2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage - DS

EARN CLE CREDITS

2nd Annual Legal, Regulatory and Compliance Summit on

Medicare Advantage

Key Government Speakers Sibel Ozcelik, ML, MS

Acting Director, Division of Health Plan Innovation Seamless Care Models Group, CMS Innovation Center

Carolyn Kapustij

Senior Advisor HHS Office of Inspector General

November 2–3, 2023 | Renaissance Nashville, Nashville, TN

Your Esteemed 2023 Co-Chairs Karen Y. Lam

Senior Counsel, Medicare, Government Programs Kaiser Permanente

Elizabeth Lippincott Managing Member Strategic Health Law

Annie Shieh

Sr. Director of Compliance Bright Health Group

SUPPORTING SPONSORS:

Prepare for an Evolving Medicare Advantage Landscape with Critically Important discussions on: » CMS Program and RADV Audit Preparedness: How to Set Your MAO Up for Success following the Final Rule » Data and Tech Oversight in MA: AI, Offshoring and Interoperability considerations » Value-Based Insurance Design and Improving Health Equity in MA » Payor-Provider Integration: Anticipating the Legal Risks of New and Complex Arrangements

ASSOCIATE SPONSORS:

REGISTER NOW AmericanConference.com/Medicare-Advantage • 888 224 2480

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Medicare Advantage Organizations are stepping into a new regulatory landscape in 2024.

Attend and Learn to Navigate the New Part C Terrain.

Medicare Advantage or Medicare Part C — the private plan alternative to traditional Medicare — has been growing steadily in recent years and is seen as the Medicare plan model for future generations.

However, despite its expansion and growing popularity, public and government scrutiny of the Medicare Advantage program has never been more intense.

Allegations of overpayments, denials and delays to care, and misleading marketing practices continue to make headlines.

In response, CMS released its long awaited RADV final rule and a new slate of policy and technical requirements for MAOs with the goal of protecting beneficiaries and the overall integrity of Medicare Advantage plans.

WHO YOU WILL MEET In-House Counsel and Business Executives from Medicare Organizations, and Insurance Companies specializing in: » Litigation » Risk Management

Attend American Conference Institute’s (ACI’s) 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage to fully understand the current MA state of play.

» Claims/Strategic Payments

Join us in Nashville on November 2-3 to help your organization make sense of this deluge of developments, assess emerging legal risks, and leverage best practices to strengthen compliance.

» Medicare Compliance

Attend and hear from plan counsel, compliance officers, attorneys from leading law firms, and key government officials who will go beyond the updates. Engage with industry leaders to find out what they are doing to effectively work with regulators, meet the needs of beneficiaries, and avoid unnecessary risks.

Highlights for 2023 include:

» Payor Relations Disputes

» Audits » Regulatory Affairs

Outside Counsel specializing in: » Health Plans and Government Programs » Regulatory Affairs and Compliance

» Interactive Q&A with HHS-OIG on emerging fraud, waste and abuse risks and compliance best practices

» Health Litigation

» Technical update on Star Ratings: Examining the impact of rate announcement and final rule on contract performance

» Medicare Advantage Contracting

» Offshoring and Data Management: Risk Mitigation measures to protect of personal health information

» Medicare Advantage Litigation

» Payor Disputes

Register today and be part of the only Medicare Advantage conference specifically designed for the MAO legal and regulatory community.

C5 celebrates 40 years of excellence! We are thrilled to have provided exceptional conference experiences globally with our outstanding team, speakers, sponsors, partners, and attendees. To mark this milestone, we're launching a new logo which represents our commitment to innovation, growth, and excellence, represented by the five Cs of C5: Current, Connected, Customer-Centric, Conscientious, and Committed.

Looking back on 40 years, we are grateful for our achievements—hosting global conferences, uniting industry leaders, and supporting business growth. However, we are not done yet! We are committed to pushing boundaries and creating impactful experiences and we're excited for the next 40 years of success.

2 | LINKEDIN Healthcare: Legal, Regulatory, and Compliance Experts

DISTINGUISHED FACULTY 2023 Co-Chairs Elizabeth Lippincott Managing Member Strategic Health Law

Annie Shieh Sr. Director of Compliance Bright Health Group

Xavier Baker Principal Groom Law Group

Steven Hamilton Partner Reed Smith LLP

Kathy Roe Attorney and Co-Founder Health Law Consultancy

Mike Cheek President and CEO SNP Alliance

Kelly Kappes Senior Associate General Counsel Elevance Health

Kanika Sabor Managing Director Ankura

Karen Y. Lam Senior Counsel, Medicare, Government Programs Kaiser Permanente

Speakers

Anne Crawford Sr. Vice President, Compliance Solutions ATTAC Consulting Jennifer Kildea Dewane Vice President & Counsel, Government Business Division Elevance Health

Carolyn Kapustij Senior Advisor HHS Office of Inspector General Teresa Mason Member of the Firm Epstein Becker Green, P.C.

