KEVIN J. MALONE is a Senior Counsel in the Health Care and Life Sciences practice in the Washington, DC, office of Epstein Becker Green and a Strategic Advisor in the firm’s affiliated consulting practice EBG Advisors. Mr. Malone provides regulatory and strategic guidance related to health care financing law and policy at both the federal and state levels, with a particular focus on Medicaid, Medicare, behavioral health, long-term care, and managed care. 

In addition to serving some of the largest companies in the health care industry, he also works with start-ups, regional and local health care companies, trade associations, and state and local governments. He joined Epstein Becker Green in 2016 after six years 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).

Mr. Malone’s representative engagements include:

• Serving as a secunded general counsel for a regional health plan with responsibility for managed care and government program matters
• Serving as acting general counsel for a national laboratory network benefit management and technology company
• Developing and serving as program manager for the nation’s first third-party commercial accreditation program assessing insurers’ capacity to comply with the requirements of the Mental Health Parity and Addiction Equity Act (federal Parity law). As part of this role, Mr. Malone developed the nation’s first enterprise-software solution for insurers and managed care entities’ parity compliance
• Serving as outside counsel to regional and national health insurers and managed care companies on compliance with:
  • federal Parity law
  • the Medicare Advantage program
  • Medicaid managed care and managed long-term care programs
  • the Programs of All Inclusive Care for the Elderly (PACE)
  • state insurance and utilization review laws
  • state and federal laws and programs governing value-based reimbursement
• Serving as strategic advisor and outside counsel to multiple national behavioral health medical specialty societies on the development and deployment of behavioral health clinical guidelines, intellectual property, and transactional matters
• Serving as strategic advisor and outside counsel to a quasi-public Medicaid pre-paid inpatient health plan (PIHP) providing managed care business strategy, government relations, and legal representation covering transactional and compliance matters in an ongoing redesign of the state’s Medicaid delivery system
• Serving as outside counsel to a multi-state, for-profit PACE company
• Serving as outside counsel to multiple national telemental health companies on state law compliance, third-party payment, and coverage compliance and negotiations
• Providing strategic counseling and transactional support to private equity and venture capital firms and other potential investors in managed care, behavioral health, and long-term care industries
• Representing hospitals and health systems in value-based contract negotiations and regulatory disputes with major national payors
• Advising states and trade associations on the design and implementation of Medicaid health delivery systems, especially those targeting Medicare-Medicaid dual-eligible beneficiaries

Prior to joining Epstein Becker Green, Mr. Malone 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. Mr. Malone 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, Mr. Malone 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, Mr. Malone 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, Mr. Malone served as a Peace Corps volunteer in Zambia, where he founded the nation’s first male-focused domestic violence prevention project.