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Layna Cook Rush, CIPP/US

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Layna Rush represents clients in both regulatory and litigation matters and routinely advises clients on state and federal regulations that affect health care entities.

Featured Videos

An HR Manager's Guide to Privacy and Security – HIPAA and Beyond January 10, 2019
Understanding Your Responsibilities under the ACA's Anti-Discrimination Rule November 1, 2016

Professional Biography

Overview

Ms. Rush practices in the Health Law Group, assisting clients with managed care contracting and compliance with state and federal regulations that affect health care entities. She is a U.S. Certified Information Privacy Professional and member of the Firm's Data Protection, Privacy and Cybersecurity Team.

Ms. Rush represents clients in regulatory, compliance, and operational issues related to managed care. She drafts agreements between health care entities including provider agreements for participation in IPAs, ACOs, TPAs, PPOs and Medicare Advantage and Medicaid managed care plans. She routinely counsels clients on state and federal legislation that impacts managed care contracting. She assists clients with developing policies and procedures that comply with federal law including Medicare Advantage regulations, Medicare Secondary Payer Laws and the Affordable Care Act.

She advises clients on state and federal laws related to privacy and security of personal information, including HIPAA, Part 2 Substance Abuse laws, the Genetic Information Nondiscrimination Act and state laws related to privacy protections and breach notification requirements. She has assisted clients in the development of policies and procedures for compliance with HIPAA and state and federal laws related to privacy and security. She counsels clients on the investigation of, and response to, potential privacy and security breaches.

Ms. Rush has extensive experience in health care related litigation. She has handled litigation involving ERISA benefit plans, Medicare Advantage and the Affordable Care Act issues. She has represented health care entities in a wide variety of matters including contract disputes, denial of benefits cases and cases involving privacy challenges.

Additional Managed Care Experience

Managed Care Contract Drafting/Editing

  • IPA Participating Provider Agreements
  • ACO Participation Agreements
  • Medicaid Managed Care Participating Provider Agreements
  • PPO/Network Agreements
  • Commercial Health Plan Provider Agreements
  • Value Based/Risk Based Participation Agreements
  • Pharmacy Benefit Manager Agreements

Payment Related Contracts/Documents

  • Assignment of Rights
  • Patient Agreements to Pay
  • Rejection of accord/satisfaction by instrument language for claims forms
  • Negotiated Rate Agreements

Regulatory/Compliance Issues

  • State laws related to out-of-network payments and balance billing
  • State laws on network adequacy
  • State prompt pay laws
  • State "any willing provider" provisions
  • Medicaid Managed Care regulations/guidance
  • Medicare Advantage regulations/guidance
  • Affordable Care Act provisions related to plan benefit design and premium payment
  • Coordination of Benefit provisions/Medicare Secondary Payer regulations
  • Association Plans/Multiple Employer Welfare Associations (MEWAs)

Formation/Licensing or Registration

  • Health Maintenance Organizations
  • Insurance Companies
  • Third-Party Administrators
  • Utilization Review Agents
  • Preferred Provider Organizations/Networks
  • Independent Physician Associations

Litigation

  • Contract disputes between health insurer and providers
  • Contract disputes between PPO and providers
  • Out-of-network/U&C billing disputes
  • Denial of benefits/ERISA claims
  • Health plan subrogation claims
  • Claims related to offsetting/recoupment of payment by payers
  • Negotiated Fee disputes
  • Third-party premium payment dispute
  • ID card logo disputes
Professional Honors & Activities
  • American Bar Association
    • Vice Chair – Health Lawyer Editorial Board (2018 – 2019)
  • American Health Lawyers Association
  • Baton Rouge Bar Association
  • Executive Secretary – Louisiana Business Group on Health Board of Directors
  • Louisiana Association of Health Plans
  • Louisiana Hospital Association
  • Louisiana State Bar Association
  • Wex S. Malone Chapter of the American Inns of Court
  • Member – International Association of Privacy Professionals (CIPP/US)
  • Fellow – American Bar Foundation
  • Recognized as a "Top Forty Under 40" by the Baton Rouge Business Report (2013)
Community and Other Activities
  • Board of Directors – Environment and Health Council of Louisiana (2010 – present; President, 2013 – present)
  • Board of Directors – March of Dimes Capital Area (2010 – 2016)
  • Board of Directors – Charles W. Lamar YMCA (2011 – 2017)
  • Board of Directors – Girls on the Run of Greater Baton Rouge (2012 – present)
  • Board of Directors – Louisiana Business Group on Health (2012 – present)
Publications
Speaking Engagements
  • "Local Perspective: How Louisiana is Addressing Cyber Attacks and What Businesses Can Do to Protect Themselves" (November 13, 2019)
  • Panelist – "Cybersecurity – Risks, Trends, Resources, and Legal Requirements," WEN 2019 National Conference, Denver, Colorado (March 2019)
  • "Professionalism," 2018 Louisiana Association of Health Plans' Annual Meeting CLE, "Issues in Health Law" (December 2018)
  • "Negotiating Effective Payer-Provider Contracts," ABA Physicians Legal Issues Conference, Chicago, Illinois (June 2018)
  • "HIPAA Compliance in the Current Healthcare Landscape," American Portable Diagnostic Association's Mid-Year Meeting, Louisville, Kentucky (May 2018)
  • "Cybersecurity for the C-Suite and Management," 31st Annual MSU Insurance Day, Starkville, Mississippi (April 2018)
  • "Surprise! You've Been Billed: Emerging Trends in Balance Billing Disputes," ABA Emerging Issues in Healthcare Law (February 2018)
  • "Ethics and E-Discovery," 2017 Louisiana Association of Health Plans' Annual Meeting CLE—Issues in Health Law (December 2017)
  • "Section 1557: Unfunded Federal Mandate or Landmark Civil Rights Healthcare Law? Understanding Healthcare Provider Responsibilities Under the ACA's Anti-Discrimination Rule," HBA Health Law Section CLE (January 2017)
  • Co-presenter – "Section 1557 – Are You Ready?," webinar, LeadingAge Texas (August 2016)
  • "Cyber Security: What Should be on Your Radar," Southern Gaming Summit/BingoWorld 2016 conference (May 2016)
  • "Legislation Effecting Our Industry," Louisiana Association of Health Plans Health Care at the Capitol conference (March 2014)
  • "Health Insurance Exchange Challenges and Solutions, Part II: Enrollment Assistance and Privacy and Security," American Health Lawyers Association webinar (August 2013)
  • "The Health Care Reform Act: A look at key health coverage provisions," VenueConnect (July 2013)
  • "The Impact of Health Reform's State Exchanges," Spring Managed Care Forum (May 2013)
  • "Making the Grade: Compliance in the Exchange Market," National Association of Specialty Health Organizations Webinar (November 2012)
  • "Explaining Health Care Reform: Exchanges And The Impact On Employers," Louisiana Business Group on Health's Webinar Series (October 2012)
  • "Explaining Health Care Reform: Wrap Up for 2011 and What to Expect in 2012," Louisiana Business Group on Health's Webinar Series (December 2011)
  • "The Impact of Healthcare Reform Law," New Orleans Regional Leadership Institute (February 2011)

Education

  • Louisiana State University Paul M. Hebert Law Center, J.D., 1999
    • Law Review
  • Louisiana State University, B.S., 1996, magna cum laude
    • Phi Kappa Phi

Admissions

  • Louisiana, 1999
  • United States District Court for the Eastern District of Louisiana
  • United States District Court for the Middle District of Louisiana
  • United States District Court for the Western District of Louisiana
  • United States Court of Appeals for the Fifth Circuit 

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