Kathleen Dixon Jaquish Counsel BlueCross BlueShield of Tennessee, Inc.

Jill Pepe MA, PMP Health Plan Services Senior Consultant BluePeak Advisors

Tara Dwyer Member Mintz Levin Cohn Ferris Glovsky and Popeo PC

Julie Nielsen Managing Director BRG

Kevin Feder Partner O’Melveny & Myers LLP Lindsey Fetzer Partner Bass, Berry & Sims PLC

Ken Nuñez, MBA, CHC Chief Compliance Officer Provider Partners Management Services

Cherié K Shortridge Senior Advisor Healthmine Benjamin Singer Partner O’Melveny & Myers LLP Lori F. Wells, Esq. Staff Vice President, Medicare Compliance Elevance Health Erin Wessling SVP and Chief Counsel, Commercial, Government Business and Litigation Cigna Melissa Wong Partner Holland & Knight LLP

Sibel Ozcelik, ML, MS Acting Director, Division of Health Plan Innovation Seamless Care Models Group, CMS Innovation Center

REGISTER NOW AmericanConference.com/Medicare-Advantage • 888 224 2480

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DAY ONE Thursday, November 2, 2023 7:45

Registration and Continental Breakfast Served

10:15

Morning Coffee Break

10:30

8:30

Co-Chairs’ Opening Remarks microphone-alt Karen Y. Lam, Senior Counsel, Medicare, Government Programs, Kaiser Permanente

CMS Audit Readiness: How to Set Your MAO Up for Success in the Year Ahead microphone-alt Teresa Mason, Member of the Firm, Epstein Becker Green, P.C.

Annie Shieh, Sr. Director of Compliance, Bright Health Group Elizabeth Lippincott, Managing Member, Strategic Health Law 8:45

In Conversation with HHS-OIG: Identifying FWA Risk areas for MA Plans and Opportunities to Improve Compliance microphone-alt Carolyn Kapustij, Senior Advisor, HHS Office of Inspector General Medicare Advantage remains a top oversight and enforcement priority for the HHS-OIG. Join Carolyn Kapustij, Senior Advisor, HHS Office of Inspector General for a focused presentation-- on the risks being identified, and targeted by the OIG—followed by an interactive Q&A.

Kanika Sabor, Managing Director, Ankura • Understanding what the latest changes to the RADV model mean for MA plans • Overview of the 2023 program audit process and critical steps for audit preparation » Establishing legal and compliance obligations » Utilizing data analytics to pinpoint compliance gaps » Rectifying errors with a corrective action plan 11:30

Navigating New Limits to the Use of Prior Authorization in Medicare Advantage microphone-alt Anne Crawford, Sr. Vice President, Compliance Solutions, ATTAC Consulting

In this session hear directly from the HHS-OIG on: • Examining top priorities for 2024 • Identifying emerging areas of risk for MAOs • Applying key takeaways from recent audits 9:15

Part D Primer for MA Plans: Preparing for the Redesign Under the Inflation Reduction Act microphone-alt Melissa Wong, Partner, Holland & Knight LLP

Elizabeth Lippincott, Managing Member, Strategic Health Law Growing concerns over delays and denials of medical treatment have prompted reforms to MAO prior authorization practices. CMS 2024 policy and technical changes are intended to streamline the process and increase transparency of the metrics being used by plans in for coverage determinations.

