Denise Rios Rodriguez is a retired partner and health care lawyer with Foley & Lardner LLP, where she focused her practice on payment issues arising under government programs such as Medicare and Medicaid, including Medicaid demonstration projects and Medicare enrollment and billing appeals.
She has represented public and private health care providers in administrative hearings, as well as in state and federal courts.
Her considerable knowledge in health-related laws and regulations has been applied in advising clients on the complexities of federal, state and local health care funding, as well as strategic planning for health care systems. Ms. Rodriguez was a member of the Health Care Industry Team.
Ms. Rodriguez was previously legal counsel for regulatory affairs for a large Miami-based HMO, where she was responsible for legal issues arising from the company’s risk-based Medicare contract.
For the first six years of her legal career, Ms. Rodriguez was an attorney for the United States Department of Health and Human Services in Washington, D.C., where she served as counsel to the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) and other agencies within the Department.
As a government attorney she was responsible for the analysis of waiver applications from various states seeking federal approval for the implementation of innovative programs for Medicaid beneficiaries.
She also provided legal advice on the development of Medicare and Medicaid regulations and policies and represented the government in federal court.
Education : Ms. Rodriguez is a graduate of the University of Michigan Law School (J.D., cum laude, 1979) and Wayne State University (B.A., with distinction, 1975).
Admissions and Professional Memberships :
Ms. Rodriguez is a member of the American Health Lawyers Association and the Hispanic National Bar Association. She was admitted to the Michigan Bar in 1979 (membership currently inactive) and the California Bar in 1988.
Representative Matters :
- Foley provided advise on various reimbursement and financing matters under Medicaid, the Section 1115 Medicaid Demonstration, and health care reform. Advice includes:
- the structuring of federal and local government financing mechanisms, ongoing compliance with Medicaid law and waiver terms and conditions, strategizing on future demonstration waiver program and funding streams, and financing and delivery organization issues associated with the Medicaid expansion population.
- Represented California Association of Public Hospitals and Health Systems (CAPH), on behalf of 20 public hospital systems, in the implementation of the Medicaid Bridge to Reform Demonstration under Section 1115 of the Social Security Act. Specific roles included negotiations and drafting of the implementing state statutes, policy guidances, Demonstration and waiver agreements with the Centers for Medicare and Medicaid Services and California Department of Health Care Services, and the structuring of federal and local government financing mechanisms, and ongoing compliance.
- The key Demonstration components include a reimbursement pool for uncompensated care costs for the uninsured, incentive payments for delivery system reform activities, and county programs providing coverage to low-income individuals under California’s early implementation of the Affordable Care Act Medicaid expansion.
- The matter is still ongoing, and, as the current waiver term end-date approaches, new efforts are underway with respect to an extension of the demonstration with new and innovative finance and service improvement components.
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