Pam Stone Email and Phone Number

Perform complex legal work for the DMHC relating to the licensing of health care service plans. Provide direction and leadership pertaining to plan benefits and plan and provider payment, risk and delegation arrangements, mergers and acquisitions, implementation of compliance with All Plan Letters, review of complex legal matters and legal research in connection with the administration and regulation of health plans pursuant to the Knox-Keene Health Care Service Plan Act of 1975 and the implementation of Federal Health Care Reform.Provide legal and policy interpretation with the DMHC necessary to administer the statutes and regulations authorized by the Knox-Keene Act, and interpret those laws to ensure compliance for new and future policy decisions. The DMHC is California’s regulator providing oversight for California’s Commercial and Medicaid Health Care Service Plans. Broad based knowledge of the health care delivery system, including the ACA, Mental and Behavioral Health Coverage, Health Plan Contracting, PBMs, EHBs, payer and provider issues, claims payments, surveys, pilot programs, fiscal and policy issues.

Experienced in litigation and transactional practice, including health care payor and provider litigation, and disputes regarding CMS obligations, Medicare, Medicaid, state actuarial rate-setting processes, and DMHC and DHCS regulatory requirements. Contract drafting and counsel regarding various facets of managed health care systems, including federal and state statutory and regulatory compliance, employment issues, data-sharing, technology, vendor and sales contracts, HIPAA and SUDs privacy protections, and contracting. Experienced in delegating authority to and supervising attorney and non-attorney professionals.

Corporate civil litigation attorney with an emphasis on intellectual property and contract disputes. Transactional advice and counsel on intellectual property and trademark issues. Litigation before federal and state courts, and the TTAB.

Judicial Law Clerk to the Hon. Garland E. Burrell, Jr., Judge, Eastern District of California