Schedule

Taylor Cooper, Staff Vice President, Associate General Counsel, Centene
David E. Kopans, DLA Piper LLP

• Defining key concepts to understand commercial health insurance
• Breaking down major regulators, stakeholders, and components of the U.S. commercial health insurance market
• Surveying the primary state and federal laws regulating health insurance
• Reviewing the health care claim submission and payment cycle

Alison Hollender, Husch Blackwell
Sara Rafferty Filipelli, Senior Associate Counsel, Parkland Health & Hospital System
Erica Waxman, General Counsel, United Urology Group

• Reimbursement systems applicable to Part A and B providers
• Beneficiary enrollment, coverage, and benefits
• Provider enrollment and certification
• Conditions of participation and payment
• Governance and structure: CMS, ROs (and the transition to PEOGs), and MACs
• How Parts A and B impact transactions
• Applicable regulations, agency guidance, and key compliance resources

Elizabeth B. Lippincott, Strategic Health Law

• Medicare Advantage and Part D programs and benefits
• Introduction to bidding and payment 
• Highlight regulatory requirements for critical Part C/D plan functions (e.g., eligibility and enrollment, organization determinations and appeals, provider and pharmacy networks, and marketing)
• Description oversight by CMS, OIG, and other governmental authorities with emphasis on key compliance risks

Vivian Wozniak, Texas Children's Health Plan

• How it works
• Eligibility
• MCOs
• Contract arrangements
• State oversight
• Program requirements

Adam Beck, SVP, Employer & Product Policy America's Health Insurance Plan (AHIP)
Rachel Portman, DLA Piper

• Budget reconciliation in Congress and the potential inclusion of health care legislation, or other impacts of tax reforms on health care
• How leadership at the US Department of Health and Human Services will likely shape the health care agenda
• Perspectives on pending litigation that impacts health care stakeholders, including US Supreme Court cases interpreting the Affordable Care Act and ERISA
• Health care regulatory reforms from the Trump Administration, including practical considerations for clients

Ellie Bane, Associate General Counsel, UCHealth
Suzanne Strothkamp, Associate General Counsel, Centene Corporation
Melissa Wong, Holland & Knight LLP

Join several of our AHLA Payers, Plans and Managed Care (“PPMC”) Practice Group members for an exciting interactive session that will provide practical, real-world insights and tips for your everyday managed care contracting dilemmas. This session will review several hypothetical scenarios that touch upon common issues that arise when negotiating managed care contracts, including:

• Claim submission timelines and prompt payment clauses
• Amendments to contracts through updates to provider manuals or when changes are required by law
• Recoupment of overpayments and ensuring payment of underpayments
• Best practices in negotiating dispute resolution provisions
• Vetting Medicare Advantage and Part D flowdown terms as well as required terms for Managed Medicaid
• Unique considerations for downstream entity and service provider contracts v. traditional provider agreements

Each hypo will reference helpful checklists and other guidance from the Managed Care Contracting Toolkit made available to PPMC members. Holland & Knight LLP will be sponsoring gift card incentives for our most active participants in what is sure to be an engaging interactive experience!

Bradley Lerner, Director, Public Policy, Behavioral Health, Elevance Health
Noreen Vergara, Husch Blackwell
Debbie Witchey, President and CEO, Association for Behavioral Health and Wellness

• Brief history of behavioral health treatment as a specialty
• Scope of practice and credentialing information
• Level of care and care delivery issues
• Mental Health Parity and Addiction Equity Act
• Current and future trends in behavioral health managed care

Christian Auty, Bryan Cave
Chris Petelle, Associate General Counsel/Chief Privacy Officer, Humana

• The use of data, including PHI, in new ways including with respect to AI and machine learning
• Recent trends in enforcement and breach response. This will include a discussion of not only trends in breach response and class action litigation, but a discussion of prophylactic measures that should be considered to limit risk
• Other hot topics including HHS enforcement priorities, deletion of recent guidance, and other issues that have arisen since the change in administrations

Jonathan M. Herman, Herman Law Firm

• A general update on trends in managed care litigation
  • Which jurisdictions new cases are being filed, against which types of providers, and against which of five major health insurers
  • Data review from Managed Care Litigation Update (TM)
• Drill down into an emerging trend–importing of civil rights statutes into health care claims, where facially neutral language used in designing plan benefits has unintended consequences in the application of coverage.
  • A collision of legal concepts between ACA provisions, mandated non-discrimination statutes, and recent Executive Orders
  • Litigation Discussion:
    • Elements of a 1557 claim
    • Litigation theories (disability discriminiation, sex discrimination, gender affirming care)
    • Recent case law
  • Key takeaways
• Conclusion