stability of prescription drug benefits for all Medicare beneficiaries.

A final noteworthy proposal in the Advance Notice involves updates to the MA and Part D Star Ratings standards. CMS issues its Star Ratings of MA and Part D plans annually to help beneficiaries compare and select plans and to drive quality improvements. The Advance Notice includes an updated list of the measures that CMS will use for Star Ratings for CY 2027 (e.g., breast cancer screening, diabetes care eye exams, controlling blood pressure, etc.); a list of which measures will be used to calculate improvement measures for the 2027 Star Ratings; an updated Categorical Adjustment Index; and a list of the natural disasters that make a plan eligible for adjusted ratings when 25% of its enrollees reside in the affected area of the natural disaster. 

CMS will announce the MA capitation rates and final payment policies for CY 2027 no later than April 6, 2026.

A copy of the Advance Notice is available here. The CMS fact sheet on the Advance Notice is available here. 

The public can submit comments or questions to the Advance Notice electronically by going to https://www.regulations.gov, entering the docket number “CMS-2026-0034” in the “Search” field, and following the instructions for “submitting a comment.” Comments are due by 11:59 p.m. ET on February 25, 2026. 

Reporter, Doug Comin, Atlanta, GA, +1 404 572 3525, dcomin@kslaw.com

CMS Solicits Guidance on How to Incentivize Hospitals to Buy American-Made PPE and Essential Medicines

CMS issued an Advance Notice of Proposed Rulemaking on January 29, 2026 soliciting public input on how to incentivize Medicare participating hospitals’ participation in buying PPE and essential medicines from domestic manufacturers. CMS is seeking feedback about creating a “Secure American Medical Supplies” designation that hospitals could earn by committing to procuring supplies from domestic manufacturers. CMS is also seeking input about a change to the Hospital Inpatient Quality Report (IQR) Program that would add a structural quality measure that would encourage hospitals to commit to buying domestic products. CMS is also open to other suggestions for making the domestic supply chain more resilient.

In the wake of the COVID-19 pandemic’s PPE shortages for healthcare workers and hospitals reporting perpetual drug shortages that last on average 18 months, CMS is soliciting public input on how CMS can work with Medicare participating hospitals to encourage domestic procurement of PPE and essential medicines. Previously, CMS has adjusted payments to Medicare participating hospitals to offset costs of domestically procuring N95 respirators when hospitals track and report on their cost reports domestic and foreign-procured respirators. However, very few hospitals have reported the information necessary to take advantage of this payment adjustment. CMS has also established a separate payment to small, independent hospitals who establish a buffer stock of essential medicines.

“Secure American Medical Supplies” Friendly Hospital Designation

CMS is seeking feedback on adding a “Secure American Medical Supplies” friendly hospital designation that would be displayed on a public website. CMS proposes having a program where Medicare participating hospitals could earn the designation by procuring a certain percentage of either total American-made PPE and essential medicines or sub-categories of American-made PPE and essential medicines. CMS is considering using the definition of essential medicines as the 86 medicines designated in the Essential Medicines Supply Chain and Manufacturing Resilience Assessment report and that PPE would include items such as surgical masks, gowns, face shields, and filters as set forth in section 70953 of the Infrastructure Investment and Jobs Act (Pub. L. 117–58). CMS is seeking input on how to classify whether the PPE and essential medicines are American made for purposes of this program. CMS is also considering having hospitals initially attest to meeting the criteria of the program on their cost reports, but is seeking input on alternative ways to implement a potential program.

Potential Payment to “Secure American Medical Supplies” Friendly Hospitals

CMS is also seeking input on how to offset the cost of procuring PPE and essential medicines from domestic sources. One potential option that CMS is considering is assuming that a certain percentage of a hospital’s total drug costs on its cost report data is for higher cost domestic essential medicines. Another non-budget neutral option under consideration is paying hospitals a lump sum either at the time of a cost report settlement or on a more regular, bi-weekly cadence to be reconciled later. CMS is also soliciting feedback on whether it would be beneficial to expand a potential payment program to other entities such as physicians who receive Medicare payments but do not submit cost reports.

Hospital IQR Measure

CMS is seeking feedback on adding a “yes” or “no” question to the IQR Program asking hospitals whether they have met a minimum percentage threshold of American-made PPE and essentials or asking hospitals to answer the same question but on a categorical-basis. CMS is asking for public input on whether this type of program would be an appropriate way to incentivize hospitals to buy American-made products and whether there are any good alternative options to the proposed attestation option.

Comments are due on March 30, 2026.