This session will cover notable changes, legal and business considerations for MAOs including: • Overview of new limits on prior authorization use • Coverage determination rules » CMS Two Midnight Rule for inpatient services

Kathleen Dixon Jaquish, Counsel, BlueCross BlueShield of Tennessee, Inc. CMS will publish the first 10 Medicare drugs selected under the Medicare Drug Price Negotiation Program established in the Inflation Reduction Act, this year. This workshop will provide an in-depth overview of what’s included in the IRA and how it will impact Part D plans moving forward. Delve into the regulations, mechanics and implementation challenges associated with:

» Ensuring plan policies comply with LCDS/NCDs • Examining the current and future state of gold carding laws and plan programs • Creating a utilization management committee

• Key provisions in the Inflation Reduction Act including Medicare drug price negotiation program » Part D Redesign: Medicare Part D brand name drug costs and spending caps • Premium benchmark stabilization vs. actual Part D plan premiums • Projecting the impact on overall plan costs » Examining opportunities to mitigate the impact through formulary design and utilization management • Part D "smoothing" of cost sharing and operational challenges

4 | LINKEDIN Healthcare: Legal, Regulatory, and Compliance Experts

12:15

Networking Luncheon

Special Focus on Enforcement in Medicare Advantage 1:15

Emerging Enforcement and Investigation Trends in Medicare Advantage microphone-alt Lindsey Fetzer, Partner, Bass, Berry & Sims PLC Julie Nielsen, Managing Director, BRG • Assessing the current enforcement landscape for Medicare Advantage plans • Top takeaways from recent FCA cases involving Medicare Advantage plans • Latest Qui Tam whistleblower claims

3:00

A Technical Briefing on the New MA Star Ratings Methodology and Projected Impact on Plans microphone-alt Cherié K Shortridge, Senior Advisor, Healthmine • Examining the latest MA and Star Ratings program changes » Technical updates from the Rate Announcement and Final Rule » Understanding the impact of health equity measures • Exploring industry developments impacting Star Ratings success 4:00

Developing a Post PHE Transition Plan for Your MA microphone-alt Erin Wessling, SVP and Chief Counsel, Commercial, Government Business and Litigation, C igna Tara Dwyer, Member, Mintz Levin Cohn Ferris Glovsky and Popeo PC

• Tracking trends in the types of fraud targeted in these cases, including falsified diagnoses, unnecessary treatment, and upcoding • Anticipating future FCA activity in Medicare Advantage • Identifying opportunities to strengthen compliance, and training to avoid litigation and regulatory scrutiny as an MAO 2:00

Conducting Internal Investigations – Special Considerations for MAOs microphone-alt Benjamin Singer, Counsel, O’Melveny & Myers LLP Lori F. Wells, Esq., Staff Vice President, Medicare Compliance, Elevance Health

• How to manage certain services provided to beneficiaries now that the PHE has ended • Identifying what plans can do as we emerge from the pandemic to ensure data accuracy and overall compliance • Assessing how the addition of telehealth diagnoses codes will impact the business and risk adjustment programs 4:45

Cocktail Reception Sponsored by

Kelly Kappes, Senior Associate General Counsel, Elevance Health This session will provide an overview of key strategies and lessons for MAOs conducting internal investigations. Key topics include: • Exploring strategies for identifying possible instances of non-compliance • Utilizing best practices for in-house investigations and identifying when to engage outside counsel • Protecting the privilege – key developments in case law affecting privilege considerations » Best practices for avoiding waiver pitfalls • Examining complexities impacting MAOs (e.g., joint defense agreements and disclosure to third parties)

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2:45

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Afternoon Networking and Refreshment Break

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REGISTER NOW AmericanConference.com/Medicare-Advantage • 888 224 2480

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DAY TWO Friday, November 3, 2023 7:45

Registration Opens and Continental Breakfast

8:45

Co-Chairs’ Opening Remarks 9:00

KEYNOTE

11:00

microphone-alt Annie Shieh, Sr. Director of Compliance, Bright Health Group

Value-Based Insurance Design (VBID): The Future State of Healthcare Service Delivery microphone-alt Sibel Ozcelik, ML, MS, Acting Director, Division of Health Plan Innovation, Seamless Care Models Group, CMS Innovation Center CMS is testing MA health plan innovations aimed reducing program costs and improving the quality of care being delivered to enrollees. In Calendar Year (CY) 2024, the VBID Model will test flexibilities for select enrollees by offering certain supplemental benefits, including FDA-approved devices, disease state management programs, reductions in cost-sharing, Part C and D rewards and incentives programs, and a hospice benefit.

This session will examine how the model has been performing to date and the implications for plans and patients moving forward.

