PRE-CONFERENCE WORKSHOPS

TUESDAY, MARCH 28

A 9:00am–12:30pm (Registration opens at 8:30am)

Due to the hands-on nature of the workshops, they are available to in-person attendees only

Medicare and Medicaid Managed Care Boot Camp: Deep Dive into the Latest Legal and Regulatory Developments

microphone-alt

Sandra Durkin, Member, Strategic Health Law

Medicare Part C and Medicaid programs are becoming a dominant force in the managed care market.

Both represent a large and growing area of business for MCOs with nearly half of the Medicare eligible population enrolled in a Medicare Advantage plan, that was nearly 28 million people in 2022. For Medicaid, enrollments spiked during the pandemic. Both are highly regulated and require MCOs to navigate a complex web of federal and state rules in their administration. This workshop will provide a firm grasp of:

• Medicare Part C, D and Medicaid program mechanics including key definitions, and regulatory requirements

• Analysis of oversight channels

» CMS RADV audits

» OIG Targeted and RADV-like audits

» Whistleblower FCA litigation

• Implementing Contract Year 2024 Policy and Technical Changes to the Medicare Advantage program

• Risk Adjustment: developing compliance oversight of risk adjustment in the absence of cohesive guidance

• Key components of the Inflation Reduction Act’s Part D benefit redesign and how to prepare

B 1:30pm–5:00pm (Registration opens at 1:00pm)

An MCO Guide to Value-Based Care Contracts

microphone-alt David E. Kopans, Partner, DLA Piper LLP

Lisa G. Han, Partner, Jones Day

At a time of escalating health care costs, value-based care agreements present an opportunity to curb spending by effectively paying for value and improving the coordination of care. This workshop is designed to prepare your organization for the future of value-based care with insights from payors, providers, and outside counsel on how to develop and execute a successful VBC. Attendees will learn gain a clear understanding of key components of these agreements, the risks, the benefits, and other key legal considerations.

• Exploring types of VBCs aimed at cost control and where these models are already being leveraged

• Considering the risks and benefits of value-based arrangement

• Identifying the risk share

• Determining what success looks like and how to measure it

• Anticipating disputes related to value-based arrangements

• Understanding the OIG and CMS safe harbors for value-based arrangements under AKS and the Stark Law

• Key privacy considerations

* A light lunch will be served to those attending both workshops.

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For over 30 years, C5 Group has proVided the opportunities that bring together business leaders, professionals and international experts from around the world to learn, meet, network and make the contacts that create the opportunities. Our conferences and related products connect the power of people with the power of information, a powerful combination for business growth and success.

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Main Conference Day One

WEDNESDAY, MARCH 29

7:45 Registration Opens

8:45

Co-Chairs’ Opening Remarks

microphone-alt Archana Rajendra, Vice President and Deputy General Counsel, Health Alliance Plan, Henry Ford Health

9:00

Managed Care Policy Briefing: Assessing the Midterm Election Aftermath, and What the New Political Agenda Could Mean for MCOs

Join us for an in-depth discussion and analysis of what the Mid-Term results mean for the MCO community. This forward looking session will dissect how the flip to a Republican controlled House, and a Democratic majority in the Senate will impact the legislative agenda and the future US health policy priorities. Key topics to be discussed include:

• Analyzing how health policy and state priorities could change following the election

» Reproductive rights

» Drug pricing

» COVID-19 pandemic response

» Building on ACA

» Movement towards value-based care

• Examining the impact on the judiciary, and key legal questions impacting managed care

9:30

Payor Risks in a Post-Dobbs World: How to Navigate the Complexities of Reproductive Health Coverage and Pinpoint Potential Litigation

microphone-alt Heather Richardson, Partner, Gibson Dunn LLP

Thomas Sullivan, Shook, Hardy, Bacon LLP

On June 23, 2022, the Supreme Court in Dobbs V. Jackson Women’s Health Organization decision overturned fifty years of precedent on abortion laws in America. The legal consequences of this monumental decision will require close attention from stakeholders across the healthcare industry including MCOs. This session will focus on:

• Examining conflicting state laws on reproductive health coverage post Dobbs

• How to manage claims for patients that are seeking care outside their home state

» Identifying potential risks for payors

- When is paying for abortions considered illegally aiding and abetting

- Coverage determinations for abortion inducing drugs and telemedicine abortion services across state lines

» Anticipating what the future litigation landscape could look like and the proactive risk mitigation measures to take