Reporter, Taylor Whitten, Sacramento, +1 916 321 4815, twhitten@kslaw.com

Key Takeaways from K&S Healthcare Deal Summit:

On January 28, King & Spalding held its second annual Healthcare Deal Summit in its New York office. The event featured panel discussions with private equity, healthcare operators, and finance and restructuring professionals, as well as a keynote discussion on the growing role of artificial intelligence in healthcare dealmaking. Below are key takeaways from the Summit.

From Deal Structures to Deal Volume: Exploring the Current Healthcare Private Equity Environment

Speakers

• Fazeela Abdul Rashid, Co-Founder and Managing Partner, Arcventis Health Partners
• Ravi Sachdev, Partner, CD&R
• Harry Eichelberger, Managing Partner, Archimedes Health Investors
• Moderator: Jason Osborn, Partner, King & Spalding

Summary

• The panelists shared perspectives on current healthcare private equity market conditions, sector-specific performance and valuation trends, evolving deal structures, and approaches to value creation and risk management in a shifting regulatory and technological environment.

Key Takeaways:

• Market sentiment remains cautious, as buyer interest has strengthened but seller expectations have not fully reset, and underwriting remains conservative with heightened focus on real EBITDA.
• Healthcare is increasingly bifurcated by subsector, with certain services categories out of favor amid regulatory scrutiny and public perception concerns, while technology- and pharma-adjacent categories continue to command stronger activity and valuations.
• Deal structuring is increasingly used to bridge valuation and risk, with greater reliance on preferred and structured equity and other downside-protection mechanisms.
• Value creation is more operational and front-loaded, with increased emphasis on early alignment around execution and measurable performance improvement.
• AI is becoming a core component of portfolio strategy, driving efficiency, accelerating development and influencing competition in areas such as revenue cycle management.

Headwinds and Tailwinds in M&A Activity: Navigating the Role of Strategics and PE Sponsors in Healthcare Dealmaking

Speakers

• Steven Boyd, Managing Director, Alvarez & Marsal Healthcare
• Bob Cooper, Partner, King & Spalding
• Simon Gisby, Senior Vice President Strategy, Northwell Health
• Christine Kocot McCoy, Executive Vice President, General Counsel and Public Affairs Lead, Ascension Health
• Moderator: Richard Zall, Partner, King & Spalding

Summary

• The panelists discussed current healthcare M&A activity and sector trends, evolving health system consolidation and physician alignment strategies, antitrust considerations affecting deal planning and execution, and increasing payer partnerships.

Key Takeaways:

• Deal activity remains uneven, with momentum in select multisite services subsectors and continued caution in traditional physician practice and ambulatory deals, alongside increased restructuring-driven activity.
• Health systems continue to prioritize regional scale and partnerships, with growing emphasis on ambulatory expansion and asset-light strategies to support lower-cost care delivery.
• Physician alignment models are becoming more flexible, with increased use of affiliations and joint ventures in addition to employment.
• Antitrust enforcement in healthcare remains steady, with regional consolidation drawing the most scrutiny and collaboration models requiring careful pre-closing guardrails.
• Payers remain active in acquiring and partnering with providers, with continued focus on vertical integration.

Restructuring Perspectives: Challenges and Opportunities in Distressed Healthcare

Speakers

• Jeffrey Finger, Managing Director, Jefferies
• Jennifer Yang, Managing Director in Credit Alternatives, Goldman Sachs Asset Management
• Moderator: Austin Jowers, Partner, King & Spalding

Summary

• The panel discussed the drivers of healthcare distress, structural challenges in physician practice management businesses, evolving lender and sponsor restructuring strategies, and the risks and opportunities associated with balance sheet repair and turnaround investments.

Key Takeaways:

• Healthcare distress is being driven by rising labor and operating costs, reimbursement pressure, and higher interest expense, leaving many leveraged platforms unable to service debt or refinance on prior terms.
• Physician practice management and rapid roll-up models continue to face structural challenges, driven in part by weak integration, limited local oversight and regulatory complexity.
• Lenders and sponsors are engaging earlier in distressed situations, with greater emphasis on liquidity management, governance and early intervention to preserve value.
• Physician engagement remains critical in restructurings, as physician-owners and key providers play a central role in business viability and must be involved in balance sheet solutions and incentive structures.
• Investment opportunities remain concentrated in good businesses with bad balance sheets, where fundamentals are intact and capital structures can be reset through disciplined restructuring and new capital.