Ken Nuñez, MBA, CHC, C hief Compliance Officer, Provider Partners Management Services • Sharing best practices to operationalize new requirements • Communicating with regulators when guidance is unclear to obtain clarification of expectations • Partnering with the business for successful compliance outcomes 11:45

Behavioral Health in Medicare Advantage: Improving Access to Services to Meet Strengthened Network Adequacy Requirements

9:45

Payor-Provider Integration and Collaboration: Future Opportunities and Key Legal Risks for MAOs to Consider microphone-alt Steven Hamilton, Partner, Reed Smith LLP Jennifer Kildea Dewane, Vice President & Counsel, Government Business Division, Elevance Health • Analyzing the different types of partnerships that are being formed between plans, providers and other entities • Pinpointing legal risks and diligence considerations for MAOs • Addressing legal risks with provider marketing and patient recruitment • Fine-tuning MAO-provider contracts » Addressing physician incentive plan requirements and limitations

PANEL & INTERACTIVE DISCUSSION

Perspectives on Change Management, Compliance and Business Best Practices for the New MA Landscape

microphone-alt Xavier Baker, Principal, Groom Law Group • Ensuring adequate access to additional behavioral health specialty types » Examining how telehealth can be used to meet requirements • Establishing programs to close the equity gap • Exploring prior authorization limitations 12:30

Networking Luncheon

1:30

Data and Tech in the Medicare Advantage Industry: Current Oversight landscape, Compliance Considerations, and Looking Ahead microphone-alt Kathy Roe, Attorney and Co-Founder, Health Law Consultancy

» Assessing the impact on shared savings and other compensation arrangements on bids etc…

Kevin Feder, Partner, O’Melveny & Myers LLP

» Navigating AKS and relevant safe harbors • Key considerations for the future integration and exclusive arrangements

• Analyzing CMS requirements and proposals for standard transactions and interoperability

10:45

• Examining congressional and DHHS concerns and considerations for algorithms and AI

Morning Coffee Break

• Exploring CMS requirements for offshore subcontracting involving PHI • Building an effective compliance program for managing risks of evolving data and technology use in Medicare Advantage

6 | LINKEDIN Healthcare: Legal, Regulatory, and Compliance Experts

2:45

Afternoon Networking and Refreshment Break

3:00

Avoiding Medicare Advantage Marketing Missteps: Top Takeaways from Real-World Examples and Best Practices for Third-Party Oversight microphone-alt Jill Pepe MA, PMP, Health Plan Services Senior Consultant, BluePeak Advisors • Reviewing the latest changes to marketing rules for the Medicare Advantage program » Determining what should be included in materials and what is prohibited under the reformed regulations • Developing third-party training and oversight program to ensure compliance with regulations and alignment with MAO expectations • Using examples of marketing and communications materials to identify problematic language, and tactics • Examining the current state of oversight and enforcement in marketing and how that may evolve

CONTINUING LEGAL EDUCATION Accreditation will be sought in those jurisdictions requested by the registrants which have continuing education requirements. This course is identified as nontransitional for the purposes of CLE accreditation.

EARN CLE/ CREDITS

ACI certifies this activity has been approved for CLE credit by the New York State Continuing Legal Education Board.

ACI certifies this activity has been approved for CLE credit by the State Bar of California.

ACI has a dedicated team which processes requests for state approval. Please note that event accreditation varies by state and ACI will make every effort to process your request.

For more information on ACI’s CLE process, visit: www.AmericanConference.com/Accreditation/CLE

3:30

Planning for the Future of Integrated Care: Key Considerations for MAOs in an Evolving D-SNP Landscape microphone-alt Mike Cheek, President and CEO, SNP Alliance A bipartisan group of Senators led by Bill Cassidy recently collected feedback on the coordination of care for dually eligible populations.

Draft legislation aimed at further integrating care for dual eligible populations is being circulated. This session will: • Assess current barriers to integration

SUPPORTING SPONSOR: BRG Health Analytics professionals bring extensive health industry experience to deliver data-driven, independent, and innovative approaches to our clients’ most complex challenges. We have worked as advisors to Medicare Advantage plans and their outside counsel in matters involving alleged fraud and/or kickbacks, breach of contract and other commercial litigation, regulatory compliance and governance issues, and other business challenges that present financial and legal risk to the plans.

Our approach is driven by our focus on data analytics and understanding of the industry.

• Examine what is being proposed in the bipartisan legislation being proposed • Anticipate potential operational considerations for MAOs 4:15

Conference Concludes

REGISTER NOW AmericanConference.com/Medicare-Advantage • 888 224 2480

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VENUE INFORMATION Renaissance Nashville Hotel

Accommodations:

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Phone: 1-615-255-8400

Please note that the guest room block cut-off date is October 10, 2023.

After that date OR when the room block fills, guestroom availability and rate can no longer be guaranteed.

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