10:15 Morning Coffee and Networking Break

Focus On The No Surprises Act

10:45 PART I

The Next Chapter in the NSA Saga—Analyzing the Evolution of the No Surprises Act and How it’s Playing Out in Practice for MCOs microphone-alt Ray Walker, Managing Counsel – Litigation, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

• Examining recent legal challenges to provisions in the NSA and the implications for the process moving forward

• How QPA is being used in the IDR process for out of network services subject to the NSA

• Navigating the intersection of federal and state laws on surprise billing

• Complying with AEOB requirements

• Payor-provider perspectives, and key takeaways on how the process is performing to date

11:15 PART II: ROUNDTABLE DISCUSSION

Navigating

the NSA:

Open Discussion on Key Challenges, and Takeaways from Recent Experiences with the Dispute Resolution Process

Contribute to the conversation on the No Surprises Act with this special opportunity to engage around the table with in-house and outside counsel. Share takeaways from a recent experience with the IDR process, raise questions, and provide perspectives on the future of the NSA and how to prepare as an organization.

11:45

Trends in Payor-Provider Disputes and Industry Tested Techniques for Managing Them More Effectively

microphone-alt Kevin Feder, Partner, O’Melveny & Myers LLP

Matthew Ryan, Senior Managing Director, Disputes & Economics, Ankura

• Assessing the impact of industry and economic factors on dispute resolution and the overall provider relationship

» Hospital staffing shortages, COVID-19 pressures, and inflation

• Identifying frequently litigated disputes

» In patient v. out-patient coverage disputes

» Determinations of “medically necessary” procedures

» Ground ambulance disputes

• Examining key caselaw concerning ERISA and Medicare Advantage preemption

• Hypotheticals on complex reimbursement cases

• Practical tips on how to prevent escalation and reach resolution early

12:30 Networking Luncheon check-square microphone-alt

Esg And Dei Focus Sessions

1:30 LIVE POLLING

What Every MCO Lawyer and Executive Needs to Know about ESG

Archana Rajendra, Vice President and Deputy General Counsel, Health Alliance Plan, Henry Ford Health

• Defining ESG within the managed care context

• Determining who owns ESG risks and oversight within the organization—whether it is general counsel or if it falls to another part of the business

• Best practices for establishing metrics, and benchmarking with other organizations

• Identifying future litigation risks, and enforcement activity

» Practical risk mitigation measures to put in play now

2:00

DEI Leadership Think Tank: How Individual Action Can Drive Change at Managed Care Organizations

microphone-alt Brian Seaman, Counsel and Chief Diversity Officer, Stradley Ronon Stevens & Young LLP

This interactive breakout session will explore how you can move the dial on DEI at your organization. Engage with in-house and outside counsel on how to build and support diversity within your legal teams. Key these to be explored include:

• How individuals at plans and their outside counsel can take responsibility for DEI within their respective organization

• Bystander intervention: Explore hypotheticals illustrating allyship best practices

• Applying a DEI lens to internal and external communication

3:00 Afternoon Coffee and Networking Break

3:15

Medical Loss Ratio: Key Data Reporting Considerations and Risk Areas for MCOs

microphone-alt Elizabeth Bock, Partner, O’Melevny & Myers LLP

Alex Oliphant, Director, Berkeley Research Group

• Examining the legal risks posed when submitting MLR data and what steps can be taken to mitigate those risks

• Factoring in statutory requirements and data reporting considerations for MLR data

• Top takeaways from MLR enforcement

4:00

Uncovering COVID-19 Schemes: How Payors Should Approach Recovery Opportunities Post-Pandemic

microphone-alt Tim McMichael, Deputy General Counsel – Director of Litigation, Premera Blue Cross

Adam Petitt, Partner, Stradley Ronon Stevens & Young LLP

• Understanding how coverage requirements for COVID-19 testing are changing as the pandemic winds down

• Tracking the evolution of federal and state reimbursement telehealth la

• Affirmative litigation opportunities to recover overpayments, and address potentially fraudulent claims

» Examining recent disputes with testing labs over billing and coding practices

» Managing claims that procedures listed online not reimbursed properly

4:30

HIPAA Compliance and Cyber Security: Best Practices for MCOs in the Age of Mobile Apps and Data Tracking Technology

microphone-alt Kirk Nahra, Partner, WilmerHale

• Examining HIPAA compliance obligations for payors and providers using third party data tracking technology on websites or mobile devices

• Assessing the risk of transmitting personal health information

• Complying with the breach notification rule

• Building compliance strategies around new HHS guidance and forecasting future litigation in this area

» Takeaways from recent class action lawsuits

• Lessons learned from recent litigation involving data trackers, and other data breach cases

5:15 Cocktail Reception