Keynote Address: How the Investment in AI Is Changing the Face of Healthcare Dealmaking and Providing Innovative Approaches to Patient Care

Speaker

• Emily Schlesinger, Assistant General Counsel, Microsoft
• Moderator: Amanda Klingler, Partner, King & Spalding

Summary

• Schlesinger shared insights from Microsoft’s healthcare technology platform on the role of AI in driving deal strategy, managing data and regulatory risk, and supporting more efficient and patient-centered care delivery.

Key Takeaways:

• AI is driving a wide range of healthcare transactions, including enterprise licensing, platform partnerships, content acquisition and EHR integration, with increased focus on scalable, extensible products.
• Data rights, de-identification and model monitoring remain central diligence and risk areas, particularly as regulators emphasize transparency and life cycle oversight.
• Post-closing integration presents significant challenges, including aligning compliance frameworks, risk tolerance and engineering systems in rapidly evolving technology environments.
• Regulatory uncertainty remains a key constraint, with shifting federal priorities, divergent state approaches and heightened international oversight requiring risk-based compliance strategies.
• AI is increasingly shaping patient engagement and clinical workflows through ambient documentation, consumer platforms and radiology tools, while raising ongoing questions around liability, governance and equity.

Also In the News

King & Spalding Welcomes Five New Healthcare Partners

On January 26, 2026, King & Spalding welcomed new partners Rachel Gilbert, Cat Kirkland, Jim Gilliam, John Connell and Renee Rayne. These five partners joined the Healthcare team in Washington D.C. to expand King & Spalding’s capabilities in Medicaid financing and managed care litigation.

Rachel Gilbert works on behalf of her clients to design, implement, and finance Medicaid supplemental reimbursement programs, including Medicaid Disproportionate Share Hospital programs, waiver programs, and state directed payment programs. Additionally, Rachel represents hospitals in complex payment and contract disputes. More information on Ms. Gilbert is available here.

Cat Kirkland’s reimbursement experience includes advising clients on state-directed payment initiatives, Medicaid rate modeling, program financing, disproportionate share hospital programs, upper payment limit arrangements and value-based or incentive-driven payment models. She also regularly advises providers in reimbursement disputes with commercial and Medicare Advantage payors, including those involving the 340B Drug Pricing Program. More information on Ms. Kirkland is available here.

Jim Gilliam represents healthcare providers in a variety of business disputes, on issues ranging from government and commercial reimbursement, misappropriation of hospital proprietary information, and post-M&A disputes. He also represents healthcare providers in government investigations, including allegations of Medicaid and Medicare billing fraud and federal/state compliance audits. More information on Mr. Gilliam is available here.

John Connell advises hospitals, health systems, academic medical centers, and other healthcare industry organizations on reimbursement disputes with health plans and compliance obligations related to participation in government health programs. He regularly represents hospitals and health systems in payment litigation, arbitrations, as well as in government investigation, including False Claims Act investigations by the U.S. Department of Justice. More information on Mr. Connell is available here.

Renee Rayne represents public hospitals, private hospitals and physician groups in regulatory compliance and transactional matters, particularly related to participation in federal and state reimbursement programs. She advises hospital systems across a wide range of regulatory compliance and reimbursement matters, including compliance with the Stark Law, federal and state anti-kickback statutes, HIPAA, Medicaid and Medicare programs, regulatory audits and appeals, along with other related regulatory requirements. Additionally, she has assisted in the development, implementation, and operation of new Medicaid reimbursement programs in several states, including managed care directed payment programs and Upper Payment Limit programs. More information on Ms. Rayne is available here.

Upcoming Events 

35^th Annual King & Spalding Health Law & Policy Forum

• Thursday, March 12, 2026, 8:00 a.m. ET

Join us for our annual forum focusing on the foremost legal and political developments impacting the healthcare industry. This full-day program will feature thought-provoking sessions and a keynote address from award-winning legal affairs correspondent Nina Totenberg, whose deep knowledge of the inner workings of the Supreme Court will provide attendees with rare insights into today’s judicial headlines. See more.

Highlights include:

• Leading practitioners providing policy and regulatory enforcement updates and other industry developments, including insights from in-house counsel on their priorities for the coming year 
• What’s next in strategic priorities for nonprofit health systems  
• Perspectives from a former U.S. attorney on key issues facing the healthcare industry
• Regulatory and legislative impacts of the current administration on the healthcare industry 

Attendees will also enjoy multiple networking opportunities, including a reception following the sessions.  

The registration fee for the full program is $95. For questions, or for information about registering, contact the K&S Events Team.

 

Editors: Chris Kenny and Ahsin Azim

Issue Editors: Will Mavity and Kasey Ashford