Recent case experience as an expert witness includes:
Medical Malpractice Case, potential damages in the form of future medical costs in a life care plan. Opinions regarding alleged $9 million+ in future medical expenses covered generally under insurance and specifically under ACA plans, Medicaid and Medicaid waivers and under what conditions they would be covered. Review deposition testimony of opposing counsel’s healthcare economist, medical experts and consider Affordable Care Act and the policies of insurance available under the ACA through State Health Insurance Exchanges, Medicaid expansion, Federal Poverty Level (FPL) calculations, as well as dual eligible Medicare and Medicaid post age 65, Medicaid under a §1915(c) of the Social Security Act, Home and Community-Based Services Waiver Medicare-Medicaid Coordinated Plan (MMCP), Minimum Essential Coverage (MEC) and Essential Health Benefits (EHB), analysis as described in New Jersey Law (case venue is Pennsylvania, at the time of this update the court has determined it will be heard under State Law).
Evaluate metal plan coverage by actuarial value, and cost sharing subsidies to estimate maximum out of pocket for lifetime of patient. Compare Life Care plans and prescribed medical services to those covered in State Benchmark Plans. Determine applicability of Prohibition of Preexisting Condition Exclusions (45 CFR § 147.108) and disabilities. Discuss impact of ACA on companion laws and standards that cover disabled individuals and workplace accommodations for essential job functions, such as Rights and Responsibilities under Section 504 and the Americans with Disabilities Act (ADA) and the Olmstead Plan (including duties of ‘Covered Entities’ aka “HIPAA Covered Entities” which means, health care providers, payors and others). Section 1557 of the Patient Protection and Affordable Care Act (ACA), punctuates other pre-existing regulations regarding people with disabilities. Section 1557 is intended to “…ensure that an individual is not excluded from participating in, denied benefits because of, or subjected to discrimination as prohibited under Section 504 of the Rehabilitation Act of 1973 (disability).
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